Invoering van de huisartsenpost in Almere: Effecten van schaalvergroting en triage op de zorgvraag

Objective: Evaluation of the effect of centralisation of primary care on the total amount of services during day and night and on assignment of tasks between the GP and the doctors assistant or nurse. Method: Analyses of the contact registration during a period of three month in six successive years, starting two years before the centralization, gives the total use of primary care during daytime and out of office hours. For each period we calculated the percentage of services by the GP, doctors assistant and nurse. Results: With the centralization the total amount of services for primary care has not been changed, neither during daytime nor out of hours. With the introduction of telephone triage about 25% of all services could be managed by the doctors assistant herself. The percentage of telephonic advice by the GP decreased within the first year statistically significant from 31,4% to 20,2% (decrease 11,5%; 95%CI 10,3-12,7) and the percentage of home visits decreased from 16,1% to 9,1% (decrease 7,1%; 95% CI 6,1-8,0). The percentage of consultation by the GP on the post did not change. The percentage of consultation by the nurse increased statistically significantly from 12,7% to 17% (increase 4,3%; 95%CI 3,4-5,3). Conclusion: The total demand of care in out of office hours was not influenced by the centralization of primary care. There was a substantial shift of telephone advice from the GP to the doctors.