For example 20.6% of the population is above 65 years old, compared to 15.9% of the overall population. The region is characterized by a relatively old and unhealthy population with a low socio-economic status (SES), as compared to the overall population of the Netherlands.
The GP practices are both located in the same region, namely in the most southern part of the Netherlands. The size and GP composition of the GP practices did not change within the included time frame of this study.
electrocardiogram, blood test laboratory, blood pressure monitors and spirometers. The GPs have access to several diagnostic tools, e.g. The multidisciplinary teams meet on a regular basis to discuss cases. They work closely together with healthcare professionals, such as nurse practitioners, dieticians, pharmacists and elderly specialists. The GPs of both practices are part of a multidisciplinary team. GP practice 1 consisted of two GPs with circa 3000 registered patients, while GP practice 2 consisted of four GPs with circa 7600 registered patients. This small-scale study focused on two GP practices. The research question was: Does an in-house internist reduce the number of referrals to internal medicine in the hospital setting? Therefore, this explorative study focused on the referral rates to specialist care in the hospital setting.
Effective collaboration between the GPs and internist should enhance the accuracy of referrals, keeping unfitting referred medical complaints out of the hospital. Besides improving the health of the population and the patients’ experiences of care, the main goal of this PC+ intervention is to decrease the number of (unnecessary) referrals to specialist care in the hospital setting. This PC+ intervention strengthens collaboration, direct communication and knowledge transfer between the GPs and internist and this has seemed to have a positive influence on the perceived quality of care and health outcomes. The internist provides consultations with patients and participates in multidisciplinary meetings within the GP practices. This study is aimed at a PC+ intervention in which GP practices have an in-house internist. Therefore, evaluations are required to estimate the effects of PC+ initiatives. PC+ is a new concept and, consequently, evidence of its effects is scarce and its support is mostly on conceptual grounds. Moreover, it intends to improve the health of the population and patients’ experience of care. PC+ is aimed at decreasing the number of (unnecessary) referrals to specialist care in the hospital setting in order to reduce the rising healthcare costs. PC+ interventions intend to support GPs in gatekeeping and treating patients by intensifying and strengthening collaboration and communication between GPs and specialists. In the Netherlands, the general practitioners (GPs) act as gatekeepers of the healthcare system: hospital care and specialist care are only accessible through GP referral.
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In the Netherlands, a relatively new healthcare delivery model of substitution of care is Primary Care Plus (PC+), which attempts to substitute specialist care from the hospital setting toward the primary care setting.
Both concepts attempt to shift care from the secondary to the primary care setting by specialists providing services in the general practice setting. For example, internationally well-known concepts are specialist outreach clinics and joint consultations. Substitution of care can be defined as: ‘the continual regrouping of resources across and within care settings to exploit the best and least costly solutions in face of changing needs and demands’. In line with these policies numerous regional initiatives have arisen, of which quite a few are focused on substitution of care. Primary care is assumed to alleviate some of the pressure of the rising healthcare costs by improving the population’s health at lower costs. Strengthening the primary care system is a common policy goal for many countries. In an attempt to rein in rising healthcare costs, many countries, among which the Netherlands, are reforming policies to stimulate the development of a (financially) sustainable healthcare system.
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