title: How does an integrated primary care approach for patients in deprived neighbourhoods impact utilization patterns? An explorative study.
abstract: To explore changes in utilization patterns for general practice (GP) and hospital care of people living in deprived neighbourhoods when primary care providers work in a more coherent and coordinated manner by applying an integrated approach.
  
  
  
  We compared expected (based on consumption patterns of a health insurers' total population) and actual utilization patterns in a deprived Dutch intervention district in the city of Utrecht (Overvecht) with control districts 1 (Noordwest) and 2 (Kanaleneiland) over the period 2006-2011, when an integrated care approach was increasingly provided in the intervention district. Standardized insurance claims data were used to indicate use of GP care and hospital care.
  
  
  
  Our findings revealed that the utilization of total GP care increased more in the intervention district than in the control districts. And that the intervention district showed a more pronounced decreasing trend in total hospital use as compared to what was expected, in particular from 2008 onwards. In addition, we observed a change in type of GP care use in the intervention district in particular: the number of regular consultations, long consultations, GP home visits and evening, night and weekend consultations were increasingly higher than expected. The intervention district also showed the largest decrease between actual and expected use of ambulatory care, clinical care and 1-day hospitalizations.
  
  
  
  Utilization patterns for general practice and hospital care of people living in deprived districts may change when primary care professionals work in a more coherent and coordinated manner by applying a more 'comprehensive' integrated care approach. Results support the expectation that a comprehensive integrated care approach might eventually contribute to the future sustainability of healthcare systems.
authors.affiliation: Department of Public Health, Academic Medical Center (AMC), University of Amsterdam, PO-box 22660, Amsterdam, 1100 DD, The Netherlands. d.s.kringos@amc.uva.nl.
authors.forename: Dionne S
authors.initials: DS
authors.lastname: Kringos
authors.affiliation: Department of Public Health, Academic Medical Center (AMC), University of Amsterdam, PO-box 22660, Amsterdam, 1100 DD, The Netherlands.
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: van den Broeke
authors.affiliation: Kenniscentrum, Zilveren Kruis Achmea, Storkstraat 12, Leusden, 3833 LB, The Netherlands.
authors.forename: Arnold P M
authors.initials: AP
authors.lastname: van der Lee
authors.affiliation: Department of Public Health, Academic Medical Center (AMC), University of Amsterdam, PO-box 22660, Amsterdam, 1100 DD, The Netherlands.
authors.forename: Thomas
authors.initials: T
authors.lastname: Plochg
authors.affiliation: Department of Public Health, Academic Medical Center (AMC), University of Amsterdam, PO-box 22660, Amsterdam, 1100 DD, The Netherlands.
authors.forename: Karien
authors.initials: K
authors.lastname: Stronks
mesh_terms: D000368:Aged; D005260:Female; D058006:General Practice / Q000379:methods / Q000706:statistics & numerical data*; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D011203:Poverty; D011320:Primary Health Care / Q000379:methods* / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors
keywords: General practice; Integrated delivery of health care; Use of GP care; Use of hospital care