Primary and Hospital care cooperation at primary care location: a twoedged sword

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Primary and Hospital care cooperation at primary
care location a two-edged sword

• A.Oomen, Cardiologist Sneek,
• H. P. Swart, Cardiologist Sneek,
• H. Arentsen, Primary care physician Lemmer,
• Y. Postma, Primary care physician Lemmer,
• N.E. van der Meulen, Health insurance
  company de Friesland Leeuwarden

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Objectives

• To keep access to hospital facilitation available
• To protect less severe patients for unnecessary
  hospital visits
• To enhance cooperation between primary care
  physicians and hospital care physicians
• To enhance quality of referrals
• To lower the costs of local healthcare

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Netherlands
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Zuid-West friesland
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De Friesland zorgverzekeraar
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De Friesland

• Health Insurance Company
• Total clients 500000
• Frysian Clients 65

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Antonius Hospital Sneek
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Antonius Hospital Sneekcardiology department

• Outpatient clinic 2005 visits 10000
• New referrals 5000
• Control patients 5000
• Admittance clinical 1700
• Area 118000

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Primary Care Facility Lemmer
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Primary care Facility Lemmer

• Primary care physicians 5
• Total population 10000
• Admittance cardiology Sneek 60

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Method

• Cardiologic consultation in the primary care
  office
• Stethoscope, electrocardiogram and handheld
  echocardiogram
• Other primary care physicians
• Conclusions

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Method

• Patient selection
• Hypertension
• Murmurs
• Shortness of breath
• Palpitations
• Atypical chest pain
• Risk stratification
• 12 times a year, one afternoon
• 6 real time patients
• Question hour

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Results
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Results

• Atypical thoracal pain
• Risk stratification
• Murmurs
• Palpitations
• Question hour
• hypertension, heartfailure
• pharmacological treatment
• Hospital admission cardiology 2005//2006

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Patient survey

• Questionaire
• Satisfaction
• Treatment
• Cooperation
• Response 45
• Satisfied 91
• More explanation 9
• Importance 100

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Financial burden

• Payment primary care physician
• Payment cardiologist
• Health care costs
• 55 pts 55 dbc 15000 euro

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Referral 2005 - 2006

• 2005 350
• 2006 256
• medium price referral 275 euro (dbc)

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Conclusions

• Safe
• Patient-friendly
• Cost-effective
• Quality-effective
• Continuous education of both health care officers

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Leeuwarder Courant