The influence of general practitioners on access points to health care in a system without gatekeeping: a crosssectional study in the context of the QUALICOPC project in Austria

Aim To assess the rates of specialist visits and visits to hospital emergency departments (ED) among patients in Austria with and without concurrent general practitioner (GP) consultation and among patients with and without chronic disease. Methods The cross-sectional questionnaire study was conducted in the context of the QUALICOPC project in 2012. Fieldworkers recruited 1596 consecutive patients in 184 GP offices across Austria. The 41-question survey addressed patients’ experiences with regard to access to, coordination, and continuity of primary care, as well demographics and health status. Descriptive statistics as well as univariate and multivariate regression models were applied. Results More than 90% of patients identified a GP as a primary source of care. Among all patients, 85.5% reported having visited a specialist and 26.4% the ED at least once in the previous year. Having a usual GP did not change the rate of specialist visits. Additionally, patients with chronic disease had a higher likelihood of presenting to the ED despite having a GP as a usual source of care. Conclusion Visiting specialists in Austria is quite common, and the simple presence of a GP as a usual source of care is insufficient to regulate pathways within the health care system. This can be particularly difficult for chronic care patients who often require care at different levels of the system and show higher frequency of ED presentations

The collateral damage of the COVID-19 pandemic on homeless people in the Netherlands; a qualitative study on the impact of health and care

IntroductionPeople experiencing homelessness, also in the Netherlands, experience poorer physical and mental health compared to the general population and suffer from unmet health needs that are strongly related to their unfavorable social situation. This makes them especially vulnerable to negative consequences of a public health emergency such as the COVID-19 pandemic. This qualitative study aims to provide insight into the experiences of people experiencing homelessness with the impact of the pandemic on their health and lives.MethodsWe performed semistructured interviews at 3 different times in the first 2 years of the pandemic including, respectively, 67, 55, and 53 persons. Interviews focused on their experienced mental and physical health, their experiences with the public health measures taken, and the care they received during the pandemic.ResultsIn each round of interviews, the self-reported mental health was lower than before. In the last round approximately half felt mentally unhealthy. Mental health was negatively impacted due to livelihood insecurity, loss of social contact and poor accessibility to social and medical care. Twenty-four hour shelter locations with smaller dormitories had a positive impact on mental health.Conclusion and recommendationsMost preventive measures taken during the pandemic negatively impacted the mental health of people experiencing homelessness but some improved their health. We recommend special attention to the effects on mental health when planning measures for pandemic control and we recommend to implement 24-h shelter and smaller dormitories

Accessible and continuous primary care may help reduce rates of emergency department use. An international survey in 34 countries

Part of the visits to emergency departments (EDs) is related to complaints that may well be treated in primary care. (i) To investigate how the likelihood of attending an ED is related to accessibility and continuity of primary care. (ii) To investigate the reasons for patients to visit EDs in different countries. Data were collected within the EU Seventh Framework project Quality and Costs in Primary Care (QUALICOPC) in 31 European countries, Australia, New Zealand and Canada. The data were collected between 2011 and 2013 and contain survey data from 60991 patients and 7005 GPs, within 7005 general practices. whether the patient visited the ED in the previous year (yes/no). Multilevel logistic regression analyses were carried out to analyse the data. Some 29.4% had visited the ED in the past year. Between countries, the percentages varied between 18% and 40%. ED visits show a significant and negative relation with better accessibility of primary care. Patients with a regular doctor who knows them personally were less likely to attend EDs. Only one-third of all patients who visited an ED indicated that the main reason for this was that their complaint could not be treated by a GP. Good accessibility and continuity of primary care may well reduce ED use. In some countries, it may be worthwhile to invest in more continuous relationships between patients and GPs or to eliminate factors that hamper people to use primary care (e.g. for costs or travelling

Additional file 1: of Propensity to seek healthcare in different healthcare systems: analysis of patient data in 34 countries

Overview of ethics committees within the QUALICOPC project. (PDF 273 kb

Additional file 3: of Propensity to seek healthcare in different healthcare systems: analysis of patient data in 34 countries

Description of variables included in negative binomial regression analyses. (PDF 268 kb