Kosteneffectieve nieuwe organisatie huisartsenpost zorgt voor minder tevreden patiënten

Hansen BL, Munck A. Out-of-hours service in Denmark: the effect of a structural change. Br J Gen Pract 1998 Aug;48(433):1497-9.

In Denemarken is de zorg buiten kantooruren door huisartsen aan het begin van 1992 hervormd. 'Rota' systemen werden vervangen door lokaal regiogebonden diensten. De nieuwe out-of-hours service heeft geresulteerd in een aanzienlijke verlaging van het totale aantal huisartsen met dienst. Doel van de studie: om te beschrijven hoe de patiënten de veranderingen ervaren kijkend naar tevredenheid, en hoe het patroon van patiëntcontact en de vergoeding voor huisartsen is veranderd met het nieuwe systeem.

BACKGROUND: In Denmark, the provision of out-of-hours care by general practitioners (GPs) was reformed at the start of 1992. Rota systems were replaced locally by county-based services. The new out-of-hours service resulted in a considerable reduction in the total number of GPs on call. AIM: To describe how the patients experienced the change from a satisfaction point of view, and how the pattern of patient contact and the fee for GPs changed with the new system. METHOD: The county of Funen was chosen as the geographical area where data were collected. A questionnaire measuring patient satisfaction was posted before the change, immediately after the change, and three years later to a random selection of patients who had been in contact with the out-of-hours service within two weeks before the mailing date. All primary care services for the Danish population are stored in a database (National Health Service Registry). From this continuously updated database, the contact pattern and the fee for GPs were extracted for 1991, 1992, and 1995. RESULTS: The total number of patient contacts was reduced by 16% in the first year, but by only 6% three years later. Three years after the change, there were more than twice as many telephone consultations as before the change, and there were only a third as many home visits. After three years, the GPs' fees were reduced by 20%. There was a significant decrease in patient satisfaction, although the overall level remained high. This decrease was lower three years after the change than immediately after the new system was introduced. CONCLUSION: The new service had a major cost-effectiveness benefit, but there was a price to pay in patient satisfaction

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