Does an in-house internist at a GP practice result in reduced referrals to hospital-based specialist care?

Tessa C. C. Quanjel, Anne Winkens, Marieke D. Spreeuwenberg, Jeroen N. Struijs, Ron A. G. Winkens, C.A. Baan, Dirk Ruwaard

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Abstract

Objective:
Consistent evidence on the effects of specialist services in the primary care setting is lacking. Therefore, this study evaluated the effects of an in-house internist at a GP practice on the number of referrals to specialist care in the hospital setting. Additionally, the involved GPs and internist were asked to share their experiences with the intervention.
Design:
A retrospective interrupted times series study.
Setting:
Two multidisciplinary general practitioner (GP) practices.
Intervention:
An internist provided in-house patient consultations in two GP practices and participated in the multidisciplinary meetings.
Subjects:
The referral data extracted from the electronic medical record system of the GP practices, including all referral letters from the GPs to specialist care in the hospital setting.
Main outcome measures:
The number of referrals to internal medicine in the hospital setting. This study used an autoregressive integrated moving average model to estimate the effect of the intervention taking account of a time trend and autocorrelation among the observations, comparing the pre-intervention period with the intervention period.
Results:
It was found that the referrals to internal medicine did not statistically significant decrease during the intervention period.
Conclusions:
This small explorative study did not find any clues to support that an in-house internist at a primary care setting results in a decrease of referrals to internal medicine in the hospital setting.
Key points:
An in-house internist at a primary care setting did not result in a significant decrease of referrals to specialist care in the hospital setting. The GPs and internist experience a learning-effect, i.e. an increase of knowledge about internal medicine issues.
Original languageEnglish
Pages (from-to)99-106
JournalScandinavian Journal of Primary Health Care
Volume36
Issue number1
DOIs
Publication statusPublished - 2018

Fingerprint

General Practice
General Practitioners
Internal Medicine
Electronic Health Records

Keywords

  • Female
  • General Practice
  • Health Services
  • Hospitals
  • Humans
  • Internal Medicine
  • Male
  • Physicians
  • Practice Patterns, Physicians'
  • Primary Health Care
  • Referral and Consultation
  • Retrospective Studies
  • Specialization

Cite this

Quanjel, Tessa C. C. ; Winkens, Anne ; Spreeuwenberg, Marieke D. ; Struijs, Jeroen N. ; Winkens, Ron A. G. ; Baan, C.A. ; Ruwaard, Dirk. / Does an in-house internist at a GP practice result in reduced referrals to hospital-based specialist care?. In: Scandinavian Journal of Primary Health Care. 2018 ; Vol. 36, No. 1. pp. 99-106.
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title = "Does an in-house internist at a GP practice result in reduced referrals to hospital-based specialist care?",
abstract = "Objective: Consistent evidence on the effects of specialist services in the primary care setting is lacking. Therefore, this study evaluated the effects of an in-house internist at a GP practice on the number of referrals to specialist care in the hospital setting. Additionally, the involved GPs and internist were asked to share their experiences with the intervention.Design: A retrospective interrupted times series study.Setting: Two multidisciplinary general practitioner (GP) practices.Intervention: An internist provided in-house patient consultations in two GP practices and participated in the multidisciplinary meetings.Subjects: The referral data extracted from the electronic medical record system of the GP practices, including all referral letters from the GPs to specialist care in the hospital setting.Main outcome measures: The number of referrals to internal medicine in the hospital setting. This study used an autoregressive integrated moving average model to estimate the effect of the intervention taking account of a time trend and autocorrelation among the observations, comparing the pre-intervention period with the intervention period.Results: It was found that the referrals to internal medicine did not statistically significant decrease during the intervention period.Conclusions: This small explorative study did not find any clues to support that an in-house internist at a primary care setting results in a decrease of referrals to internal medicine in the hospital setting.Key points:An in-house internist at a primary care setting did not result in a significant decrease of referrals to specialist care in the hospital setting. The GPs and internist experience a learning-effect, i.e. an increase of knowledge about internal medicine issues.",
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Does an in-house internist at a GP practice result in reduced referrals to hospital-based specialist care? / Quanjel, Tessa C. C.; Winkens, Anne; Spreeuwenberg, Marieke D.; Struijs, Jeroen N.; Winkens, Ron A. G.; Baan, C.A.; Ruwaard, Dirk.

In: Scandinavian Journal of Primary Health Care, Vol. 36, No. 1, 2018, p. 99-106.

Research output: Contribution to journalArticleScientificpeer-review

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AU - Quanjel, Tessa C. C.

AU - Winkens, Anne

AU - Spreeuwenberg, Marieke D.

AU - Struijs, Jeroen N.

AU - Winkens, Ron A. G.

AU - Baan, C.A.

AU - Ruwaard, Dirk

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N2 - Objective: Consistent evidence on the effects of specialist services in the primary care setting is lacking. Therefore, this study evaluated the effects of an in-house internist at a GP practice on the number of referrals to specialist care in the hospital setting. Additionally, the involved GPs and internist were asked to share their experiences with the intervention.Design: A retrospective interrupted times series study.Setting: Two multidisciplinary general practitioner (GP) practices.Intervention: An internist provided in-house patient consultations in two GP practices and participated in the multidisciplinary meetings.Subjects: The referral data extracted from the electronic medical record system of the GP practices, including all referral letters from the GPs to specialist care in the hospital setting.Main outcome measures: The number of referrals to internal medicine in the hospital setting. This study used an autoregressive integrated moving average model to estimate the effect of the intervention taking account of a time trend and autocorrelation among the observations, comparing the pre-intervention period with the intervention period.Results: It was found that the referrals to internal medicine did not statistically significant decrease during the intervention period.Conclusions: This small explorative study did not find any clues to support that an in-house internist at a primary care setting results in a decrease of referrals to internal medicine in the hospital setting.Key points:An in-house internist at a primary care setting did not result in a significant decrease of referrals to specialist care in the hospital setting. The GPs and internist experience a learning-effect, i.e. an increase of knowledge about internal medicine issues.

AB - Objective: Consistent evidence on the effects of specialist services in the primary care setting is lacking. Therefore, this study evaluated the effects of an in-house internist at a GP practice on the number of referrals to specialist care in the hospital setting. Additionally, the involved GPs and internist were asked to share their experiences with the intervention.Design: A retrospective interrupted times series study.Setting: Two multidisciplinary general practitioner (GP) practices.Intervention: An internist provided in-house patient consultations in two GP practices and participated in the multidisciplinary meetings.Subjects: The referral data extracted from the electronic medical record system of the GP practices, including all referral letters from the GPs to specialist care in the hospital setting.Main outcome measures: The number of referrals to internal medicine in the hospital setting. This study used an autoregressive integrated moving average model to estimate the effect of the intervention taking account of a time trend and autocorrelation among the observations, comparing the pre-intervention period with the intervention period.Results: It was found that the referrals to internal medicine did not statistically significant decrease during the intervention period.Conclusions: This small explorative study did not find any clues to support that an in-house internist at a primary care setting results in a decrease of referrals to internal medicine in the hospital setting.Key points:An in-house internist at a primary care setting did not result in a significant decrease of referrals to specialist care in the hospital setting. The GPs and internist experience a learning-effect, i.e. an increase of knowledge about internal medicine issues.

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KW - General Practice

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KW - Referral and Consultation

KW - Retrospective Studies

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JF - Scandinavian Journal of Primary Health Care

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