The online version of this article (doi:10.1186/1471-2296-15-114) contains supplementary material, which is available to authorized users.
The authors declare that they have no competing interest.
LF contributed to research design, data collection, analyses, and led the draft of the manuscript. GM contributed to data collection and drafting of the manuscript. MBC and FO contributed to research design and drafting of the manuscript. MV contributed to the data collection and to the research design, and drafting of the manuscript. PV contributed on the research design and drafting of the manuscript. All authors read and approved the final manuscript.
The general practitioner (GP) plays an important role for chronic disease care. Continuous and close contact with daytime general practice is intended to prevent medical problems arising outside office hours due to already diagnosed chronic disease. However, previous studies indicate that patients with chronic diseases are frequent users of out-of-hours primary care services (OOH), but knowledge is limited on reasons for encounter (RFE), severity of symptoms, and OOH patient handling. We aimed to describe contacts to the OOH services from patients with chronic heart disease, lung disease, severe psychiatric disorders, diabetes, and cancer in terms of RFE, OOH GP diagnosis, assessed severity of symptoms, and actions taken by the GP.
Eligible patients (aged 18 years and older) were randomly sampled from a one-year cross-sectional study comprising 15,229 contacts to the OOH services in the Central Denmark Region. A cohort of patients with one or more of the five selected chronic diseases were identified by linking data on the Danish civil registration number (CPR) through specific nationwide Danish health registers.
Out of 13,930 identified unique patients, 4,912 had at least one of the five chronic diseases. In total, 25.9% of all calls to the OOH services came from this chronic disease patient group due to an acute exacerbation; 32.6% of these calls came from patients with psychiatric diagnoses. Patients with chronic disease were more likely to receive a face-to-face contact than the remaining group of patients, except for calls from patients with a psychiatric disorder who were more often completed through a telephone consultation. Patients with heart disease calling due to a new health problem formed the largest proportion of all OOH referrals to hospital (13.3%) compared to calls from the other groups with chronic disease (3.4-6.7%).
A third of the patients randomly sampled by their OOH call had one or more of the five selected chronic diseases (i.e. chronic lung disease, heart disease, diabetes, psychiatric disease, or cancer). Patients with chronic disease were more often managed by OOH GPs than other patients.
Danish Health and Medicines Authority: Kronisk sygdom. Patient, sundhedsvæsen og samfund. Chronic disease. Patient, healthcare system and society. Edited by: Jørgensen SJ. 2005, Copenhagen: Danish Health and Medicines Authority
Danish Health and Medicines Authority: Forløbsprogrammer for kronisk sygdom – Generisk model og Forløbsprogram for diabetes. 1.0 ed. Chronic disease self-management programmes - the generic model on diabetes. 2008, Copenhagen: Danish Health and Medicines Authority
Danish Health and Medicines Authority: KOL - Kronisk Obstruktiv Lungesygdom, Anbefalinger for tidlig opsporing, opfølgning, behandling og rehabilitering. COPD - Chronic Obstructive Lung Disease. Recommendations on early detection, follow-up and rehabilitation. 2007, Copenhagen: Danish Health and Medicines Authority, 20
Danish Health and Medicines Authority: Referenceprogram for unipolar depression hos voksne: udarbejdet af en arbejdsgruppe nedsat af Sekretariatet for Referenceprogrammer - SfR. Reference programme on depression among adults, produced by a working group at the Danish Health and Medicines Authority. 2007, Copenhagen: Danish Health and Medicines Authority
Danish Health and Medicines Authority: Referenceprogram for angstlidelser hos voksne: udarbejdet af en arbejdsgruppe nedsat af Sekretariatet for Referenceprogrammer - SfR. Reference programme on anxiety among adults, produced by the Danish Health and Medicines Authority. 2007, Copenhagen: Danish Health and Medicines Authority
Frank Hansen M, Haagen Pedersen L: Sundhedsudgifter og finanspolitisk holdbarhed. [Health expenses and fiscal durability]. Dan Econ Soc J. 2010, 148 (1): 21-42.
World Health Organization: Innovative care for chronic conditions. S.l.: Noncommunicable Diseases and Mental Health. 2002, Geneva: World Health Organization
Christensen MB: Frequent attenders at the out of hours service in Denmark - Implementation of change in general practice. A stratified cluster randomised controlled trial among frequent attenders at the out of hours service in the County of Northern Jutland, Denmark. 2001, Aarhus: PhD thesis. Aarhus University, Faculty of Health Sciences
Statistic Denmark: http://www.statistikbanken.dk/statbank5a/default.asp?w?=?1920,
Olivarius NF, Hollnagel H, Krasnik A, Pedersen PA, Thorsen H: The Danish National Health Service Register. A tool for primary health care research. Dan Med Bull. 1997, 44: 4-
Flarup L, Moth G, Christensen MB, Vestergaard M, Olesen F, Vedsted P: A feasible method to study the Danish out-of-hours primary care service. Dan Med J. 2014, 61 (5): A4847- PubMed
Lynge E, Sandegaard JL, Rebolj M: The Danish national patient register. Scand J Publ Health. 2011, 39 (7 Suppl): 30-33. 10.1177/1403494811401482. CrossRef
Carstensen B, Kristensen JK, Marcussen MM, Borch-Johnsen K: The national diabetes register. Scand J Publ Health. 2011, 39 (7 suppl): 58-61. 10.1177/1403494811404278. CrossRef
Mors O, Perto GP, Mortensen PB: The Danish psychiatric central research register. Scand J Publ Health. 2011, 39 (7 suppl): 54-57. 10.1177/1403494810395825. CrossRef
Storm HH, Michelsen EV, Clemmensen IH, Pihl J: The Danish cancer registry-history, content, quality and use. Dan Med Bull. 1997, 44: 535-539. PubMed
Gjerstorff ML: The Danish cancer registry. Scand J Publ Health. 2011, 39 (7 suppl): 42-45. 10.1177/1403494810393562. CrossRef
Pedersen CB, Gøtzsche H, Møller JØ, Mortensen PB: The Danish civil registration system. Dan Med Bull. 2006, 53: 441-449. PubMed
Mosbech J, Jorgensen J, Madsen M, Rostgaard K, Thornberg K, Poulsen TD: The national patient registry. Evaluation of data quality. Ugeskr Laeger. 1995, 157 (26): 3741-3745. PubMed
Thygesen LC, Ersboll AK: Danish population-based registers for public health and health-related welfare research: introduction to the supplement. Scand J Publ Health. 2011, 39 (7 Suppl): 8-10. 10.1177/1403494811409654. CrossRef
Thygesen SK, Christiansen CF, Christensen S, Lash TL, Sorensen HT: The predictive value of ICD-10 diagnostic coding used to assess Charlson comorbidity index conditions in the population-based Danish National Registry of Patients. BMC Med Res Methodol. 2011, 11: 83-10.1186/1471-2288-11-83. CrossRefPubMedPubMedCentral
International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders: A conceptual framework for the revision of the ICD-10 classification of mental and behavioural disorders. World Psychiatr. 2011, 10: 86-92. CrossRef
Denmark S: Mænd & kvinder 2011. [Men & women 2011]. 2011, Statistics Denmark: Copenhagen
Folkesundhedsrapporten Danmark 2007: Report on Public Health in Denmark 2007. 2007, Copenhagen: National Institute of Public Health
Schroll H, Christensen RD, Thomsen JL, Andersen M, Friborg S, Sondergaard J: The danish model for improvement of diabetes care in general practice: impact of automated collection and feedback of patient data. Int J Fam Med. 2012, Article ID 208123: 5
Coleman K, Austin BT, Brach C, Wagner EH: Evidence on the chronic care model in the new millennium. Health Aff (Millwood). 2009, 28 (1): 75-85. 10.1377/hlthaff.28.1.75. CrossRef
- Chronic-disease patients and their use of out-of-hours primary health care: a cross-sectional study
Morten Bondo Christensen
- BioMed Central
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