Formal Professional Relationships Between General Practitioners and Specialists in Shared Care: Possible Associations with Patient Health and Pharmacy Costs



Shared care in chronic disease management aims at improving service delivery and patient outcomes, and reducing healthcare costs. The introduction of shared-care models is coupled with mixed evidence in relation to both patient health status and cost of care. Professional interactions among health providers are critical to a successful and efficient shared-care model.


This article investigates whether the strength of formal professional relationships between general practitioners (GPs) and specialists (SPs) in shared care affects either the health status of patients or their pharmacy costs. In strong GP–SP relationships, the patient health status is expected to be high, due to efficient care coordination, and the pharmacy costs low, due to effective use of resources.


This article measures the strength of formal professional relationships between GPs and SPs through the number of shared patients and proxies the patient health status by the number of comorbidities diagnosed and treated. To test the hypotheses and compare the characteristics of the strongest GP–SP connections with those of the weakest, this article concentrates on diabetes—a chronic condition where patient care coordination is likely important. Diabetes generates the largest shared patient cohort in Hungary, with the highest frequency of specialist medication prescriptions.


This article finds that stronger ties result in lower pharmacy costs, but not in higher patient health status.


Overall drug expenditure may be reduced by lowering patient care fragmentation through channelling a GP’s patients to a small number of SPs.

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Fig. 1


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    The term general practitioner (GP) is synonymous with family doctor, family medical practitioner, generalist medical practitioner, and primary care doctor—GPs provide continuing and comprehensive medical care to individuals, families, and communities [4]. In contrast, the term specialist (SP) refers to a medical practitioner who focuses on certain disease categories, types of patients, or methods of treatment [4]. The term doctor describes any medical practitioner who holds a professional medical degree.

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    Drugs are classified into groups by the World Health Organization—through the Anatomical Therapeutic Chemical (ATC) Classification System. Groups reflect the organ or system on which drugs act and/or their therapeutic and chemical characteristics.

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    International Statistical Classification of Diseases and Related Health Problems 10th Revision [22].

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    ATC code for drugs used in diabetes.

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    The third level of an ATC code includes the main anatomical group (first level, one letter), the main therapeutic group (second level, two digits), and the therapeutic/pharmacological subgroup (third level, one letter), but excludes the chemical/therapeutic/pharmacological subgroup (fourth level, one letter) and the chemical substance (fifth level, two digits) [43].

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    Cardiovascular system drugs for treating angina, irregular heartbeats, heart attack, heart failure, and high blood pressure.

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    Cardiovascular system drugs for treating angina, irregular heartbeats, and high blood pressure.

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    Nervous system drugs for alleviating pain.

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    Nervous system drugs with calming effects.

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    Alimentary tract and metabolism drugs for acid-related disorders.


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The authors are grateful to DoktorInfo Ltd, for waiving the subscription charge in the interest of scientific research; Petra Baji, Edina Berlinger, László Gulyás, and three anonymous reviewers, for valuable comments and suggestions on an earlier draft; participants at the 2014 Joint International Health Economics Association (iHEA) and European Conference on Health Economics (ECHE) Congress and participants at the 2014 Annual Meeting of the Decision Sciences Institute (DSI), for helpful discussions; Anamaria M. Cristescu-Martin, for editorial assistance; and AXA Research Fund (, for awarding Ágnes Lublóy the post-doctoral research grant that enabled this research.

Author contributions

Ágnes Lublóy conceived and designed the study, developed the methodology, analysed and interpreted the data, drafted the manuscript, revised it critically, and gave final approval. Judit Lilla Keresztúri designed the study, developed the methodology, analysed and interpreted the data, drafted the manuscript, revised it critically, and gave final approval. Gábor Benedek conceived and designed the study, acquired the data, supervised the data analysis, revised the manuscript critically, and gave final approval.

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Corresponding author

Correspondence to Ágnes Lublóy.

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Ethical standards

The prescription data used in this article were collected by a reputable government-endorsed organisation in agreement with the relevant Hungarian and international legislation—they are available for market research by subscription. This article used the prescription data in an aggregate format, in no way detrimental to individual or collective patients and doctors—patients and doctors cannot be identified either individually or collectively on the basis of this article. The use of prescription data in this article was in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments and as such was approved by the Ethics Committee of Corvinus University of Budapest.

Funding and conflicts of interest

DoktorInfo Ltd has played no role in study design; in the analysis and interpretation of data; in the writing of this article; or in the decision to submit it for publication. Ágnes Lublóy is the beneficiary of a post-doctoral grant from the AXA Research Fund. AXA Research Fund has played no role in the preparation of this manuscript. Gábor Benedek is a partner at Lynx Analytics and Thesys SEA Pte Ltd; neither company has been involved in study design; in the analysis and interpretation of data; in the writing of this article; or in the decision to submit it for publication. Judit Lilla Keresztúri has no conflicts of interest to disclose.

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Lublóy, Á., Keresztúri, J.L. & Benedek, G. Formal Professional Relationships Between General Practitioners and Specialists in Shared Care: Possible Associations with Patient Health and Pharmacy Costs. Appl Health Econ Health Policy 14, 217–227 (2016).

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  • General Practitioner
  • Charlson Comorbidity Index
  • Shared Care
  • Oral Antidiabetic Agent
  • Pharmacy Cost