[Which chronic conditions are suitable for specialist-led care within a primary care system? : An exploratory...

With the introduction of general practitioner (GP) gate keeping, specialists would also be able to assume primary care responsibilities for patients with severe chronic conditions. The aim of this study was to develop a data-driven method for identifying potentially suitable conditions and to illustrate the relevance of individual medical specialties to patient care.

Using nationwide claims data of statutory health insurance physicians for 2024, the proportions of cases and treatment days per patient treated by primary care physicians and specialists were determined for each ICD‑3 code (the first three digits of the International Classification of Diseases). Categories were considered to have high relevance for specialist care if for more than half of the patients, at least 60% of treatment cases and at least 50% of treatment days were attributable to specialists. F33, G35, K51, M05, and N25 were analyzed in greater detail as examples.

There were 173 ICD-3 codes highly relevant to specialist care. With regard to the five selected ICD-3 codes, patients with impaired renal function (N25) had the highest proportion of specialist care: 83% of patients were receiving nephrological treatment, with nephrologists accounting for 77% of disease-specific cases but only 37% of all treatment days. For all five indications, general practitioners accounted for the highest proportion of all treatment days (43% to 55%). Of these patients, 92 to 97% were treated by general practitioners.

If specialists were to take on the role of primary care coordinators for these patients, they would have to coordinate care across a broad range of medical specialties. This would likely limit their cross-specialty coordination tasks to individual cases or restrict it to their own specialty.