Background
Methods
Study design and setting
Procedure
Enrolment
The care substitution service
ICPC codes | |
---|---|
Orthopaedics | |
L03 | Low back pain without radiation |
L15 | Knee symptoms |
L83 | Hernia spine |
L84 | Arthrosis |
L92 | Shoulder complaints |
L93 | epicondylitis |
L98 | Twisted abnormality extremities |
L99 | Other musculoskeletal disease(s) |
Cardiology | |
K77 | Congestive heart failure |
K78 | Atrial fibrillation |
K81 | Heart murmur |
Dermatology | |
S04 | Local swelling, papule, nodule skin, subcutis |
S05 | Multiple swellings/papules/lumps of skin/subcutis |
S77 | Skin malignancy |
S79 | Other benign neoplasm skin |
S87 | Constitutional eczema |
S82 | Nevus, birthmark |
S88 | Contact eczema, other eczema |
S96 | Acne |
S99 | Other sin diseases, subcutis |
Patient satisfaction
Outcomes
Analysis
Results
GP and patient characteristics
Before implementation | After implementation | |
---|---|---|
Total consults, N (%) | ||
Overall | 2408 | 2522 |
Dermatology | 1279 (53.11) | 1381 (54.76) |
Orthopaedics | 1072 (44.52) | 1087 (43.10) |
Cardiology | 57 (2.37) | 54 (2.14) |
Age in years, mean ± SD | ||
Overall | 51.18 ± 18.26 | 53.08 ± 18.06 |
Dermatology | 49.63 ± 18.86 | 51.94 ± 18.66 |
Orthopaedics | 51.84 ± 16.87 | 53.48 ± 16.73 |
Cardiology | 73.51 ± 13.96 | 74.31 ± 14.75 |
Female, N (%) | ||
Overall | 1408 (58.47%) | 1465 (58.09%) |
Dermatology | 772 (60.36%) | 816 (59.09%) |
Orthopaedics | 609 (56.81%) | 619 (56.95%) |
Cardiology | 27 (47.39%) | 30 (55.56%) |
Participants with co-morbiditya, N (%) | ||
Overall | 398 (16.53) | 459 (18.20) |
Dermatology | 174 (13.60) | 216 (15.64) |
Orthopaedics | 205 (19.12) | 220 (20.24) |
Cardiology | 19 (33.33) | 23 (42.59) |
Referrals
Costs
Patient satisfaction
Themes | Facilitator/barriers | Quotes |
---|---|---|
Preference for substitution care | ||
Financial | No financial consequences | ‘Don’t have to pay own contribution’ |
Organisation | Short waiting times between GP visit and substitutional care visit, short waiting times in the waiting room. Good communication between specialist and GP. | ‘Short waiting time, lines are really short’ ‘I experienced a short communication line between specialist and GP’ |
Competent and proper care | Clear advice and correct/expert care. | ‘Good and clear explanation of the medical problem’ |
Feeling/experience | Ambience is friendly, attentive, and less clinical. Personal and informal approach. A lot of attention. | ‘Small scale, friendly and very helpful’ ‘Less of an emotional burden than a hospital visit’ |
Preference hospital care | ||
Organisation | Substitutional care is an unnecessary step, no immediate medicine recipe or follow-up appointment. | ‘First have to go back to my GP, before being referred to hospital’ ‘Immediately receiving medication in the hospital, now it is an unnecessary step’ |
Feeling/experience | A patient’s feelings. | ‘I like hospital more’ ‘Hospital is specialised’ |
No preference | ||
Competent and proper care | Quality of care is important. | ‘It’s all about receiving an knowledgeable advice. If such an advice can be provided at the substitutional care it is great, otherwise hospital care is fine’ ‘Receiving proper care is important, place does not matter’ |