Reduction of adverse clinical outcomes among older patients within a structured primary care programme: findings from...

Previous studies have shown that structured and coordinated primary care may reduce adverse outcomes for older patients. However, little is known about the long-term effects of these programmes. In 2004, Germany introduced the general practitioner (GP)-centred healthcare programme Hausarztzentrierte Versorgung with the main goal of delivering structured and coordinated care. This study describes the long-term effects of this programme on adverse outcomes in older patients over a 12-year observation period (2011-22).

A longitudinal, observational cohort study was conducted based on German health insurance claims data, covering the period 2011-22. Patients aged over 65 years at the beginning of the observation period were included. Multivariate models were calculated, adjusting for key confounders to reduce selection bias, comparing usual care with GP-centred care.

In 2011, 575 363 primary care patients over 65 years of age were enrolled. By 2022, 634 316 patients over 65 years of age were enrolled. Over the 12-year observation period, participants in GP-centred care had lower rates of all-cause hospitalisation, hospitalisations for ambulatory-care-sensitive conditions, prescriptions of potentially inappropriate medications and all-cause mortality compared with those in usual care.

Participation in structured and coordinated primary care programmes offers significant, sustained benefits for older patients, including reductions in hospitalisations, avoidable hospitalisations, inappropriate medication use and all-cause mortality. Given aging populations, these findings underline the critical role of such programmes in enhancing health care for older adults and strongly support broader implementation of GP-centred primary care models.