Background
Theme | Feature |
---|---|
General | Out-of-hours primary care is provided by large-scale general practitioner (GP) cooperatives |
Participation of 50–250 GPs per cooperative with a mean of 4 hours on call per week | |
Circa 125 GP cooperatives in the Netherlands | |
Population of 100,000 to 500,000 patients | |
Out-of-hours defined as daily from 5 p.m. to 8 a.m. and the entire weekend | |
Location | GP cooperative usually situated in or near a hospital |
Distance of patients to GP cooperative maximally 30 km | |
Accessibility | Access via a single regional telephone number, meaning the first contact mostly is with a triage nurse (only 5-10% walk in without a call in advance) |
Telephone triage by nurses supervised by GPs: contacts are divided into telephone advice, centre consult, or GP home visit | |
Facilities | Drivers in identifiable GP cars that are fully equipped (e.g. oxygen, intra venous drip equipment, automated external defibrillator, medication) |
Information and communication technology (ICT) support including electronic patient files, online connection to the GP car, and sometimes connection with the electronic medical record in the GP daily practice |
Methods
Design and setting
Measures
Statistical analysis
Ethics
Results
Sample characteristics
Variable | Low use group | High use group |
---|---|---|
Mean (range) | Mean (range) | |
Percentage of foreignersa | 9.8 (1.6-26.4) | 27.7 (3.8-82.2)** |
Percentage of patients aged 0 to 4 years | 4.8 (2.5-9.7) | 5.6 (3.0-9.9)* |
Distance from general practice to out-of-hours GP cooperative (kilometers) | 13.4 (3.0-30.8) | 3.4 (0.9-11.0)** |
Variable | Low use group | High use group | Odds ratioa |
---|---|---|---|
N (%) | N (%) | (95% CI) | |
Telephone accessibility
| |||
Waiting time on telephone (minutes) | |||
Mean (range) | 1.04 (0–10) | 1.97 (0–10) | 1.26 (1.09-1.46)** |
Median (range)*** | 0.41 (0–10) | 0.88 (0–10) | |
Telephone contact with assistantb possible (no answering machine) (hours a week) | |||
Mean (range) | 36.1 (9–45) | 35.3 (14–45) | 1.06 (0.97-1.15) |
Telephone lines (per 1000 pts) | |||
Mean (range) | 1.3 (0.3-4.6) | 1.4 (0.4-6.4) | 1.51 (0.44-5.25) |
Availability for consultations
| |||
Waiting time for non urgent consultations (days) | |||
Mean (range) | 0.76 (0–5) | 1.02 (0–5) | 1.54 (0.67-3.53) |
Consultation after 5 p.m. possible | 14 (28.6) | 8 (15.7) | 0.42 (0.08-2.05) |
Has telephone consulting hour | 31 (63.3) | 23 (45.1) | 0.26 (0.05-1.34) |
Open during holidays (with replacement) | 24 (54.5) | 15 (31.3) | 0.42 (0.08-2.33) |
Personally available for palliative patients (including out-of-hours) | 41 (83.7) | 25 (49.0) | 0.22 (0.06-0.76)* |
Clinician-hours (per 1000 pts) | |||
Mean (range) | 11.1 (2.0-30.2) | 12.6 (5.1-24.1) | 0.98 (0.81-1.17) |
GP characteristics
| |||
Age (years) | |||
Mean (range) | 51.9 (34–63) | 53.6 (36–65) | 1.00 (0.89-1.12) |
Gender: female | 6 (12.2) | 9 (17.6) | 2.38 (0.19-30.07) |
Years of employment as GP | |||
Mean (range) | 19.8 (5–34) | 21.6 (3–39) | 1.00 (0.92-1.09) |
Work satisfaction (score 1–10; 1 = low;10 = high) | |||
Mean (range) | 7.8 (7–9) | 8.0 (4–10) | 2.41 (0.80-7.23) |
High experienced workload | 26 (53.1) | 38 (74.5) | 2.18 (0.40-11.90) |
Speak to patients with unnecessary out-of-hours contacts | 9 (18.8) | 13 (25.5) | 1.29 (0.21-7.86) |
Practice organisation
| |||
Practice type: solo practice | 32 (65.3) | 27 (52.9) | 0.95 (0.19-4.85) |
Practice size (number of pts) | |||
Mean (range) | 2459 (464–4103) | 2511 (1295–4556) | 1.00 (1.00-1.00) |
Training in telephone triage for assistantsb | 8 (16.7) | 18 (35.3) | 1.87 (0.39-8.98) |
Number of contacts (per pt)c | |||
Mean (range) | 4.4 (1.7-10.7) | 5.2 (2.3-8.4) | 1.44 (0.85-2.44) |
Number of diagnostic tests and therapeutic procedures (per 1000 pts)d | |||
Mean (range) | 74.4 (5.1-304.8) | 119.6 (4.4-935.4) | 1.02 (1.01-1.04)** |
Presence of professionals (half days a week, per 1000 pts) | |||
GPs | |||
Mean (range) | 4.1 (2.1-8.8) | 4.2 (1.9-10.5) | 1.34 (0.66-2.75) |
Assistantsb | |||
Mean (range) | 4.9 (2.1-14.4) | 5.5 (2.7-11.0) | 1.71 (1.07-2.73)* |
Nurse practitioners mental health | |||
Mean (range) | 0.2 (0.0-5.2) | 0.3 (0.0-4.2) | 4.61 (0.35-61.24) |
Nurse practitioners somatics | |||
Mean (range) | 1.1 (0.0-5.2) | 1.6 (0.0-4.7) | 2.07 (0.99-4.32) |
Physicians in training | |||
Mean (range) | 0.5 (0.0-3.1) | 0.5 (0.0-3.9) | 0.94 (0.38-2.40) |