What is the impact of introducing a non-clinical community health advice and navigation service on the demand for primary care in socially deprived areas?:Evidence from an observational panel study with difference-in-differences design

OBJECTIVES: To examine the effect of introducing a non-clinical community health advice and navigation service on the demand for primary care in a socially deprived area.

DESIGN: Observational panel study with difference-in-differences design. We conducted fixed-effects negative binomial regressions to compare changes in the number of visits to general practitioners (GPs) in individuals who visited the health advice and navigation service and a matched control group of individuals who did not visit the service. In addition, we analysed the effects of visiting the service multiple times.

SETTING AND PARTICIPANTS: Our empirical setting is a socially deprived urban area in Germany with a multicultural population of about 110 000 people. Our analyses are based on patient data (N=1044) from a non-clinical community health advice and navigation service and from two statutory health insurers.

OUTCOME MEASURES: Patient demand for primary care measured as the number of visits to GPs before and after the first visit to the health advice and navigation service.

RESULTS: Visiting the service for the first time significantly decreased the number of GP visits compared with the control group (β=-0.113, p<0.1). Each additional visit to the service, however, significantly decreased the effect of the first visit (β=0.037, p<0.05).

CONCLUSIONS: Our findings suggest that non-clinical community health advice and navigation services can serve as a low-threshold first point of contact. As first point contact, such services might possibly reduce the burden of primary care physicians in socially deprived areas. At the same time, such services might function as a gateway to accessing the health system, reducing unmet care needs and stimulate demand. Ongoing counselling in the service can identify medical needs that require a physician visit. Our findings may be useful for policymakers and healthcare leaders seeking to reduce the demand on the primary care workforce and can stimulate further research in this area.