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Determinants of hospitalisation rates: does primary health care play a role?
Linköping University, Department of Department of Health and Society, General Practice. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Department of Health and Society, General Practice. Linköping University, Faculty of Health Sciences.
Department of Primary Health Care, Göteborg University, Göteborg, Sweden.
Linköping University, Department of Department of Health and Society, General Practice. Linköping University, Faculty of Health Sciences.
2003 (English)In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 21, no 1, 15-20 p.Article in journal (Refereed) Published
Abstract [en]

Objective - To analyse the influence of rates of general practitioner visits on rates of hospitalisations.

Design  - Ecological cross-sectional study of factors influencing hospitalisation rates. Aggregated data on primary care centre area level.

Setting - The county of Östergötland, Sweden, with 3 hospital districts and 41 primary health care centres, and the hospital district of Jönköping in the county of Jönköping, Sweden, with 11 primary health care centres.

Outcome measure - Hospitalisation rates.

Results  - Age and rates of outpatient hospital visits were the most important factors explaining the variation in rates of hospitalisations between the primary health care centre areas. Hospital districts, socioeconomic factors and rates of GP visits also influenced the rates of hospitalisations.

Conclusion - When evaluating the influence of primary health care on the rates of hospitalisations, both socioeconomic factors and health care structure must be taken into consideration. Doing this, the rates of GP visits correlated negatively with the rates of hospitalisations.

Place, publisher, year, edition, pages
2003. Vol. 21, no 1, 15-20 p.
Keyword [en]
Health Care Structure, Hospitalisation, Primary Care, Socioeconomic Factors
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-13653DOI: 10.1080/02813430310000500OAI: oai:DiVA.org:liu-13653DiVA: diva2:21115
Available from: 2004-06-23 Created: 2004-06-23 Last updated: 2017-12-13Bibliographically approved
In thesis
1. Quality, costs and the role of primary health care
Open this publication in new window or tab >>Quality, costs and the role of primary health care
2004 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The general aim of this thesis is to describe and analyse the role of primary care in health care systems in terms of health, health care utilisation and costs, and to study the feasibility of retrieval of data from computerised medical records to monitor medical quality.

The thesis includes five studies, a systematic literature review, a register study of utilisation of hospital and primary care, a study based on data from computerised medical records of individual patients cost for primary care, and two studies of management of respiratory infections in primary care based on data from computerised medical records of twelve health centres.

The general findings of the literature review were that an expansion of the primary care component of the health care system would most likely result in better health, lower hospital care consumption and lower expenses for care. The personal physician and continuity of care were core elements to achieve this, and the significance of the way primary care is organised and funded was evident.

In the register study fifty health centres were compared. Age and rates of outpatient hospital visits were the most important factors explaining the variation of rates of hospitalisations between the health centres’ areas. Hospital district also influenced hospitalisation rates in the different health centres’ areas, indicating that the health care structure in the district per se was an important factor. The rates of visits to general practitioners correlated negatively with rates of hospitalisations.

The study of costs in primary care showed that the variation in the costs of the individual patients was substantial, also within age groups and within the diagnosis-related Adjusted Clinical Groups (ACG). Age and gender explained a smaller part of the variation in costs per patient in primary care. Adding the ACG weight had a major influence on improving the ability to explain the variation in costs at patient level. The ACG system might be of value in the calculation of weighted capitation in Swedish primary care, but appears to be sensitive to the thoroughness with which physicians register diagnoses.

The retrieval of data from computerised medical records comprised a total number of 19 965 encounters for respiratory tract infections i.e. 199 per 1000 inhabitants during the year 2001. Most frequent diagnoses were common cold, acute tonsillitis, and acute bronchitis. The number of antibioticprescriptions was 7 961, accounting for 47% of the episodes. The most commonly prescribed antibiotics were phenoxymethylpenicillin (61%), tetracyclines (18%) and macrolides (8%).

A rapid test was performed in 43% of the encounters: for C-reactive protein (CRP) in 31%; for Group A beta-haemolytic streptococci (StrepA) in 22%; and both tests were performed in 10% of the encounters. The findings in the study indicate that StrepA and CRP tests were used too frequently and often with minor contributions to patient management. The frequencies of tests and of antibiotic prescriptions varied greatly between health centres in a way that hardly could be explained by differences in morbidity.

Computerised medical records provided a source of clinical information, which might be a feasible and pragmatic method for studying daily practice, and for follow-up of adherence to guidelines in general practice.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2004. 72 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 854
Keyword
Drug utilization review methods, Hospitalization statistics and numerical data, Outpatient clinics, hospital utilization, Primary health care, Quality of health care, Respiratory tract infections, drug therapy, Family practice, Cost-benefit analysis, Efficiency, Organizational, Health care costs
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-5198 (URN)91-7373-827-1 (ISBN)
Public defence
2004-06-03, Aulan, Hälsans hus, Campus US, Linköpings universitet, Linköping, 13:00 (English)
Opponent
Supervisors
Available from: 2004-06-23 Created: 2004-06-23 Last updated: 2012-01-25Bibliographically approved
2. Methods for quality development on the primary health care structure
Open this publication in new window or tab >>Methods for quality development on the primary health care structure
2002 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis was to describe and analyse methods for quality development of the Swedish primary health care structure. Specific aims were as follows. To describe and test a medical-audit method of determining the optimum level of outpatient medical care. To describe and test the tracer-condition methodology for quality assessment of the medical care delivered by the primary health care. To describe and test a practice-visiting method to compare the total qualities of primary health care centres in order to facilitate quality improvement. To describe and test Donabedian's method (structure, process, outcome) of evaluating a health-promotion programme giving special attention to outcome. To use register data as a method to analyse important determinants of hospitalisation rates and whether the primary health care has any influence.

Different methods for quality development, such as peer review, medical audit, practice-visiting and tracer-condition technique, were used in order to evaluate the quality of care at the primary health care centres and to identify the role of primary health care in the total health care system. Papers I-V were based on studies of everyday activities in ordinary health care centres and hospitals in three counties in southern Sweden during 1987-2000.The methods used were chosen and adapted for the purpose of the studies.

It was agreed upon that about 75% of the outpatient visits to a doctor could be managed by a general practitioner (GP) (Paper I). There was no difference in quality when patients with insulin-treated diabetes mellitus visiting a GP were compared with those visiting a doctor at a hospital (Paper II). Practice-visiting proved to be a suitable method of comparing different primary health care centres with respect to medical quality (Paper III). A health promotion progrannne could be integrated into the everyday work at the health centres and was found to improve lifestyle habits and influence cardiovascular risk factors (Paper IV). The most important determinants of hospitalisation rates were age, the proportion of the population born abroad, the structure of the health care organisation, and the number of outpatient visits to hospital (Paper V).

The different methods which have been described need to be adapted to Swedish primary health care. The methods described in this thesis (medical audit, the tracer-condition method, practice-visiting and Donabedian's method) were usable for the purposes described. Register studies yielded valuable information in analysing important factors for explaining hospitalisations.

Place, publisher, year, edition, pages
Linköping: Linköpings universitet, 2002. 65 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 719
Keyword
Quality development, primary health care, evaluation, medical audit, tracercondition method, practice-visiting, health promotion, register study
National Category
Social Sciences
Identifiers
urn:nbn:se:liu:diva-26342 (URN)10866 (Local ID)91-7373-161-7 (ISBN)10866 (Archive number)10866 (OAI)
Public defence
2002-07-01, Administrationsbyggnadens aula, Universitetssjukhuset, Linköping, 09:00 (Swedish)
Opponent
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2012-09-17Bibliographically approved

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Lindström, KjellEngström, SvenBorgquist, Lars

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