Staat, markt en burgermaatschappij als samenstellende delen van de conceptuele driehoek.
OBJECTIVE: To assess the reliability and validity of a shortened version of the Rainbow Model of Integrated Care (RMIC) measurement tool (MT). The original version of the measurement tool has been modified (shortened) for the Australian context.DESIGN: Validation of the psychometric properties of the RMIC-MT.SETTING: Healthcare providers providing services to a geographically defined rural area in New South Wales (NSW), Australia.PARTICIPANTS: A sample of 56 healthcare providers providing mental and physical healthcare.MAIN OUTCOME MEASURES: The psychometric properties of the tool were tested using principal component analysis for validity and Cronbach's alpha for reliability.RESULTS: The tool was shown to have good validity and reliability. The 35 items used in the shortened version of the tool were reduced to 29 items grouped into four dimensions: community-governance orientation, normative integration, functional integration and clinical-professional coordination.CONCLUSIONS: The shortened version of the RMIC-MT is a valid and reliable tool that evaluates integrated care from a healthcare provider's perspective in NSW, Australia. In order to assess the tool's appropriateness in an international context, future studies should focus on validating the tool in other healthcare settings.
Background: The substitution of healthcare is a way to control rising healthcare costs. The Primary Care Plus (PC+) intervention of the Dutch ‘Blue Care’ pioneer site aims to achieve this feat by facilitating consultations with medical specialists in the primary care setting. One of the specialties involved is dermatology. This study explores referral decisions following dermatology care in PC+ and the influence of predictive patient and consultation characteristics on this decision. Methods: This retrospective study used clinical data of patients who received dermatology care in PC+ between January 2015 and March 2017. The referral decision following PC+, (i.e., referral back to the general practitioner (GP) or referral to outpatient hospital care) was the primary outcome. Stepwise logistic regression modelling was used to describe variations in the referral decisions following PC+, with patient age and gender, number of PC+ consultations, patient diagnosis and treatment specialist as the predicting factors. Results: A total of 2952 patients visited PC+ for dermatology care. Of those patients with a registered referral, 80.2% (N = 2254) were referred back to the GP, and 19.8% (N = 558) were referred to outpatient hospital care. In the multivariable model, only the treating specialist and patient’s diagnosis independently influenced the referral decisions following PC+. Conclusion: The aim of PC+ is to reduce the number of referrals to outpatient hospital care. According to the results, the treating specialist and patient diagnosis influence referral decisions. Therefore, the results of this study can be used to discuss and improve specialist and patient profiles for PC+ to further optimise the effectiveness of the initiative.
