Interaction between GPs and hospitals: The effect of cooperation initiatives on GPs satisfaction Ass Professor Lars Erik Kjekshus and Post doc Trond Tjerbo Department of Health Management and Health Economics
Bacground GPs as gatekeepers in the Norwegian health care system The need for cooperation between levels of care The coordination reform 28 June 2011 Department of Health Management and Health Economics Dr. Lars Erik Kjekshus, associate professor 13
DATA INTORG-survey 2005 60 hospital units 80-95 % response rate GP survey 2006 1723 physicians 50.9 % response rate 28 June 2011 Department of Health Management and Health Economics Dr. Lars Erik Kjekshus, associate professor 14
General practitioner satisfaction with the coordination of health care between themselves and their primary hospital for patients in need of follow up from a general practitioner. Percent (n). Very dissatisfied 0-1 3 (55) Dissatisfied 2-4 27 (465) Satisfied 5-7 56 (961) Very satisfied 8-10 14 (242) N 100 (1723)
GP satisfaction with hospital coordination 7 6 5 4 3 2 1 Satisfaction with coordination Medical dpt. Satisfaction with coordination Surgical dpt. Satisfaction with coordination All in all 0 University hospital Central hospital Local hospital 28 June 2011 Department of Health Management and Health Economics Dr. Lars Erik Kjekshus, associate professor 16
Organising for coordination Rotated factor matrix. Varimax solution Factor 1 INTERNAL Cost decrease Factor 2 EXTERNAL Cost increase Changes in patient flow 0,5 0,05 Changes in coordination routines (general) 0,84 0,03 localization w/municipal emergency ward -0,05-0,03 Systematic training scheme for primary health 0,57 0,18 care personell Ambulatory teams 0,09 0,18 Visiting GP -0,16-0,10 Consultations outside hospital -0,03 0,96 Patient report time -0,55 0,23 Routines for contacting municipality at time of discharge -0,13 0,82 Contract with municipality transfer of patients 0,46 0,15 Dialisys in municipality -0,57-0,10 28 June 2011 Department of Health Management and Health Economics Dr. Lars Erik Kjekshus, associate professor 17
General practitioner satisfaction with the coordination of health care between themselves and their primary hospital. Standardized regression coefficients (p value) (Constant) 19.56 (<0.001) Women GPs with long The number of years of the GP practice 0.06 (0.030) Sex tenure tend to be more 0.08 (0.009) Central hospital* satisfied with the 0.186 (<0.001) Local hospitals* coordination The GPs tend to be 4.998 (<0.001) Factor 1 (Cost decreasing) more satified with the 1.473 (0.141) Factor 2 (Cost increasing) coordinations with 5.463 (<0.001) F statistic smal local hospitals 11.370 (<0.001) Adjusted R 2 0.05 with cost increasing coordination *Reference: University hospitals
INTORG Organisational development in Norwegian hospitals 1999-2009
The hospital specialist has regulary consultations outside Tabell 43. Har leger ved den virksomheten faste dager for konsultasjon utenfor sykehus - hos fastleger? the Prosentandel hospital (N) 2003 2005 2007 2009 Ja 28 % 7 % 2 % 2 % N (80) (106) (102) (87) Related to patients discharge, the GPs are contacted in kontakt med fastlegen før hjemsendelse? advance Tabell 49. For pasienter med behov for medisinsk oppfølging, tas det da rutinemessig Prosentandel (N) 2003 2005 2007 2009 Ja 40 % 22 % 20 % 33 % N (73) (104) (99) (85) Source: Kjekshus, Lars Erik; Bernstrøm, Vilde. (2010) Helseforetakenes interne organisering og ledelse - INTORG 2009. Oslo: Universitetet i Oslo HERO skriftserie (4)
Dedicated coordinator at the hospital who organise Tabell 52. Har virksomheten en egen person/personer som har som sin hovedoppgave å ta kontakt med hjemkommunene til pasientene for å forberede utskrivning av utskrivningsklare pasienter som trenger pleie? Prosentandel the patient (N) transfere 1999 2001 2003 2005 2007 2009 Ja 35 % 38 % 48 % 27 % 26 % 25 % N (96) (96) (80) (102) (102) (85) The hospital has meetings with the municipality on regular basis Tabell 53. Har virksomheten fellesmøter med representanter fra kommunene? Prosentandel (N) 2003 2005 2007 2009 Ja 90 % 56 % 64 % 75 % N (82) (106) (100) (87)
Patient report time after discharge to mailed report Tabell 46. Hvor lang tid tar det vanligvis fra pasienten utskrives til epikrisen sendes? Prosentandel (N) 7 2003 2005 2007 2009 Samme dag 0 % 5 % 2 % 2 % 1 dag 0 % 1 % 1 % 2 % 2-4 dager 5 % 4 % 17 % 18 % 5-7 dager 33 % 45 % 57 % 62 % 8-14 dager 32 % 40 % 22 % 15 % >14dager 29 % 5 % 1 % 0 % N (78) (102) (101) (87) Source: Kjekshus, Lars Erik; Bernstrøm, Vilde. (2010) Helseforetakenes interne organisering og ledelse - INTORG 2009. Oslo: Universitetet i Oslo HERO skriftserie (4)
The hospital has trainingprogram for the primary health care workers Tabell 37. Har den medisinske virksomheten systematiske opplæringsprogram for personell i primærhelsetjenesten? Prosentandel (N) 2005 2007 2009 Medisinsk virksomhet Ja 26 % 22 % 48 % Under etablering 17 % 9 % 7 % N (42) (54) (42) Kirurgisk virksomhet Ja 15 % 16 % 8 % Under etablering 8 % 10 % 10 % N (60) (49) (39) The hospital has amulant teams visiting the utvalgte pasientgrupper i primærhelsetjenesten? municipalities on regular basis Tabell 38. Har virksomheten ambulante team som driver oppsøkende behandling for Prosentandel (N) 2005 2007 2009 Medisinsk virksomhet Ja 43 % 61 % 64 % Under etablering 16 % 6 % 9 % N (44) (54) (44) Kirurgisk virksomhet Ja 5 % 8 % 5 % Under etablering 8 % 4 % 5 % N (63) (49) (41) Source: Kjekshus, Lars Erik; Bernstrøm, Vilde. (2010) Helseforetakenes interne organisering og ledelse - INTORG 2009. Oslo: Universitetet i Oslo HERO skriftserie (4)
Conclusion How the specialist healthcare is organised has an effect on how satisfied the GPs are with the coordination Hospitals are not necessarily organising according to GP satisfaction. The perspective of the GPs is less seen in the decisions about future hospital design. Although increased focus on coordination between levels of care in Norway