THE IMPACT OF A COMMUNITY HEALTH WORKER INTERVENTION VERSUS USUAL CARE ON HEALTHCARE UTILIZATION AMONG PEOPLE WITH UNMET HEALTH NEEDS IN BELGIUM: A MIXED METHODS STUDY
Author(s)
Tijs Van Iseghem, MSc1, Linda Campbell, MSc, PhD2, Emilie Op de Beeck, MSc2, Laura Vroonen, MSc2, Caroline Masquillier, MSc, PhD2, Josefien Van Olmen, MSc, PhD2, Hilde Bastiaens, MSc, PhD2, Edwin Wouters, MSc, PhD2, Nick Verhaeghe, MSc, DrPH, PhD3.
1PhD student, Ghent University, Ghent, Belgium, 2University of Antwerp, Antwerp, Belgium, 3Ghent University, Ghent, Belgium.
1PhD student, Ghent University, Ghent, Belgium, 2University of Antwerp, Antwerp, Belgium, 3Ghent University, Ghent, Belgium.
OBJECTIVES: Individuals with complex medical and social needs often receive care that does not adequately address their problems. Consequently, unresolved needs drive repeated health care use and increased system pressure. To address this, the Community Health Workers (CHWs) for Primary Healthcare Access (COMPASS) study implemented a cluster-RCT with 18 general practitioner (GP) practices in Antwerp, Belgium. Participants in the intervention arm received structured support from CHWs in addition to usual care, while the control arm received care as usual. This paper examined changes in healthcare utilization between the two arms, both quantitatively and qualitatively.
METHODS: Healthcare utilization data (iMCQ) was collected at baseline, 6 months and one year on the number of visits to GPs, specialists, emergency departments (ED), and hospitalizations. Negative binomial mixed-effects models were fitted including fixed effects for time, intervention, and covariates, with random intercepts for individuals to account for repeated measurements. Qualitative data was collected through group interviews with the GP practice’s team to explore perceived changes in healthcare use of the participants. Qualitative data were analysed using thematic analysis, and findings were used to explain and contextualize the quantitative results.
RESULTS: There was no between-group statistical evidence of a change in GP, ED, specialist visits or hospitalizations between baseline and twelve months. However, several GP practice teams indicated a perceived decrease in visits and that the CHW offered them substantive support. Additionally, GPs experienced an efficiency gain during consultations by being able to focus more directly on the medical burden of the patient, instead of social and administrative issues.
CONCLUSIONS: There was no statistical evidence of between-group changes in healthcare utilization. However, when triangulating quantitative and qualitative results, this study demonstrated consistent evidence of a meaningful shift in GP utilisation patterns that aligns with the intervention's theory of change, resulting in fewer visits and more medically-focused consultations.
METHODS: Healthcare utilization data (iMCQ) was collected at baseline, 6 months and one year on the number of visits to GPs, specialists, emergency departments (ED), and hospitalizations. Negative binomial mixed-effects models were fitted including fixed effects for time, intervention, and covariates, with random intercepts for individuals to account for repeated measurements. Qualitative data was collected through group interviews with the GP practice’s team to explore perceived changes in healthcare use of the participants. Qualitative data were analysed using thematic analysis, and findings were used to explain and contextualize the quantitative results.
RESULTS: There was no between-group statistical evidence of a change in GP, ED, specialist visits or hospitalizations between baseline and twelve months. However, several GP practice teams indicated a perceived decrease in visits and that the CHW offered them substantive support. Additionally, GPs experienced an efficiency gain during consultations by being able to focus more directly on the medical burden of the patient, instead of social and administrative issues.
CONCLUSIONS: There was no statistical evidence of between-group changes in healthcare utilization. However, when triangulating quantitative and qualitative results, this study demonstrated consistent evidence of a meaningful shift in GP utilisation patterns that aligns with the intervention's theory of change, resulting in fewer visits and more medically-focused consultations.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
HSD25
Topic
Epidemiology & Public Health, Health Service Delivery & Process of Care, Patient-Centered Research
Disease
Diabetes/Endocrine/Metabolic Disorders (including obesity), Musculoskeletal Disorders (Arthritis, Bone Disorders, Osteoporosis, Other Musculoskeletal), No Additional Disease & Conditions/Specialized Treatment Areas