New primary care approach gaining traction

Rowan Smeets

New primary care approach gaining traction

Societal impact of research

03-10-2023 · Interview

In today’s world, the societal impact of research findings seems more important than getting published in an academic journal like Nature or The Lancet. What impact has research at UM achieved in recent years? This week: how a UM pilot study in seven general practices grew into a movement involving over a hundred practices.

Over the past decade, five hundred GPs in the Netherlands under the age of 50 quit their practice. 2021 alone saw 101 GPs under 50 quit, according to a survey conducted by the Dutch General Practitioner’s Association (LHV). Despite GP assistants taking on more responsibilities, including mental health and diabetes care, 75 percent of GPs are still faced with heavy workloads.

This is due to worker shortages, especially in more remote areas of the country, but also because of the ageing population. People are living to older ages, staying in their own homes longer, and increasingly using primary care services.

In an effort to reduce GP workload, researcher Rowan Smeets and colleagues developed TARGET, a new approach and vision for general practice. Commissioned by primary care group Zorggroep Dokter Drenthe, the programme began as a pilot study involving seven general practices in Drenthe. Since then, it has spread across the province like wildfire. Today, 119 practices have implemented the programme. And there is growing interest in other parts of the Netherlands.

Addiction

What does TARGET entail? It may sound strange, but GPs first need to ask themselves who exactly their patients are – how much care they use, how often they contact the practice, and how often they come in for a consultation. To gain insight into their patient population, GPs can use UM-developed software that analyses their patient database.

“Our research shows that 6 per cent of attenders use 23 per cent of all GP care”, says Smeets. “Two-thirds of this 6 per cent have long-term conditions like diabetes or COPD. To our surprise, the remaining one-third turned out to consist of people aged 50 or younger. They struggle primarily with mental health problems such as burnout.”

After identifying their “frequent attenders”, GPs sit down with patients whose frequent attendance cannot be readily explained by, say, a progressive disease or another condition that requires regular monitoring. These in-depth conversations with patients may reveal that they have something entirely different going on, says Smeets. “Some are in debt; others are struggling with addiction. They might be better served by support from local authorities or addiction services. This reduces GP workload. It’s crucial for GPs to have an extensive network of support workers in other disciplines. Some practices have appointed a network coordinator for this purpose.”

Autonomy

The approach frees up time for patients with complex healthcare needs. But there’s even more to gain by easing standardised guidelines. “According to national guidelines, patients with diabetes have to come in for a check-up four times per year. This makes sense for patients who don’t have their diabetes under control yet. But an annual check-up may be sufficient for patients who eat well, are active and are on the right medication. The health insurance company Zilveren Kruis, a participant in the TARGET programme, is giving GPs more freedom and autonomy to organise their services as they see fit.” Many of these check-ups could also be conducted through video calls or home monitoring. “eHealth offers a lot of opportunities in this regard.”

But the key question is: can GP workload be reduced? “It’s not easy”, says Smeets, “especially in a time when the number of patients with complex care needs is increasing and there is a shortage of healthcare workers. TARGET gave some GPs more time for their patients, but not others. We have an evaluation of the programme coming up. Our main goal is to increase job satisfaction, which significantly reduces subjective workload. We’ve found that GPs mainly appreciate increased autonomy, reduced administrative burdens, and feeling like their work is meaningful.”

Limburg

Rowan Smeets and her colleagues are getting weekly inquiries about TARGET from GPs, health insurers and medical specialists. “The Council of Public Health & Society (RVS) has called the project a role model for others, and Zilveren Kruis is considering implementing the approach beyond Drenthe. There is already a great deal of interest from other provinces, including Limburg, which is home to a large population of older adults. TARGET could be a great fit here.”

Photo: Ellen Oosterhof

Categories: news_top, Science
Tags: Impact, gp, onderzoek

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