PC-related conditions and mechanisms for care coordination in Europe Wienke Boerma, Dionne Sofia Kringos, Jasper van Riet Paap On behalf of the PHAMEU Consortium NIVEL-Netherlands Institute for Health Services Research www.nivel.eu / www.phameu.eu
CONSORTIUM - NIVEL (coordinator) - University of Tartu (EE) -IRDES (F) - Heinrich Heine University (DE) - University Witten/Herdecke - Bocconi University (I) - University of Tromso (N) - Jagiellonian University (PL) - University of Ljubljana (SV) - IDIAP Jordi Gol (ES) - Sheffield University (UK) - University of Leicester (UK) -WHO Europe - European Forum for PC - EUPHA -EGPRN Funded by European Commission
1) PC Monitoring Instrument 2) Data collection in 31 countries METHODS International statistical datasets National statistical datasets Policy documents Published literature Expert enquiries Use of networks, incl: National PC experts WHO-Euro EUPHA European Forum for PC EGPRN
METHOD for Instrument Development Systematic literature review - key PC dimensions - relevance for health (system) outcomes - identification of PC indicators - expert consultation round Kringos et al. The breadth of primary care: a systematic literature review of its core dimensions. BMC Health Services Research 10:65
PRIMARY CARE SYSTEM FRAMEWORK Dimensions of the PC structure Governance of PC system Economic conditions of PC system PC Workforce development Dimensions of the PC Process Access to PC services Comprehensiveness of PC services Continuity of PC Coordination of PC Dimensions of PC outcomes Quality of PC Efficiency of PC
Indicators on coordination Patients registered with a GP Population per GP GP-specialist ratio Scale of GP/PC practice Meetings with PC providers Asking advice from med. Specialists (Patients trust)
Patients registered with a GP Registered with GP ( LIST ) Not registered ( NO LIST ) Bulgaria Czech Republic Denmark Estonia Spain Finland United Kingdom Ireland Iceland Italy Lithuania Latvia Netherlands Norway Poland Romania Slovenia Slovakia Turkey Slovakia Austria Belgium Switzerland Cyprus Germany France Luxemburg Malta 20 8
GP density (population per GP) Systems with: LIST NO LIST Spain Italy Norway Poland Low <1550 Belgium France Luxemburg Medium 1550-1825 Bulgaria Czech Republic Denmark Estonia United Kingdom Ireland Iceland Lithuania Latvia Slovenia High >1825 Finland Netherlands Romania Slovakia Turkey Austria Germany Malta 7 10 8
GP-specialist ratio (GP/Spec) LIST Systems with: NO LIST Low <.43 Bulgaria Czech Republic Estonia Spain United Kingdom Iceland Lithuania Latvia Norway Poland Slovenia Slovakia Austria Belgium Switzerland Germany France Malta 18 High >.43 Denmark Finland Ireland Italy Netherland Romania Turkey Luxemburg 8
Scale of GP practice Dominant mode of practice: Single handed GPs group practice GPs+Spec practice No data
GPs meeting with other PC providers Systems with: LIST NO LIST Seldom or never meet Denmark Latvia Slovakia Austria Cyprus Germany France 7 Switzerland Luxemburg Malta Belgium Occasionally meet Bulgaria Czech Republic Estonia Spain Finland United Kingdom Italy Netherlands Poland Slovenia Turkey 15 Often meet Ireland Iceland Lithuania 3
GPs asking advice from medical specialists Systems with: LIST NO LIST Rare Bulgaria Czech Republic Estonia Ireland Iceland Spain Finland United Kingdom Italy Poland Slovenia Slovakia Turkey Austria Germany France Luxemburg, Malta 18 Usual Lithuania Norway Belgium Switzerland 4 (Very) common Netherlands 1
Patients trust in GPs Systems with: <75% 75-90% >90% LIST Bulgaria Finland Lithuania Latvia Netherlands Romania Turkey Slovakia Estonia Ireland Spain Norway United Kingdom NO LIST Belgium Germany Cyprus 7 2 8
CONCLUSION ON PHAMEU Good starting point for a comprehensive European PC database Variation in availability and quality of data Comparability of data Intra-country variation (regions) CONCLUSION ON COORDINATION Conditions favourable in most countries Much can be improved in daily practice Coordination and patient satisfaction not parallel