Use of medical emergency services

In the Wesel District (North Rhine-Westphalia), emergency ambulances have been called out with increasing frequency and clinics report that their emergency departments (ED) are increasingly being used outside the consultation hours of panel doctors/compulsory health insurance (CHI) physicians. Therefore, the District Health Conference put this issue on its agenda.

The aims were to obtain data on the following questions: 1. What do people do when they need medical help outside consultation hours of panel doctors? 2. Do people know that there is a duty panel doctor on call? Do they know how to contact this service? Do people know about the medical emergency service and phone number 112, and the new phone number 19222 for patient transport ambulances?

The study comprised all residents of the District of Wesel between 18 and 87 years of age (approximately 385,000 people). The sample contained 1089 persons drawn in accordance with the Gabler-Häder method and in a second step with the “birthday method”. The survey was carried out by the CATI (computer-assisted telephone interviews) laboratory at the Institute of Public Health (LÖGD, Bielefeld) between 18 February and 28 March 2002.

On being asked “how would you act in case of a non-life-threatening disease outside consultation hours of panel doctors”, 48.6% of respondents were “correct” (i.e. on-call CHI duty physicians), while 51.5% of respondents were “incorrect”, for example “I go to the hospital/emergency department” (24.3%) or “I call the number 112” (13%). About 80% of respondents said they knew about on-call CHI duty physicians. More than 95% of respondents stated they knew about the emergency service of the fire department, and 86% of these respondents were able to recall the correct number 112. About 4% of the respondents said they knew the national telephone number for patient transport, and 58% of these respondents mentioned the correct number (19222).

The tiered medical emergency system should be used properly. This aim could be achieved by: (1) informing the public about the 24-hour on-call service provided by panel doctors, that the majority of medical conditions can be treated by panel doctors, and in severe cases a professional and quick referral will be done, and that self-referral to hospital may reduce or even obstruct professional resources for the treatment of “real” emergency patients; (2) informing target groups (elderly people) about the emergency number 112; and (3) informing the public about the national number 19222 for patient transport. Structural measures include: (1) Specific on-call services, and (2) improvement in the transparency and reachability of panel doctors’ on-call services.