ArticleJournal of global health2016
Shifting chronic disease management from hospitals to primary care in Estonian health system: analysis of national panel data.
Article in Journal of global health, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 1 of them a synthesis that pooled it.
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Who cites it
13 citing papers in PubMed, 1 synthesis or guideline pooled it, 32 citations in OpenAlex.
- Primary healthcare reform for chronic conditions in countries with high or very high human development index: A systematic review.Chronic illness · 2022Pooled it
- Burden of atherosclerotic cardiovascular disease attributable to high body mass index, high fasting plasma glucose or high low density lipoprotein cholesterol in young and middle-aged adults from 1990 to 2050.Diabetology & metabolic syndrome · 2026Article
- Defining chronic ambulatory care sensitive conditions in Malaysia: a collaborative consensus study.BMJ open · 2026Article
- Effect of primary health care on hospitalizations: health services analysis based on Estonian data.Primary health care research & development · 2025Article
- Reforms and innovations in primary health care in different countries: scoping review.Primary health care research & development · 2024Article
- Prevalence of chronic conditions and multimorbidity in Estonia: a population-based cross-sectional study.BMJ open · 2021Article
- Regional variation of potentially avoidable hospitalisations in Switzerland: an observational study.BMC health services research · 2021Observational
- A Survey on the Management of Children with Asthma in Primary Care Setting in Italy.Pediatric allergy, immunology, and pulmonology · 2021Article
- Shifting care from hospital to community, a strategy to integrate care in Singapore: process evaluation of implementation fidelity.BMC health services research · 2020Article
- Public Hospitals in China: Is There a Variation in Patient Experience with Inpatient Care.International journal of environmental research and public health · 2019Article
- Effect of the economic crisis on the use of health and home care services among Spanish COPD patients.International journal of chronic obstructive pulmonary disease · 2018Article
- Does the impact of case management vary in different subgroups of multimorbidity? Secondary analysis of a quasi-experiment.BMC health services research · 2017Article
- Fukushima after the Great East Japan Earthquake: lessons for developing responsive and resilient health systems.Journal of global health · 2017Article
Corrections and comments
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Authors and funding
9 authors at 7 institutions in 4 countries.
Funding
Abstract
backgroundFollowing independence from the Soviet Union in 1991, Estonia introduced a national insurance system, consolidated the number of health care providers, and introduced family medicine centred primary health care (PHC) to strengthen the health system.
methodsUsing routinely collected health billing records for 2005-2012, we examine health system utilisation for seven ambulatory care sensitive conditions (ACSCs) (asthma, chronic obstructive pulmonary disease [COPD], depression, Type 2 diabetes, heart failure, hypertension, and ischemic heart disease [IHD]), and by patient characteristics (gender, age, and number of co-morbidities). The data set contained 552 822 individuals. We use patient level data to test the significance of trends, and employ multivariate regression analysis to evaluate the probability of inpatient admission while controlling for patient characteristics, health system supply-side variables, and PHC use.
findingsOver the study period, utilisation of PHC increased, whilst inpatient admissions fell. Service mix in PHC changed with increases in phone, email, nurse, and follow-up (vs initial) consultations. Healthcare utilisation for diabetes, depression, IHD and hypertension shifted to PHC, whilst for COPD, heart failure and asthma utilisation in outpatient and inpatient settings increased. Multivariate regression indicates higher probability of inpatient admission for males, older patient and especially those with multimorbidity, but protective effect for PHC, with significantly lower hospital admission for those utilising PHC services.
interpretationOur findings suggest health system reforms in Estonia have influenced the shift of ACSCs from secondary to primary care, with PHC having a protective effect in reducing hospital admissions.
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