Examining differences in out-of-hours primary care use in Belgium and the Netherlands: a cross-sectional study

Abstract

BackgroundThe organizational model of out-of-hours primary care is likely to affect healthcare use. We aimed to examine differences in the use of general practitioner cooperatives for out-of-hours care in the Netherlands and Belgium (Flanders) and explore if these are related to organizational differences.MethodsA cross-sectional observational study using routine electronic health record data of the year 2016 from 77 general practitioner cooperatives in the Netherlands and 5 general practitioner cooperatives in Belgium (Flanders). Patient age, gender and health problem were analyzed using descriptive statistics.ResultsThe number of consultations per 1000 residents was 2.3 times higher in the Netherlands than in Belgium. Excluding telephone consultations, which are not possible in Belgium, the number of consultations was 1.4 times higher. In Belgium, the top 10 of health problems was mainly related to infections, while in the Netherlands there were a larger variety of health problems. In addition, the health problem codes in the Dutch top 10 were more often symptoms, while the codes in the Belgian top 10 were more often diagnoses. In both countries, a relatively large percentage of GPC patients were young children and female patients.ConclusionDifferences in the use of general practitioner cooperatives seem to be related to the gatekeeping role of general practitioners in the Netherlands and to organizational differences such as telephone triage, medical advice by telephone, financial thresholds and number of years of experience with the system. The information can benefit policy decisions about the organization of out-of-hours primary care.

Antibiotic Prescribing Quality in Out-of-Hours Primary Care and Critical Appraisal of Disease-Specific Quality Indicators

“…Antibiotics prescriptions linked to a symptom diagnosis, i.e., coding the diagnosis with a code for reasons for encounter such as fever, ear ache, cough, sore throat, etc., were not included in calculating APQI values. However, Flemish GPs not often register symptom diagnoses [7]. Indeed, when looking at the total number of antibiotic prescriptions, only a small percentage was made for symptom diagnosis.…”

“…In Belgium, but also in the rest of Europe, the on-going establishment of large-scale general practitioner cooperatives (GPCs) represents one of the most important developments for primary OOH health care. The most common reason for an encounter in Flemish (Northern part of Belgium) OOH primary care is an infection [7]. Many infections are self-limiting and no antimicrobial treatment is necessary.…”

More room for telemedicine after COVID-19: lessons for primary care?

“…GPs are also considered crucial 'gate-keepers' for filtering secondary care induced by specialist consultants [4]. This is their traditional role in the 'Beveridgian' public health systems (like the British and Italian NHSs), more recently played by GPs also in 'Bismarckian' social health insurance systems (like the Belgian and Dutch ones) [5]. Although GPs' costs are mainly covered by public services or social insurances in all European nations, they are still officially self-employed physicians (in Italy and the UK too).…”

Improving primary care in Europe beyond COVID-19: from telemedicine to organizational reforms

“…Furthermore, GPs are considered crucial ‘gate-keepers’ to filter secondary and tertiary care provided by specialist consultants. This is their traditional role in the Beveridge-type public health systems like the British and Italian NHSs–with universal coverage, mainly funding from general taxation, and mainly public provision–but more recently also in Bismarck-type health insurance systems like the Belgian and Dutch ones–with almost universal coverage, funding from mandatory social contributions, and public–private mix of provision [ 5 ]. Although GPs’ costs are mainly covered by public services or social insurances in all European nations, they are still self-employed physicians everywhere.…”