Coordination and integration of primary care in Western Europe.

Riet-Paap, J.C. van, Boerma, W., Kringos, D.S. Coordination and integration of primary care in Western Europe. European Journal of Public Health: 2010, 20(suppl. 1), p. 99. Abstract. 3rd European Public Health Conference 'Integrated Public Health', 10 - 13 November 2010, Amsterdam.
Background: Due to ageing a larger proportion of the population suffers from multiple and complex health problems that need treatment from more than one health care provider. Fragmentation of care is a critical development that all health care systems in Europe need to cope with. To improve the responsiveness of patient care there is a need for coherent and well coordinated provision of health care services. Methods: On the basis of a systematic review of the literature on primary care (PC) and consultations with experts across Europe, key features and indicators of coordination of care were identified. In 2009–10 data was collected in Belgium, France, Germany, Ireland, The Netherlands and the UK. Data sources were national and international statistical databases, policy papers, national and international (scientific) literature and expert organizations. Results: Coordination of PC will be measured with indicators including the existence of a gatekeeping system, patients’ freedom to choose their own PC physician, the use of referral letters and the existence of task substitution between general practitioners (GPs) and nurses. Preliminary results show that there are many different coordination mechanisms used in PC across countries. Main outcomes indicate variation in the coordinating role of GPs, patient satisfaction with their GP, direct access to other levels of care and the level of communication between PC and secondary care. Discussion/conclusions: The discussion will explain the differences related to coordination of PC. The results will be placed in the context of the key features of the studied health care systems, and the structure and organization of the PC systems in Western Europe.