Less is More in Primary Health Care

Doctoral Candidate, Sanne Lykke Lundstrøm

Project in cooperation between- DTU Management Engineering, Technical University of Denmark- Research Unit of General practice, University of Copenhagen- Research Unit of General practice, University at Southern

Denmark

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General Practice in Denmark• The Danish welfare system with universal access to health care is

build around the primary health care

• All Danish residents have free and direct access to general practitioners (GPs)

• This gatekeeping system essentially is designed to support the principle that treatment ought to take place at the lowest effective care level along with the idea of continuity of care provided by a family doctor

• General practices have been able to adapt and position them as an important part of the Danish health care system by providing cost-efficient, first-line services and careful gatekeeping

3 DTU Management, Danmarks Tekniske Universitet

General practice are facing big challenges • Quality of treatment have showed significant variation in general

practice

• The patient load are getting bigger due to a growing elderly population and a decreasing number of GPs

• The number of patients with chronic diseases are growing in general practice

• Patients who earlier were treated in the secondary sector are now being moved to general practice for treatment and monitoring e.g. patients with diabetic, COPD…

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Relational Coordination

Shared goals

Shared knowledge

Mutual respect

Frequent communication

Timely communication

Problem-solving communication

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Organisational Social Capital

Justice

Cooperation

Trust

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Aim of this study

• To measure levels of relational coordination and organisational social capital in the Danish general practice

• To examine if high relational coordination and/or relational coordination is correlated with characteristics of general practice.

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Questionnaire • Relational coordination:

– 7 items– 7 dimensions

• Social capital:– 11 items– 4 dimension:

• Vertical trust, • Horizontal trust• Justice• cooperation skills

• Background information:– Profession– Full time – part time – Gender– Years in general practice

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Data collection

Profession Antal

Doctor – owner

1127

Doctor - employee

801

Secretary 674

Nurse 253

Technician 63

Others 75

Didn’t check the box

36

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Results

• The practice form were highly significant for the rating of organisational social capital and relational coordination.

• Single-handed practices had the highest rating of social capital and relational coordination;

– partnership had the lowest

• Practices with a higher patient to employee ratio had higher relational coordination.

• Geography location, gender and age were not significant for the rating of organisational social capital or relational coordination

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Are we building a better or worse general practice?• There is a general move towards larger practices from both a

political side as well as from healthcare professionals, in particular physicians

• In order for larger general practices to fully utilise the resources available to them, they need to make coordination and communication a priority

• Earlier studies shows that relational coordination is associated with high quality of treatment and organisational social capital is associated with job satisfaction and low turnover.

• We need to reconsider if fewer, but larger general practice are the right way to handle the increasing demand on general practice due to the growing and ageing population.

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Thank you for your attention