100 likes | 108 Vues
Primary Care in The Netherlands: General Practitioners in the Lead Jako Burgers, MD, PhD Dutch College of General Practitioners. Common Wealth Fund Webinar March 1, 2016. My Background. General Practitioner, Gorinchem (2 days/ wk )
E N D
Primary Care in The Netherlands: General Practitioners in the LeadJako Burgers, MD, PhDDutch College of General Practitioners Common Wealth Fund Webinar March 1, 2016
My Background • General Practitioner, Gorinchem (2 days/wk) • Head Dep. Guideline Development and Research, Dutch College of General Practitioners • Harkness Fellow 2008/2009, Commonwealth Fund International Program in Health Policy & Practice My general practice
Characteristics of the Dutch Health Care System 3 • Complete coverage for all residents (< 1% uninsured) • All patients are registered in one general practice • General practitioner is gatekeeper to hospital and specialist care • Strong national organization of healthcare professionals, responsible for quality of care • Balance between external, governmental systems and internal, professionally led systems for quality improvement
11,000 general practitioners (GPs); 7,900 practices 100% have practice assistant; 92% practice nurse GP is family physician covering whole population GPs offer after-hours service covering whole country GP addresses 96% of medical and non medical problems GP visit is free, but deductible for other health services (appr. US $ 400 to 800) Satisfaction with GP is high (8 on scale from 0 to 10) Primary Care in Netherlands: Basic Characteristics 4
Care Coordination & Communication • Practice nurse support chronic care (diabetes, COPD, CVRM), and increasingly elderly care through bundled payments with Care Groups • Specialized practice nurse support mental health care, including monitoring of chronic patients • Communication between medical specialist and GP: • short notification of ER visit, hospital admission and discharge on same day • full letter after 2 to 4 weeks (on paper or electronically) • phone consultation on demand • use of local protocols strongly varies per region
Access & After-Hours Care • 127 GP Cooperatives cover the whole country offering after-hour primary care • Most GP Cooperatives are located near or within a hospital and some collaborate closely with ER • Access to GP and after-hours care is well perceived • First contact / telephone triage by trained nurses, using national guidelines and protocols • Home visits with medically trained car drivers in fully equipped cars (e.g. O2, AED) • t
Access to General Practice in Netherlands: Travel Times Regular hours After-hours
Health Information Technology • Eight different software programs for general practice • All support electronic drug prescription according to national guidelines • Most support ordering of laboratory testing, imaging, and referral to hospital care • Generating panel information and feedback on performance has much improved last years • Electronic communication with hospitals is improving but complex due to variety of programs • Online patient access to medical record is low, but introduction of individual care plan is promising
Quality Assurance Policy • Continuing Medical Education using practice guidelines developed by Dutch College of GPs, is mandatory for re-licence (every 5 years) • Participation in local peer review groups is mandatory • Practice visitation is mandatory since 2016, including: • Individual professional (360 degree) feedback • Patient satisfaction survey • Recent dissatisfaction with data registration and performance measurement is being resolved within National Taskforce
Key factors for success: National government supports primary healthcare Strong, well-accepted national professional organization Payment system supports coordination of care and additional primary care services, including after hour care Longstanding evidence-based guideline program Collaboration and local peer support Can Other Countries Learn from Dutch Primary Care?