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Regional variation in health care substitution for intrauterine device insertion: a retrospective cohort study: A retrospective cohort study

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Titel: Regional variation in health care substitution for intrauterine device insertion: a retrospective cohort study: A retrospective cohort study
Autoren: Vink, Maarten D, Portrait, France R, van Wezep, Tim, Koolman, Xander, Mol, Ben W, van der Hijden, Eric J
Quelle: BMC Prim Care
BMC Primary Care, Vol 25, Iss 1, Pp 1-10 (2024)
Verlagsinformationen: Springer Science and Business Media LLC, 2024.
Publikationsjahr: 2024
Schlagwörter: Adult, Medicine (General), Primary Health Care, IUD insertion, Research, Healthcare Disparities/statistics & numerical data, Medical practice variation, Middle Aged, Secondary Care, 3. Good health, Young Adult, Contraception, R5-920, Humans, Female, Healthcare Disparities, Cohort study, Care substitution, Intrauterine Devices/statistics & numerical data, Intrauterine Devices, Retrospective Studies, Netherlands
Beschreibung: Background Rising health care costs are a major concern in most Western countries. The substitution of healthcare stands as a strategic approach aimed at mitigating costs while offering medical services in proximity to patients’ residences. An illustrative instance involves the migration of outpatient hospital care to primary care settings. Notably, the insertion of intrauterine devices (IUDs) can be safely executed within primary care contexts. In order to establish a pragmatic objective for the rate of IUD substitution, we conducted an evaluation of regional disparities in healthcare substitution pertaining to the insertion of intrauterine devices. Furthermore, we investigated disparities in the follow-up ultrasound and reinsertion of IUDs between primary and secondary healthcare environments. Methods All women who underwent IUD insertion in Dutch primary care (by general practitioners and midwives) and secondary care (by hospital physicians) between January 1, 2016, and December 31, 2020 were included. The main outcome measures were the case-mix adjusted IUD insertion rates at the regional level by care setting and the proportions requiring follow-up ultrasound and IUD reinsertion within three months. Results Of the 840,766 IUD placements, 74% were inserted in primary care and 26% in secondary care. The proportion inserted in primary care increased from 70% in 2016 to 77% in 2020. The observed substitution rate ranged from 58 to 82% between regions. Compared with health care professionals in primary care, those in secondary care performed more ultrasounds to verify IUD placement (23% vs. 3%; p-value Conclusions IUDs are increasingly being inserted in Dutch primary care, with peak regional IUD insertion care substitution rates at ≥ 80%. IUD insertion care substitution to primary care appears to be associated with significantly fewer women having follow-up ultrasound or IUD reinsertion within three months.
Publikationsart: Article
Other literature type
Sprache: English
ISSN: 2731-4553
DOI: 10.1186/s12875-024-02546-7
Zugangs-URL: https://pubmed.ncbi.nlm.nih.gov/39127618
https://doaj.org/article/11a6e919d7cd496cb96555d9763773f2
https://hdl.handle.net/1871.1/acdf1f42-3488-47b3-b948-74f1c445e29e
https://doi.org/10.1186/s12875-024-02546-7
https://research.vu.nl/en/publications/acdf1f42-3488-47b3-b948-74f1c445e29e
Rights: CC BY
URL: http://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (http://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (http://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
Dokumentencode: edsair.doi.dedup.....40bf8e949fce208dfdfc42dc94bdbe3e
Datenbank: OpenAIRE
Beschreibung
Abstract:Background Rising health care costs are a major concern in most Western countries. The substitution of healthcare stands as a strategic approach aimed at mitigating costs while offering medical services in proximity to patients’ residences. An illustrative instance involves the migration of outpatient hospital care to primary care settings. Notably, the insertion of intrauterine devices (IUDs) can be safely executed within primary care contexts. In order to establish a pragmatic objective for the rate of IUD substitution, we conducted an evaluation of regional disparities in healthcare substitution pertaining to the insertion of intrauterine devices. Furthermore, we investigated disparities in the follow-up ultrasound and reinsertion of IUDs between primary and secondary healthcare environments. Methods All women who underwent IUD insertion in Dutch primary care (by general practitioners and midwives) and secondary care (by hospital physicians) between January 1, 2016, and December 31, 2020 were included. The main outcome measures were the case-mix adjusted IUD insertion rates at the regional level by care setting and the proportions requiring follow-up ultrasound and IUD reinsertion within three months. Results Of the 840,766 IUD placements, 74% were inserted in primary care and 26% in secondary care. The proportion inserted in primary care increased from 70% in 2016 to 77% in 2020. The observed substitution rate ranged from 58 to 82% between regions. Compared with health care professionals in primary care, those in secondary care performed more ultrasounds to verify IUD placement (23% vs. 3%; p-value Conclusions IUDs are increasingly being inserted in Dutch primary care, with peak regional IUD insertion care substitution rates at ≥ 80%. IUD insertion care substitution to primary care appears to be associated with significantly fewer women having follow-up ultrasound or IUD reinsertion within three months.
ISSN:27314553
DOI:10.1186/s12875-024-02546-7