PDF(Pubmed)
Abstract：
BACKGROUND: Rising health care costs are a major concern in most Western countries. The substitution of healthcare stands as a strategic approach aimed at mitigating costs while offering medical services in proximity to patients\' residences. An illustrative instance involves the migration of outpatient hospital care to primary care settings. Notably, the insertion of intrauterine devices (IUDs) can be safely executed within primary care contexts. In order to establish a pragmatic objective for the rate of IUD substitution, we conducted an evaluation of regional disparities in healthcare substitution pertaining to the insertion of intrauterine devices. Furthermore, we investigated disparities in the follow-up ultrasound and reinsertion of IUDs between primary and secondary healthcare environments.
METHODS: All women who underwent IUD insertion in Dutch primary care (by general practitioners and midwives) and secondary care (by hospital physicians) between January 1, 2016, and December 31, 2020 were included. The main outcome measures were the case-mix adjusted IUD insertion rates at the regional level by care setting and the proportions requiring follow-up ultrasound and IUD reinsertion within three months.
RESULTS: Of the 840,766 IUD placements, 74% were inserted in primary care and 26% in secondary care. The proportion inserted in primary care increased from 70% in 2016 to 77% in 2020. The observed substitution rate ranged from 58 to 82% between regions. Compared with health care professionals in primary care, those in secondary care performed more ultrasounds to verify IUD placement (23% vs. 3%; p-value < 0.01) and more IUD reinsertions within three months (6% vs. 2%; p-value < 0.01).
CONCLUSIONS: IUDs are increasingly being inserted in Dutch primary care, with peak regional IUD insertion care substitution rates at ≥ 80%. IUD insertion care substitution to primary care appears to be associated with significantly fewer women having follow-up ultrasound or IUD reinsertion within three months.
METHODS: All women who underwent IUD insertion in Dutch primary care (by general practitioners and midwives) and secondary care (by hospital physicians) between January 1, 2016, and December 31, 2020 were included. The main outcome measures were the case-mix adjusted IUD insertion rates at the regional level by care setting and the proportions requiring follow-up ultrasound and IUD reinsertion within three months.
RESULTS: Of the 840,766 IUD placements, 74% were inserted in primary care and 26% in secondary care. The proportion inserted in primary care increased from 70% in 2016 to 77% in 2020. The observed substitution rate ranged from 58 to 82% between regions. Compared with health care professionals in primary care, those in secondary care performed more ultrasounds to verify IUD placement (23% vs. 3%; p-value < 0.01) and more IUD reinsertions within three months (6% vs. 2%; p-value < 0.01).
CONCLUSIONS: IUDs are increasingly being inserted in Dutch primary care, with peak regional IUD insertion care substitution rates at ≥ 80%. IUD insertion care substitution to primary care appears to be associated with significantly fewer women having follow-up ultrasound or IUD reinsertion within three months.
摘要：
背景：在大多数西方国家，医疗保健费用的上涨是一个主要问题。替代医疗保健是一种战略方法，旨在降低成本，同时在患者住所附近提供医疗服务。一个说明性实例涉及将门诊医院护理迁移到初级护理设置。值得注意的是,在初级保健环境中可以安全地插入宫内节育器(IUD).为了建立宫内节育器替代率的务实目标，我们对与插入宫内节育器有关的医疗替代的地区差异进行了评估.此外，我们调查了一级和二级医疗保健环境在随访超声和宫内节育器再插入方面的差异.
方法：所有在2016年1月1日至2020年12月31日期间在荷兰初级保健（由全科医生和助产士）和二级保健（由医院医生）接受宫内节育器插入的妇女纳入研究。主要结果指标是按护理环境在区域一级按病例混合调整的IUD插入率，以及需要在三个月内进行随访超声和IUD重新插入的比例。
结果：在840,766个IUD放置中，74%的人被安置在初级保健中，26%被安置在二级保健中。初级保健的比例从2016年的70%增加到2020年的77%。在区域之间观察到的替代率范围为58％至82％。与初级保健专业人员相比，那些接受二级保健的人进行了更多的超声检查以验证宫内节育器的放置(23%与3％；p值<0.01）和三个月内更多的宫内节育器重插（6％vs.2%；p值<0.01)。
结论：宫内节育器越来越多地插入荷兰的初级保健中，区域IUD插入护理替代率峰值≥80%。IUD插入护理替代初级保健似乎与在三个月内进行超声随访或IUD重新插入的妇女人数显着减少有关。
方法：所有在2016年1月1日至2020年12月31日期间在荷兰初级保健（由全科医生和助产士）和二级保健（由医院医生）接受宫内节育器插入的妇女纳入研究。主要结果指标是按护理环境在区域一级按病例混合调整的IUD插入率，以及需要在三个月内进行随访超声和IUD重新插入的比例。
结果：在840,766个IUD放置中，74%的人被安置在初级保健中，26%被安置在二级保健中。初级保健的比例从2016年的70%增加到2020年的77%。在区域之间观察到的替代率范围为58％至82％。与初级保健专业人员相比，那些接受二级保健的人进行了更多的超声检查以验证宫内节育器的放置(23%与3％；p值<0.01）和三个月内更多的宫内节育器重插（6％vs.2%；p值<0.01)。
结论：宫内节育器越来越多地插入荷兰的初级保健中，区域IUD插入护理替代率峰值≥80%。IUD插入护理替代初级保健似乎与在三个月内进行超声随访或IUD重新插入的妇女人数显着减少有关。
