Substitution of Hospital Care with Primary Care: Defining the Conditions of Primary Care Plus.
OBJECTIVE
To analyse barriers and facilitators in substituting hospital care with primary care to define preconditions for successful implementation.


METHODS
A descriptive feasibility study was performed to collect information on the feasibility of substituting hospital care with primary care. General practitioners were able to refer patients, about whom they had doubts regarding diagnosis, treatment and/or the need to refer to hospital care, to medical specialists who performed low-complex consultations at general practitioner practices. Qualitative data were collected through interviews with general practitioners and medical specialists, focus groups and notes from meetings in the Netherlands between April 2013 and January 2014. Data were analysed using a conventional content analysis which resulted in categorised barriers, facilitators and policy adjustments, after which preconditions were formulated.


RESULTS
The most important preconditions were make arrangements on governmental level, arrange a collective integrated IT-system, determine the appropriate profile for medical specialists, design a referral protocol for eligible patients, arrange deliberation possibilities for general practitioners and medical specialists and formulate a diagnostic protocol.


CONCLUSIONS
The barriers, facilitators and formulated preconditions provided relevant input to change the design of substituting hospital care with primary care.
Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
Sofie Johanna Maria
SJ
van Hoof
Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
Mariëlle Elisabeth Aafje Lydia
ME
Kroese
Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands; Centre for Technology in Care, Zuyd University of Applied Sciences, Heerlen, The Netherlands.
Marieke Dingena
MD
Spreeuwenberg
Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
Arianne Mathilda Josephus
AM
Elissen
Primary Care Organisation Care in Development (ZIO), Maastricht, The Netherlands.
Ronald Johan
RJ
Meerlo
Department of Patient and Care, Academic Hospital Maastricht (azM), Maastricht, The Netherlands.
Monique Margaretha Henriëtte
MM
Hanraets
Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
Dirk
D
Ruwaard
Substitution; hospital care; preconditions; primary care