Overview article: Impact of primary and secondary care collaboration on hospitalization for chronic heart failure: Two comparative studies.

INTRODUCTION: In the past decade, a legal framework was created in Germany that promotes intense collaboration at the interface between primary and secondary care. This overview article distinguishes between the effects of two complementary programs aimed at improving ambulatory care in Baden-Wuerttemberg: (1) general practitioner-centered care (GPCC), which strengthens the role of general practitioners, and (2) collaborative cardiology care (CCC), which coordinates primary and cardiology care. METHODS: The overview article presents two already published studies that assess the impact of the programs on hospitalizations in patients with chronic heart failure (CHF) based on claims data from 2016. The hospitalization rate of patients enrolled in GPCC (N=75,096) and CCC (N=13,404) were compared with corresponding control groups (N=65,618 and N=8,776 respectively). RESULTS: The hospitalization rate in GPCC was lower than in the control group (risk ratio 0.97; 95% CI: 0.95-0.99, P=0.0024). GPCC patients with CHF that received specialist cardiology care as part of CCC had significantly lower hospitalization rates than those receiving standard cardiology care (risk ratio 0.92; 0.88-0.97, P=0.0014). DISCUSSION: This overwiew study shows that reforming medical care and compensation at the interface between general practice and specialist care can lead to fewer hospital admissions in patients with CHF. CONCLUSION: Overall, this article underlines the importance of collaboration between primary care physicians and specialists for patients with CHF that are receiving ambulatory care.