Co-organization of General Practitioners with Other Primary Health Care Services: A Systematic Review [Internet]

Excerpt

In this systematic review we have summarized results from 28 controlled US studies that compared co-organized clinics with clinics where primary health care resources were not co-organized.

As one of several measures to meet existing challenges in primary care, a co-organization of general practitioners with other primary health service providers has been proposed by Norwegian authorities in the Meld. St. 26 (2014–2015): “The primary health and care services of tomorrow - localized and integrated”.

In this systematic review we have summarized results from 28 controlled US studies that compared co-organized clinics with clinics where primary health care resources were not co-organized. The evidence, therefore, consists only of studies conducted in a different context than the Norwegian context. Based on this evidence we have drawn the following conclusions:

1. For the use of health services, it is uncertain whether a co-ordination effort will lead to more, fewer or the same number of visits to an emergency department service or specialist health care service. For hospitalizations, there is possibly little or no difference.

2. For follow-up of patients with diabetes or heart disease respectively measured as the proportion of patients having their HbA1c or lipid values measured, there is possibly little or no difference.

3. For preventive work, measured as the proportion of patients being screened for cervical cancer, colorectal cancer or chlamydia, there is possibly little or no difference. On the other hand, it is possible that marginally more patients in co-organized clinics will be screened for breast cancer.

4. Co-organization of general practitioners with other primary health care service providers can possibly lead to somewhat lower costs.

For all outcomes, we considered the evidence to be of low quality and we therefore have limited confidence that the estimates are close to the true value. More studies or further follow-up on the interventions that were implemented in the included studies may change the estimates and our confidence in them.

Keywords: Primary health care; General practitioners.