Integrated primary care needs integrated research infrastructure: The Netherlands Primary Care...

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Integrated primary care needs integrated research infrastructure: The Netherlands Primary Care Database Robert Verheij, NIVEL Primary Care Information Network. [email protected]

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Page 1: Integrated primary care needs integrated research infrastructure: The Netherlands Primary Care Database Robert Verheij, NIVEL Primary Care Information.

Integrated primary care needs integrated research infrastructure:

The Netherlands Primary Care Database

Robert Verheij, NIVEL Primary Care Information Network. [email protected]

Page 2: Integrated primary care needs integrated research infrastructure: The Netherlands Primary Care Database Robert Verheij, NIVEL Primary Care Information.

Health care system in NL

• Gatekeeping role for GP for specialist care.• GP: List system (epidemiological

denominator).• Health care entrepreneurs• Managed competition • Health insurers play a key role• Doctors are never far away

Page 3: Integrated primary care needs integrated research infrastructure: The Netherlands Primary Care Database Robert Verheij, NIVEL Primary Care Information.

Routine Electronic health records

• Increasing use (eg. 99% of GPs use EHR system).

• Represent a continuous source of information relating to diseases, illnesses and treatment of patients.

Page 4: Integrated primary care needs integrated research infrastructure: The Netherlands Primary Care Database Robert Verheij, NIVEL Primary Care Information.

Why EHR data from primary care?• Primary care first point of contact with health care system for

most problems;• Dense network of services;• Covers all morbidity:

– not only serious cases (cf hospital data or causes of death);– And not only reportable deseases (as in occupational health

monitors).• Routinely available;• Cheaper than health interview surveys; • Much cheaper than health examination surveys;• Professional health assessment; • Epidemiological denominator is not a problem in countries

with list system (UK, Italy, DK, NL). In other countries (B, Fr) this can be resolved;

• Longitudinal: follow patients through time!

Page 5: Integrated primary care needs integrated research infrastructure: The Netherlands Primary Care Database Robert Verheij, NIVEL Primary Care Information.

Information about what?

• Quality of care• Accessibility• Developments in public health• Manpower planning

Dinny de Bakker
deze zou ik weglaten, hoort onder volksgezondheid
Page 6: Integrated primary care needs integrated research infrastructure: The Netherlands Primary Care Database Robert Verheij, NIVEL Primary Care Information.

Information for whom?

• Managers of practices or groups of practices• Patient organisations• Ministry of health• Health insurers

Page 7: Integrated primary care needs integrated research infrastructure: The Netherlands Primary Care Database Robert Verheij, NIVEL Primary Care Information.

NIVEL repositories based on EHR data

NIVEL repositories representative samples of:• General practices (120 practices; 400.000

patients)• Allied health services (40 physiotherapists, 40

exercise therapists, 30 dieticians).• Primary care psychologists (650)

Page 8: Integrated primary care needs integrated research infrastructure: The Netherlands Primary Care Database Robert Verheij, NIVEL Primary Care Information.

Research examples

• Evaluation of health care system reform (Van Dijk 2012)

• Association between different diseases (Raterman et al 2012).

• Quality of care trends (Van Dijk, 2011).• Multimorbidity (eg Van Oostrom et al. 2008).• Developments in public health (eg Verhaak 2005).• Evaluation direct access to allied health services

(Bossen et al. 2011).

Page 9: Integrated primary care needs integrated research infrastructure: The Netherlands Primary Care Database Robert Verheij, NIVEL Primary Care Information.

Silo’s of data that can not be linked

Page 10: Integrated primary care needs integrated research infrastructure: The Netherlands Primary Care Database Robert Verheij, NIVEL Primary Care Information.

National trend towards integrated care

Multidisciplinary guidelines Multidisciplinary disease management programs; Physiotherapistst and primary mental health care

accessible without referral; Introduction of GP out of hours co-ops; Primary care entrepreneurs

… make it necessary to broaden the information basis and include also other primary care disciplines.

 

Page 11: Integrated primary care needs integrated research infrastructure: The Netherlands Primary Care Database Robert Verheij, NIVEL Primary Care Information.

Record linkage

• GPs Pharmacies allied health services, out of hours services primary mental health care

+ possibility to link to secondary care data

• follow patients through the health care system. • possibility to approach patients for additional

information.

Page 12: Integrated primary care needs integrated research infrastructure: The Netherlands Primary Care Database Robert Verheij, NIVEL Primary Care Information.

timeline

Page 13: Integrated primary care needs integrated research infrastructure: The Netherlands Primary Care Database Robert Verheij, NIVEL Primary Care Information.

How to collect data in health care system of small scale individual health care professionals?

Page 14: Integrated primary care needs integrated research infrastructure: The Netherlands Primary Care Database Robert Verheij, NIVEL Primary Care Information.

Primary care groupPrimary care groups

Out of hours service region

GP

phyisio

dietician

psych

pharmacyGP

phyisio

dietician

psych

pharmacy

GP

phyisio

dietician

psych

pharmacy

GP

phyisio

dietician

psych

pharmacy

GP

phyisio

dietician

psych

pharmacy

GP

phyisio

dietician

psych

pharmacy

Secondary care

Page 15: Integrated primary care needs integrated research infrastructure: The Netherlands Primary Care Database Robert Verheij, NIVEL Primary Care Information.

Useful feedback for practice management and negotiations with insurers.

www.nivel.nl/mijnpraktijk-demo

http://www.nivel.nl/mijnpraktijk-demo
Page 16: Integrated primary care needs integrated research infrastructure: The Netherlands Primary Care Database Robert Verheij, NIVEL Primary Care Information.

But what about privacy?

Page 17: Integrated primary care needs integrated research infrastructure: The Netherlands Primary Care Database Robert Verheij, NIVEL Primary Care Information.

Fexible zone model (Kuchinke et al. 2011)

Linking anonymous data using pseudonyms

Via Trusted Third Party (TTP)

Page 18: Integrated primary care needs integrated research infrastructure: The Netherlands Primary Care Database Robert Verheij, NIVEL Primary Care Information.

Additional information via informed consent

Page 19: Integrated primary care needs integrated research infrastructure: The Netherlands Primary Care Database Robert Verheij, NIVEL Primary Care Information.

Software complexity

Page 20: Integrated primary care needs integrated research infrastructure: The Netherlands Primary Care Database Robert Verheij, NIVEL Primary Care Information.

• General practitioners: 8 software packages• Allied health care: appr 10 software packages• Out of hours services: 3 software packages

Page 21: Integrated primary care needs integrated research infrastructure: The Netherlands Primary Care Database Robert Verheij, NIVEL Primary Care Information.

But what about the quality of the data?

Page 22: Integrated primary care needs integrated research infrastructure: The Netherlands Primary Care Database Robert Verheij, NIVEL Primary Care Information.

EMR-scan: data Quality checks

www.nivel.nl/mijnpraktijk-demo

Page 23: Integrated primary care needs integrated research infrastructure: The Netherlands Primary Care Database Robert Verheij, NIVEL Primary Care Information.

Governance

Strong emphasis on involvement of professional organisations.

• National association of GPs• Association of primary care psychologists• Association of dieticians• Etc……Decide upon data requests and research themes

Page 24: Integrated primary care needs integrated research infrastructure: The Netherlands Primary Care Database Robert Verheij, NIVEL Primary Care Information.

Examples of research questions

Page 25: Integrated primary care needs integrated research infrastructure: The Netherlands Primary Care Database Robert Verheij, NIVEL Primary Care Information.

Chronic patients

Relation GP-dietician and • Nutrition advice: dietician better than GP? • Fysiotherapists in GP practices: what happens

in elsewhere in the health care system? • Effects of prevention in primary care on

morbidity and health care utilisation. • Evaluation of different payment systems and

organisational models.

Page 26: Integrated primary care needs integrated research infrastructure: The Netherlands Primary Care Database Robert Verheij, NIVEL Primary Care Information.

Acute care

Relation GP versus out of hours service• Relation between GP care during office hours • Unnecessary use of out of hours service. • Did patients consult their regular GP for the

same problem?

Page 27: Integrated primary care needs integrated research infrastructure: The Netherlands Primary Care Database Robert Verheij, NIVEL Primary Care Information.

Mental health

Relation GP-primary care psychologist• What happens in the GP practice before

people consult a psychologist? • And after? • What is the role of the practice assistant for

mental health problems? • Co-morbidity.

Page 28: Integrated primary care needs integrated research infrastructure: The Netherlands Primary Care Database Robert Verheij, NIVEL Primary Care Information.

Netherlands Primary Care Research Database: A research infrastucture

like a a Swiss army knife


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