Referral decisions and its predictors related to orthopaedic care.  A retrospective study in a novel primary care setting

Bogaart, Esther H. A. van den; Spreeuwenberg, Marieke; Kroese, Mariëlle; Boogaart, Mark W. van den; Boymans, Tim A.E.J.; Ruwaard, Dirk

doi:10.1371/journal.pone.0227863

Cited by 8 publications

(4 citation statements)

References 35 publications

(42 reference statements)

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“…Recently, initiatives have been taken to implement specialized orthopedic care in the primary care setting to reduce referral rates from primary care to the orthopedic clinic in the hospital. 34 This arrangement allows orthopedic clinicians to make a diagnosis in the primary care setting. This may address the concerns of the clinicians, and with that, the disease-specific ptDA can be distributed to patients at an early phase of hip or knee osteoarthritis care.…”

Section: Discussionmentioning

confidence: 99%

Implementation of a Decision Aid for Hip and Knee Osteoarthritis in Orthopedics: A Mixed-Methods Process Evaluation

Bossen,

Wesselink,

Heyligers

et al. 2023

Med Decis Making

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Background In orthopedics, the use of patient decision aids (ptDAs) is limited. With a mixed-method process evaluation, we investigated patient factors associated with accepting versus declining the use of the ptDA, patients’ reasons for declining the ptDA, and clinicians’ perceived barriers and facilitators for its use. Methods Patients with an indication for joint replacement surgery ( N = 153) completed questionnaires measuring demographics, physical functioning, quality of life (EQ-5D-3L), and a visual analog scale (VAS) pain score at 1 time point. Subsequently, their clinician offered them the relevant ptDA. Using a retrospective design, we compared patients who used the ptDA (59%) with patients who declined (41%) on all these measures as well as the chosen treatment. If the use of the ptDA was declined, patients’ reasons were recorded by their clinician and analysed ( n = 46). To evaluate the experiences of clinicians ( n = 5), semistructured interviews were conducted and thematically analyzed. Clinicians who did not use the ptDA substantially (<10 times) were also interviewed ( n = 3). Results Compared with patients who used the ptDA, patients who declined use had higher VAS pain scores (7.2 v. 6.2, P < .001), reported significantly worse quality of life (on 4 of 6 EQ-5D-3L subscales), and were less likely to receive nonsurgical treatment (4% v. 28%, P < .001). Of the patients who declined to use the ptDA, 46% said they had enough information and felt ready to make a decision without the ptDA. The interviews revealed that clinicians considered the ptDAs most useful for newly diagnosed patients who had not received previous treatment. Conclusion These results suggest that the uptake of a ptDA may be improved if it is introduced in the early disease stages of hip and knee osteoarthritis. Highlights Patients who declined the use of a patient decision aid (ptDA) for hip and knee osteoarthritis reported more pain and worse quality of life. Most patients who declined to use a ptDA felt sufficiently well informed to make a treatment decision. Patients who declined the ptDA were more likely to have received prior treatment in primary care. Clinicians found the ptDA to be a helpful addition to the consultation, particularly for newly diagnosed patients.

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Section: Discussionmentioning

confidence: 99%

Implementation of a Decision Aid for Hip and Knee Osteoarthritis in Orthopedics: A Mixed-Methods Process Evaluation

Bossen,

Wesselink,

Heyligers

et al. 2023

Med Decis Making

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“…Primary Care Plus (PC1) was a new model of care implemented in the Dutch pioneer site Blue Care in the southern Netherlands in 2014 by primary and secondary care providers, local health authorities, the largest health insurer in the region, and a local patient organization. 27,28 Its triple aim was to improve population health and patient satisfaction by improving quality of and access to care while avoiding unnecessary outpatient hospital visits. 29 After its piloting, the decision of the multiple collaborating and responsible organizations (ie, stakeholders) was to disinvest or scale up its implementation in other areas in The Netherlands.…”

Section: Setting and Decision Contextmentioning

confidence: 99%

Economic Evaluation of New Models of Care: Does the Decision Change Between Cost-Utility Analysis and Multi-Criteria Decision Analysis?

et al. 2021

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Objectives: To experiment with new approaches of collaboration in healthcare delivery, local authorities implement new models of care. Regarding the local decision context of these models, multi-criteria decision analysis (MCDA) may be of added value to cost-utility analysis (CUA), because it covers a wider range of outcomes. This study compares the 2 methods using a side-by-side application.Methods: A new Dutch model of care, Primary Care Plus (PC1), was used as a case study to compare the results of CUA and MCDA. Data of patients referred to PC1 or care-as-usual were retrieved by questionnaires and administrative databases with a 3-month follow-up. Propensity score matching together with generalized linear regression models was used to reduce confounding. Univariate and probabilistic sensitivity analyses were performed to explore uncertainty in the results.Results: Although both methods indicated PC1 as the dominant alternative, complementary differences were observed. MCDA provided additional evidence that PC1 improved access to care (standardized performance score of 0.742 vs 0.670) and that improvement in health-related quality of life was driven by the psychological well-being component (standardized performance score of 0.710 vs 0.704). Furthermore, MCDA estimated the budget required for PC1 to be affordable in addition to preferable (V521.42 per patient). Additionally, MCDA was less sensitive to the utility measures used.Conclusions: MCDA may facilitate an auditable and transparent evaluation of new models of care by providing additional information on a wider range of outcomes and incorporating affordability. However, more effort is needed to increase the usability of MCDA among local decision makers.

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“…PC+ is an initiative implemented in the pioneer site Blue Care, located in the Maastricht-Heuvelland region, in which 81 GPs in 55 GP practices care for a population of approximately 170,000 people [35]. In this region, different organisations work together and developed the PC+ intervention to substitute specialised medical care with primary care [36]. After a pilot, in which medical specialist performed consultations in GP practices, PC+ was implemented on a larger scale with two independent PC+ centres located in the city of Maastricht [37,38].…”

Section: Settingmentioning

confidence: 99%

Reorganising dermatology care: predictors of the substitution of secondary care with primary care

Bogaart

Kroese

Spreeuwenberg

et al. 2020

BMC Health Serv Res

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Background: The substitution of healthcare is a way to control rising healthcare costs. The Primary Care Plus (PC+) intervention of the Dutch 'Blue Care' pioneer site aims to achieve this feat by facilitating consultations with medical specialists in the primary care setting. One of the specialties involved is dermatology. This study explores referral decisions following dermatology care in PC+ and the influence of predictive patient and consultation characteristics on this decision. Methods: This retrospective study used clinical data of patients who received dermatology care in PC+ between January 2015 and March 2017. The referral decision following PC+, (i.e., referral back to the general practitioner (GP) or referral to outpatient hospital care) was the primary outcome. Stepwise logistic regression modelling was used to describe variations in the referral decisions following PC+, with patient age and gender, number of PC+ consultations, patient diagnosis and treatment specialist as the predicting factors. Results: A total of 2952 patients visited PC+ for dermatology care. Of those patients with a registered referral, 80.2% (N = 2254) were referred back to the GP, and 19.8% (N = 558) were referred to outpatient hospital care. In the multivariable model, only the treating specialist and patient's diagnosis independently influenced the referral decisions following PC+. Conclusion: The aim of PC+ is to reduce the number of referrals to outpatient hospital care. According to the results, the treating specialist and patient diagnosis influence referral decisions. Therefore, the results of this study can be used to discuss and improve specialist and patient profiles for PC+ to further optimise the effectiveness of the initiative.

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Referral decisions and its predictors related to orthopaedic care. A retrospective study in a novel primary care setting

Cited by 8 publications

References 35 publications

Implementation of a Decision Aid for Hip and Knee Osteoarthritis in Orthopedics: A Mixed-Methods Process Evaluation

Implementation of a Decision Aid for Hip and Knee Osteoarthritis in Orthopedics: A Mixed-Methods Process Evaluation

Economic Evaluation of New Models of Care: Does the Decision Change Between Cost-Utility Analysis and Multi-Criteria Decision Analysis?

Reorganising dermatology care: predictors of the substitution of secondary care with primary care

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