Background
Emergency care in the Netherlands is mainly provided by emergency departments (ED) and general practitioners (GP). During out-of-hours care, GPs mostly collaborate in out-of-hours services: large on-call rotations in which they take care of each other’s patients. In order to have access to hospital care, including EDs, patients are obliged to have a referral from an ambulant emergency service or GP, who functions as a gatekeeper. However, in practice, many patients attend the ED directly. Out-of-hours GP services and ED contacts are covered by obligatory health insurance. For hospital services (i.e. ED visits), there is a compulsory fee of at least €170 (at the moment of data collection). Prices of care pathways are determined by the national DTC system (DTC means the registered diagnosis and treatment combination). Out-of-hours GP services operate with one fixed budget, based on the catchment population, which is converted to a price per medical service (advice, consultation at care center, consultation at home). Since the 2006 Health Insurance Act, the Dutch healthcare system is based on a market of regulated competition. The prices for medical services are determined after negotiations between health insurance companies and care providers. As all citizens of the Netherlands are required to have health insurance coverage, every citizen pays for annual healthcare expenditures. |
Urgent care collaborations
Employees’ experience
Research questions
Methods
Study population
Data
Questionnaire
Quality of care
|
Workload
|
Co-operation
| |
---|---|---|---|
Employee involvement | 0.403 | ||
Pleasant organisation | 0.474 | 0.376 | |
Quality of work front desk personnel | 0.546 | ||
Quality of work residents ED | 0.550 | −0.352 | |
Quality of work medical specialists ED | 0.480 | ||
Quality of work nurses ED | 0.363 | ||
Quality of work assistant out-of-hours GP service | 0.690 | ||
Quality of work nurse out-of-hours GP service | 0.651 | ||
Quality of work ambulance driver out-of-hours GP service | 0.469 | ||
Quality of work GP | 0.531 | ||
Quality of the organisation | 0.651 | ||
Quality of physical triage | 0.575 | ||
Quality of triage by telephone | 0.587 | ||
Quality of patient care | 0.644 | ||
Quality, patient safety | 0.508 | ||
Quality of care inadequate | 0.499 | ||
Recommendation of organisation to acquaintance | 0.446 | ||
Workload during work at the care centre | 0.799 | ||
Workload during home visits | 0.513 | ||
Workload during work at the call centre | 0.512 | ||
Workload due to the amount of contacts | 0.798 | ||
Workload due to self-referrals | 0.545 | ||
Workload due to less urgent or unnecessary patients | 0.425 | ||
Workload due to very urgent or complex patients | 0.326 | ||
Workload due to triage | 0.404 | ||
Workload due to arranging hospital admission | 0.315 | ||
Workload due to arranging admission outside the hospital | 0.333 | ||
Sufficient time for accurate patient care | 0.354 | 0.581 | |
Sufficient time to discuss patient care problems with colleagues | 0.540 | ||
Sufficient time for direct patient care | 0.338 | 0.520 | |
Quality of work and available time | 0.684 | ||
Co-operation out-of-hours GP service – ED, differences in culture/perspective | 0.367 | −0.593 | |
Co-operation out-of-hours GP service – ED, quality of medical performance | 0.503 | −0.564 | |
Co-operation out-of-hours GP service – ED, referral | 0.392 | −0.549 | |
Co-operation out-of-hours GP service – ED, feedback after referral | −0.601 | ||
Co-operation out-of-hours GP service – ED, meeting | −0.788 | ||
Co-operation out-of-hours GP service – ED, co-operation colleagues | −0.843 | ||
Co-operation out-of-hours GP service – ED, acquaintance with colleagues | 0.324 | −0.559 | |
Co-operation out-of-hours GP service – ED, patient flow | 0.382 | −0.553 | |
Co-operation out-of-hours GP service – ED, efficiency | 0.453 | −0.552 | |
Co-operation out-of-hours GP service – ED, right care at right place | 0.408 | −0.511 | |
Variance explained (%) | 22.115 | 9.422 | 7.026 |
Eigenvalues | 9.067 | 3.863 | 2.881 |
Total number of items | 17 | 14 | 10 |
Alpha | 0.90 | 0.84 | 0.87 |
Employee and employer characteristics
Analysis
Results
Total | Usual care | UCCs | ||||
---|---|---|---|---|---|---|
n
| responders (%) |
n
| responders (%) |
n
| responders (%) | |
Total | 1307 | 581 (44.4%) | 751 | 341 (45.3%) | 557 | 240 (43.1%) |
Physician* | 797 | 276 (34.6%) | 459 | 150 (32.7%) | 338 | 126 (37.3%) |
Support staff | 510 | 304 (59.6%) | 292 | 191 (65.4%) | 218 | 113 (51.8%) |
Total | Out-of-hours GP services | EDs | ||||
---|---|---|---|---|---|---|
Usual care | UCCs | Usual care (n = 216) | UCCs (n = 141) | Usual care (n = 125) | UCCs (n = 99) | |
Profession*‡ | ||||||
Physician | 150 (44.0%) | 126 (52.7%) | 128 (59.3%) | 92 (65.2%) | 22 (17.6%) | 34 (34.7%) |
Support staff | 191 (56.0%) | 113 (47.3%) | 88 (40.7%) | 49 (34.8%) | 103 (82.4%) | 64 (65.3%) |
Gender‡ | ||||||
Male | 115 (33.7%) | 93 (38.8%) | 94 (43.5%) | 56 (39.7%) | 21 (16.8%) | 37 (37.4%) |
Female | 226 (66.3% | 147 (61.2% | 122 (56.5%) | 85 (60.3%) | 104 (83.2%) | 62 (62.6%) |
Age (mean ± SD) | 43.79 ± 11.88 | 43.59 ± 11.10 | 45.4 ± 11.7 | 44.9 ± 11.2 | 41.04 ± 11.8 | 41.7 ± 10.7 |
Out-of-hours GP services | EDs | |||
---|---|---|---|---|
Usual care | UCC | Usual care | UCC | |
All employees | 12 | 12 | 3 | 3 |
Physicians | 19 | 20 | 7 | 12 |
Support staff member | 33 | 32 | 4 | 4 |
Perceived quality, workload and co-operation
Item | Usual care | UCCs | Mean difference (95% CI) | |||
---|---|---|---|---|---|---|
n
| mean ± SD |
N
| mean ± SD | |||
Total | Quality | 313 | 3.55 ± 0.42 | 226 | 3.54 ± 0.43 | −0.013 (− 0.084 to 0.058) |
Workload | 329 | 2.83 ± ± 0.53 | 222 | 2.92 ± 0.62 | 0.084 (−0.013 to 0.181) | |
Co-operation | 280 | 3.21 ± 0.52 | 216 | 3.38 ± 0.56 | 0.177 (0.080 to 0.273) | |
Out-of-hours GP services | Quality | 206 | 3,57 ± 0,42 | 133 | 3,58 ± 0,42 | 0.012 (− 0.153 to 0.074) |
Workload | 206 | 2,77 ± 0,56 | 132 | 2,65 ± 0,53 | −0.120 (− 0.239 to 0.003) | |
Co-operation | 171 | 3,27 ± 0,55 | 123 | 3,39 ± 0,58 | 0.122 (−0.009 to 0.254) | |
ED | Quality | 107 | 3,52 ± 0,38 | 93 | 3,48 ± 0,43 | −0.040 (− 0.153 to 0.074) |
Workload | 123 | 2,94 ± 0,47 | 90 | 3,31 ± 0,52 | 0.367 (0.233 to 0.501) | |
Co-operation | 109 | 3,11 ± 0,46 | 93 | 3,37 ± 0,52 | 0.264 (0.129 to 0.400) |
Factors associated with quality, workload and co-operation
Quality | Workload | Co-operation between out-of-hours GP services and EDs | ||
---|---|---|---|---|
Beta coefficients | Settinga | −0.059 | 0.052 | 0.140* |
Employerb | −0.156* | 0.303** | −0.137* | |
Genderc | 0.003 | 0.068 | −0.002 | |
Age | −0.084 | 0.026 | −0.017 | |
Professiond | 0.062 | −0.247** | −0.029 | |
Quality | – | 0.272** | 0.360** | |
Co-operation | 0.299** | 0.188** | – | |
Workload | 0.352** | – | 0.212** |