Recent trends and variations in general practitioners' involvement in accident care in Switzerland: an analysis of claims data

Abstract

Background: As in other countries, there is concern and some fragmentary evidence that GPs' central role in the Swiss healthcare system as the primary provider of care might be changing or even be in decline. Our study gives a systematic account of GPs' involvement in accident care from 2008 to 2016 and identifies changes in GPs' involvement in this typical field of primary care: how frequently GPs were involved along the care pathway, to what extent they figured as initial care provider, and what their role in the care pathway was.

Methods: Using a claims dataset from the largest Swiss accident insurer with two million accident cases, we constructed individual care pathways, i.e., when and from which providers patients received care. We calculated probabilities for the involvement of various care provider groups, for initial care provision, and for the role of GPs in patients' care pathways, adjusted for injury and patient characteristics using multinomial regression.

Results: In 2014, GPs were involved in 70% of all accident cases requiring outpatient care but no inpatient stay, and provided initial care in 56%. While involvement stayed at about the same level for accidents occurring from 2008 to 2014, the share of accidents where GPs provided initial care decreased by 4 percentage points. The share of cases where GPs acted as sole care provider decreased by 7 percentage points down to 44%. At the same time, accident cases involving care from an ED at any point in time increased from 38 to 46% and the share receiving initial care from an ED from 30 to 35 percentage points - apparently substituting for the declining involvement of GPs in initial care. GPs' involvement in accident care is higher in rural compared to urban regions, among elderly compared to younger patients, and among Swiss compared to non-Swiss citizens.

Conclusions: GPs play a key role in accident care with considerable variation depending on region and patient profile. From 2008 to 2014, there is a remarkable decline in GPs' provision of initial care after an accident. This is a strong indication that the GPs' role in the Swiss healthcare system is changing.

Keywords: Accident care; Claims data; Emergency department; General practitioner; Health Services research; Patient behavior; Primary care; Trauma care.

Fig. 1

Probability of involvement and of providing initial care for different providers over time. Outpatient cases only, N = 2,007,513. Raw probabilities, adjusted probabilities are nearly identical (see Supporting Information S 2). SE of the estimates is always < 0.01 percentage points

Fig. 2

Probability of providing initial care for different providers by patients’ place of residence, gender, and citizenship. 2014, outpatient cases only, N = 305,125. Raw and adjusted probabilities, numbers are for raw probabilities. SE of the estimates is always < 0.01 percentage points. The broken red line indicates the mean. Adjusted probabilities are based on a multinomial logistic model controlling for injury type and anatomical location, occupational vs. non-occupational accident, point in time of the accident, patient’s gender, citizenship, age, and place of residence

Fig. 3

Probability of providing initial care for different providers by patients’ age. 2014, outpatient cases only, N = 305,125. Raw and adjusted probabilities. SE of the estimates is always < 0.01 percentage points. The broken red line indicates the mean. Adjusted probabilities are based on a multinomial logistic model controlling for injury type and anatomical location, occupational vs. non-occupational accident, point in time of the accident, patient’s gender, citizenship, age, and place of residence

Fig. 4

Probability of providing initial care for different providers by time-of-day of the accident. 2014, outpatient cases only, N = 305,125. Raw and adjusted probabilities, with 95%-confidence interval. The dashed red line indicates the mean. Adjusted probabilities are based on a multinomial logistic model controlling for injury type and anatomical location, occupational vs. non-occupational accident, point in time of the accident, patient’s gender, citizenship, age, and place of residence.NA: time of accident not available

Fig. 5

Probability for various roles of GPs in the care pathway over time. Outpatient cases only, N = 2,007,513. Raw probabilities. SE of the estimates is always < 0.01 percentage points. GPs → ED outpatient: initial care by GPs and subsequent care by emergency department (outpatient)GPs → specialists: initial care by GPs and subsequent care by medical specialists