title: What's the effect of the implementation of general practitioner cooperatives on caseload? Prospective intervention study on primary and secondary care.
abstract: BACKGROUND
  Out-of-hours care in the primary care setting is rapidly changing and evolving towards general practitioner 'cooperatives' (GPC). GPCs already exist in the Netherlands, the United Kingdom and Scandinavia, all countries with strong general practice, including gatekeepers' role. This intervention study reports the use and caseload of out-of-hours care before and after implementation of a GPC in a well subscribed region in a country with an open access health care system and no gatekeepers' role for general practice.
  
  
  METHODS
  We used a prospective before/after interventional study design. The intervention was the implementation of a GPC.
  
  
  RESULTS
  One year after the implementation of a GPC, the number of patient contacts in the intervention region significantly increased at the GPC (OR: 1.645; 95% CI: 1.439-1.880), while there were no significant changes in patient contacts at the Emergency Department (ED) or in other regions where a simultaneous registration was performed. Although home visits decreased in all general practitioner registrations, the difference was more pronounced in the intervention region (intervention region: OR: 0.515; 95% CI: 0.411-0.646, other regions: OR: 0.743; 95% CI: 0.608-0.908). At the ED we observed a decrease in the number of trauma cases (OR: 0.789; 95% CI: 0.648-0.960) and of patients who came to hospital by ambulance (OR: 0.687; 95% CI: 0.565-0.836).
  
  
  CONCLUSIONS
  One year after its implementation more people seek help at the GPC, while the number of contacts at the ED remains the same. The most prominent changes in caseload are found in the trauma cases. Establishing a GPC in an open health care system, might redirect some patients with particular medical problems to primary care. This could lead to a lowering of costs or a more cost-effective out of hours care, but further research should focus on effective usage to divert patient flows and on quality and outcome of care.
authors.affiliation: Department of General Practice, University of Antwerp, Universiteitsplein 1, Gebouw R, 3de verd, B-2610 Wilrijk, Belgium. hilde.philips@ua.ac.be
authors.forename: Hilde
authors.initials: H
authors.lastname: Philips
authors.forename: Roy
authors.initials: R
authors.lastname: Remmen
authors.forename: Paul
authors.initials: P
authors.lastname: Van Royen
authors.forename: Marc
authors.initials: M
authors.lastname: Teblick
authors.forename: Leo
authors.initials: L
authors.lastname: Geudens
authors.forename: Marc
authors.initials: M
authors.lastname: Bronckaers
authors.forename: Herman
authors.initials: H
authors.lastname: Meeuwis
mesh_terms: D000293:Adolescent; D000328:Adult; D039602:After-Hours Care / Q000458:organization & administration*; D001530:Belgium; D002648:Child; D003299:Cooperative Behavior; D004059:Diffusion of Innovation; D017598:Efficiency, Organizational; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010821:Physicians, Family; D011320:Primary Health Care; D011446:Prospective Studies; D055815:Young Adult