title: Substitution of outpatient care with primary care: a feasibility study on the experiences among general practitioners, medical specialists and patients.
abstract: Reinforcing the gatekeeping role of general practitioners (GPs) by embedding specialist knowledge into primary care is seen as a possibility for stimulating a more sustainable healthcare system and avoiding unnecessary referrals to outpatient care. An intervention called Primary Care Plus (PC+) was developed to achieve these goals. The objective of this study is to gain insight into: (1) the content and added value of PC+ consultations according to stakeholders, and (2) patient satisfaction with PC+ compared to outpatient care.
  
  
  
  A feasibility study was conducted in the southern part of the Netherlands between April 2013 and January 2014. Data was collected using GP, medical specialist and patient questionnaires. Patient characteristics and medical specialty data were collected through the data system of a GP referral department.
  
  
  
  GPs indicated that they would have referred 85.4 % of their PC+ patients to outpatient care in the hypothetical case that PC+ was not available. Medical specialists indicated that about one fifth of the patients needed follow-up in outpatient care and 75.9 % of the consultations were of added value to patient care. The patient satisfaction results appear to be in favour of PC+.
  
  
  
  PC+ seems to be a feasible intervention to be implemented on a larger scale, because it has the potential to prevent unnecessary hospital referrals. PC+ will be evaluated on a larger scale regarding the effects on health outcomes, quality of care and costs (Triple Aim principle).
authors: Department of Health Services Research, Faculty of Health Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands. s.vanhoof@maastrichtuniversity.nl.
authors: Sofie J M
authors: SJ
authors: van Hoof
authors: Department of Health Services Research, Faculty of Health Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands. m.spreeuwenberg@maastrichtuniversity.nl.|Research Centre for Technology in Care, Zuyd University of Applied Sciences, Heerlen, The Netherlands. m.spreeuwenberg@maastrichtuniversity.nl.
authors: Marieke D
authors: MD
authors: Spreeuwenberg
authors: Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
authors: Mariëlle E A L
authors: ME
authors: Kroese
authors: Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
authors: Jessie
authors: J
authors: Steevens
authors: Primary Care Organisation Care In Development ZIO, Wilhelminasingel 81, 6221 BG, Maastricht, The Netherlands.
authors: Ronald J
authors: RJ
authors: Meerlo
authors: Department of Patient and Care, Academic Hospital Maastricht azM, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.
authors: Monique M H
authors: MM
authors: Hanraets
authors: Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
authors: Dirk
authors: D
authors: Ruwaard
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D003695:Delivery of Health Care / Q000379:methods*; D003880:Dermatology / Q000706:statistics & numerical data; D005240:Feasibility Studies; D005260:Female; D058006:General Practice; D019538:Health Care Surveys; D006801:Humans; D007388:Internal Medicine / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D009462:Neurology / Q000706:statistics & numerical data; D009985:Orthopedics / Q000706:statistics & numerical data; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data; D013038:Specialization
keywords: Collaboration; Outpatient care; Primary care; Substitution