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The following is a summary of “Regional variation in health care substitution for intrauterine device insertion: a retrospective cohort study,” published in the August 2024 issue of Primary Care by Vink et al.

Rising healthcare costs are a significant concern in many Western countries, prompting a strategic shift towards substituting specialized healthcare services with more accessible options closer to patients’ homes. A prime example of this trend is the transition of specific outpatient procedures, such as intrauterine device (IUD) insertion, from secondary to primary care settings. This study aims to evaluate the extent of this substitution across different regions and to assess associated differences in follow-up care practices, such as ultrasound evaluations and reinsertion procedures, between primary and secondary healthcare environments.

Researchers comprehensively analyzed all IUD insertions performed in the Netherlands from January 1, 2016, to December 31, 2020, distinguishing between primary care settings (general practitioners and midwives) and secondary care settings (hospital physicians). The primary outcome measures included the case-mix adjusted IUD insertion rates by region and care setting and the rates of follow-up ultrasound and IUD reinsertion within three months of the initial procedure.

Of 840,766 IUD insertions, 74% were carried out in primary care settings, while 26% occurred in secondary care settings. The proportion of IUDs inserted in primary care increased from 70% in 2016 to 77% in 2020. Regional substitution rates varied significantly, ranging from 58% to 82%. Notably, secondary care settings conducted more follow-up ultrasounds to verify IUD placement compared to primary care settings (23% vs. 3%; p<0.01) and had a higher rate of IUD reinsertion within three months (6% vs. 2%; p < 0.01).

The findings demonstrate a growing trend toward performing IUD insertions in Dutch primary care settings, with regional substitution rates reaching up to 80%. This shift to primary care is associated with a reduction in the need for follow-up ultrasounds and IUD reinsertion within three months. These results suggest that increased adoption of primary care for IUD insertion effectively reduces the burden on secondary care facilities while maintaining patient outcomes.

Source: bmcprimcare.biomedcentral.com/articles/10.1186/s12875-024-02546-7