Women at risk of coronary heart disease experience barriers to diagnosis and treatment: A qualitative interview study

Objective To describe the types of patients admitted to the first Dutch general practitioner (GP) hospital, their health-related quality of life and its substitute function.

Design A prospective observational study.

Setting The remaining 20-bed ward of a former district general hospital west of Amsterdam; a region with 62?000 inhabitants and 26 GPs.

Subjects All patients admitted during the 12 months between 1 June 1999 and 1 June 2000.

Main outcome measures Patients’ health-related quality of life (Medical Outcome Study 36-item Short Form Health Survey, Groningen Activities Restriction Scale), GPs assessments of severity of illness (DUSOI/WONCA Severity of Illness Checklist) and alternative modes of care.

Results In total, 218 admissions were recorded divided into 3 bed categories: GP beds (n=131), rehabilitation beds (n=62) and nursing home beds (n=25). The mean age of all patients was 76 years. Main reasons for admission were immobilization due to trauma at home (GP beds), rehabilitation from surgery (rehabilitation beds) and stroke (nursing home beds). Overall, patients showed a poor health-related quality of life on admission. If the GP beds had not been available, the GPs estimated that the admissions would have been almost equally divided among home care, nursing home and hospital care. The severity of the diagnosis on admission of the ‘hospital-care group’ appeared to be significantly higher than the other care groups.

Conclusion The GP hospital appears to provide a valuable alternative to home care, nursing home care and hospital care, especially for elderly patients with a poor health-related quality of life who are in need of short medical and nursing care.