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Observational Study
. 2019 Jul 26;9(1):10859.
doi: 10.1038/s41598-019-47344-9.

Strong primary care and patients' survival

Michel Wensing  1 , Joachim Szecsenyi  2 , Petra Kaufmann-Kolle  3 , Gunter Laux  4
Affiliations
Observational Study

Strong primary care and patients' survival

Michel Wensing et al. Sci Rep. .

Abstract

Primary healthcare is the cornerstone of any healthcare system. A major health system reform to strengthen primary care has been implemented in Germany since 2008. Key components include: voluntary participation, intensive management of patients with chronic diseases, coordination of access to medical specialists, continuous quality improvement, and capitation-based reimbursement. The objective of this study was to assess the effect of this reform on survival of enrolled patients. We conducted a comparative cohorts study with 5-year follow-up, starting in the year 2012 in Baden-Wuerttemberg, Germany. Participants were 1,003,336 enrolled patients and 725,310 control patients. A Cox proportional hazards regression model was applied to compare survival of enrolled patients with a composed control cohort of non-enrolled patients, adjusted for a range of patient and physician characteristics. Average age of enrolled patients was 57.3 years and 56.1% were women. Compared to control patients, they had lower mortality (Hazard Ratio: 0.978; 95% CI: 0.968; 0.989). Participation in chronic disease management programs had independent impact on survival rate (Hazard Ratio 0.744, 95% CI: 0.734; 0.753). We concluded that strong primary care is safe and potentially beneficial in terms of patients' survival.

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Conflict of interest statement

Joachim Szecsenyi holds stocks in the AQUA-Institute, which provides services to AOK Baden-Wuerttemberg. He also has a long and ongoing collaboration with AOK Baden-Wuerttemberg, which involved payment to Heidelberg University Hospital of scientific services. Other authors have no competing interests.

Figures

Figure 1
Figure 1
Survival rates, unadjusted.
See this image and copyright information in PMC

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