Charité-based researchers present a new model
What type of health care is best suited to a specific type of patient? When do patients benefit from family practitioners playing a prominent role? Which parameters are crucial in ensuring a health care system can offer a balance of services for long-term care? In an attempt to map the complex structure of health care utilization, researchers from Charité – Universitätsmedizin Berlin have been working with researchers from Norway to develop a model, which will make it easier to conduct research into, and make adaptations to, health care services that meet long-term needs. Results from this study have been published in the journal PlosOne*.
In order to be able to adequately describe the structure and key dynamics of a particular health care system, one has to understand the way in which this system is used by its patients. Previous studies have focused on the impact of issues such as socio-economic and regional differences, or the way in which discrepancies in educational attainment may influence health care use. This type of research provides important information, which allows health care planners to design services around the needs of patients.
For the team of researchers led by Dr. Wolfram Herrman of Charité's Institute of General Practice, the starting point for their qualitative, comparative study of the German and Norwegian health care systems was the realization that German patients visit their physicians much more frequently than patients in other countries do. However, that this does not result in patients being healthier or living longer. “The average number of contacts between physician and patient does not adequately reflect the complexity of the health care services provided,” explains Dr. Herrmann. He adds: “We therefore decided to ask whether there might be a better model to describe health care use.” The researchers used qualitative data collection methods which included interviews and observations made in family practice settings in both Germany and Norway. They found that patients did often not have a specific reason for consulting their family practitioner, but that a number of issues were addressed during these consultations.
“A visit to the family practitioner is not an isolated event, but forms part of a sequence of visits,” emphasizes Dr. Herrmann. “We also found that health care systems differ in terms of who is involved in the provision of health care services, and how information is exchanged between individual health care providers. In Norway, for instance, very few specialists work in private practice. Referrals are usually made by the family physician, and sent electronically to specialists based in hospital outpatient units. These, in turn, invite the patient to attend for a consultation. Discharge reports, which are also sent in electronic format, are delivered directly to the family practitioner.”
The data collected as part of the study allowed the researchers to develop a model to describe long-term health care utilization. The model, which depicts a patient's contacts with health care providers, as well as the flow of information between these contacts over time, aims to help researchers determine which types of health care services benefit which types of patients. By doing so, the model is contributing to future improvements in long-term health care services.
*Herrmann WJ, Haarmann A, Bærheim A. A sequential model for the structure of health care utilization. PLoS One. 2017 May 12;12(5):e0176657. doi: 10.1371/journal.pone.0176657. eCollection 2017. PubMed PMID: 28498872; PubMed Central PMCID: PMC5428914.
Dr. Wolfram Herrmann
Institut für Allgemeinmedizin
Charité – Universitätsmedizin Berlin
t: +49 30 450 514 225
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