Inhalt des Dokuments
The effects of gatekeeping: A systematic review of the literature.
Autor | Velasco Garrido
M, Zentner A, Busse R |
Verlag | Scand
J Primary Health Care 29: 28-38 (DOI:
10.3109/02813432.2010.537015) |
Zusammenfassung
Objective. To assess the effects of
physician-centred gatekeeping on health, health care utilization, and
costs by conducting a systematic review of the literature. Methods.
Systematic search in PubMed (MEDLINE and Pre-MEDLINE), EMBASE, and the
Cochrane Library, from the databases' respective inception dates up to
January 2010, using the search words "gatekeeping",
"gatekeeper*", "first contact", and
"self-referral". We included RCTs, CCTs, cohort studies,
CBAs, and interrupted time-series. We included only studies in which
the gatekeeper function was exercised by a physician and that reported
health and patient-related outcomes including quality of life and
satisfaction, quality of care, health care utilization, and/or
economic outcomes (e.g. expenditures or efficiency). Selection was
made independently by two reviewers and discrepancies were solved by
consensus after discussion. Data on target population, intervention,
additional interventions, study results, and methodological quality
were extracted. Methodological quality was assessed independently by
two reviewers following the previously defined criteria. Discrepancies
were solved by consensus after discussion. Results. This review
includes 26 studies in 32 publications. The majority of studies (62%)
reported data from the United States and in most gatekeeping was
associated with lower utilization of health services (up to -78%) and
lower expenditures (up to -80%). However, there was great variability
in the magnitude and direction of the differences. Conclusion.
Overall, the evidence regarding the effects of gatekeeping is of
limited quality. Many studies are available regarding the effects on
health care utilisation and expenditures, whereas effects on health
and patient-related outcomes have been studied only exceptionally and
are inconclusive.Read More:
informahealthcare.com/doi/abs/10.3109/02813432.2010.537015 [1]
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