strength of primary care & health outcomes for chronically ill people peter groenewegen, dionne...
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Strength of Primary Care & Health Outcomes
for chronically ill people
Peter Groenewegen, Dionne Sofia Kringos, Johan Hansen,
Wienke Boerma
Research question and hypotheses
Is strong primary care at system level related to individual health outcomes?
In systems with stronger PC: • people with chronic conditions are better off
Strong PC is:• more effective with comorbidity and with
primary care sensitive conditions
And less inequality by education
Data and methods Dependent variables
• Self-rated health • Limitations in activities of daily life • Untreated chronic conditions
Source of individual level data:• Eurobarometer survey, people with at
least one chronic condition (n= 15,085; 27 EU member states)
Data and methods
Independent country level variables• Structure of primary care • Access • Continuity • Coordination • Comprehensiveness
Source of country level variables: • PHAMEU study
Data and methods
• Multilevel linear regression analysis• Strength of PC (level 2) variables one
by one• Crosslevel interactions also one by one• Individual level covariates (age, gender, education,
occupational status, nr of possessions, having more than one chronic condition, having one or more primary care sensitive conditions)
• country level covariate (GDP ppp)
Are people with chronic conditions better off?
Having Self-rated Untreated chroniclimitations health conditions
Structure ns + ns
Access + ns ns
Continuity ns ns ns
Coordination ++ ns ns
Comprehensiveness ns ns ns
Stronger PC structure better self-rated healthAccess and coordination: against hypothesis
More effective with comorbidity?
Having Self-rated Untreated chroniclimitations health conditions
Multimorb * Structure ns ++ ---
Multimorb * Access + ns -
Multimorb * Continuity ns ns ns
Multimorb * Coordination ns ns ---
Multimorb * Compr.ness -- ns -
With multimorbidity:Stronger PC structure better self-rated health
Less untreated chronic conditions
People with multimorbidity have less untreated conditions with strong PC structure
More effective with primary care sensitive conditions?
Having Self-rated Untreated chroniclimitations health conditions
Pc sens con * Structure - ns --
Pc sens con * Access ns ns ns
Pc sens con * Continuity ns ns ns
Pc sens con * Coordination ns ns ---
Pc sens con * Compr.ness -- ns ns
For those with PC sensitive conditions:Stronger PC less limitations and less untreated condition
Less inequality by education?
Having Self-rated Nr untreated chroniclimitations health conditions
Education * Structure ns --- ns
Education * Access ns - ns
Education * Continuity ns - ns
Education * Coordination ns -- ns
Education * Compr.ness ns ns ns
For those with lower education:Stronger PC better self-rated health
People with lower education benefit more from strong primary care structure
Conclusions
Conclusions
• With stronger PC people are better off• Especially with > 1 chronic disease or a
PC sensitive condition• With stronger primary care less
inequality by education
But• many non-significant relationships• For access also contrary to hypotheses
What this research adds
• Clear population of countries: EU member states
Europe is our research laboratory! • Health outcomes in stead of mortality• More effects where PC is most important• Evidence for equity effect
