Background
Methods
Study design and setting
Data collection
GP pop-up questionnaire
All OOH-PC contacts | Contacts assessed by triage GP as medically inappropriate | ||
---|---|---|---|
N (%) | n (%) | n/100 contacts (95% CI) | |
All contacts | 5333 (100) | 1266 (100) | 23.7 (22.6–24.9) |
Level of care | |||
Telephone consultation only | 2884 (54.1) | 993 (78.4) | 34.4 (32.7–36.2) |
Triaged to face-to-face contact in OOH-PC | 2188 (41.0) | 258 (20.4) | 11.8 (10.5–13.2) |
Triaged to ED or hospital admission | 261 (4.9) | 15 (1.2) | 5.7 (3.3–9.3) |
Patient characteristics | |||
Sex | |||
Male | 2336 (43.8) | 539 (42.6) | 23.1 (21.4–24.8) |
Female | 2997 (56.2) | 727 (57.4) | 24.3 (22.7–25.8) |
Age groups (years) | |||
18–30 | 1410 (26.4) | 396 (31.3) | 28.1 (25.8–30.5) |
31–40 | 1010 (18.9) | 251 (19.8) | 24.9 (22.2–27.6) |
41–60 | 1368 (25.7) | 350 (27.6) | 25.6 (23.3–28.0) |
61–75 | 786 (14.7) | 168 (13.3) | 21.4 (18.6–24.4) |
> 75 | 759 (14.2) | 101 (8.0) | 13.3 (11.0–15.9) |
Symptom characteristics (medical perspective) | |||
Top 10 RFE for medically assessed inappropriate contactsa
| |||
1. Request for medication (-50)b
| 334 (6.3) | 181 (14.3) | 54.2 (48.7–59.6) |
2. Fever (A03) | 440 (8.3) | 75 (5.9) | 17.0 (13.6–20.9) |
3. Cough (R05) | 257 (4.8) | 71 (5.6) | 27.6 (22.3–33.5) |
4. Abdominal pain/cramps general (D01) | 302 (5.7) | 58 (4.6) | 19.2 (14.9–24.1) |
5. Throat symptom/complaints (R21) | 193 (3.6) | 47 (3.7) | 24.4 (18.5–31.0) |
6. Headache (N01) | 189 (3.5) | 45 (3.6) | 23.8 (17.9–30.5) |
7. Back symptom/complaint (L02) | 137 (2.6) | 37 (2.9) | 27.0 (19.8–35.2) |
8. Vertigo/dizziness (N17) | 145 (2.7) | 35 (2.8) | 24.1 (17.4–31.9) |
9. Nausea (D09) | 155 (2.9) | 33 (2.6) | 21.3 (15.1–28.6) |
10. Ear pain (H01) | 100 (1.9) | 33 (2.6) | 33.0 (23.9–43.1) |
Other RFE(s) (includes 276 different RFEs) | 3532 (66.2) | 754 (59.6) | 21.3 (20.0–22.7) |
Reason for contact | |||
New episode (including symptoms of long duration) | 4120 (77.3) | 860 (67.9) | 20.9 (19.6–22.1) |
Exacerbation of chronic disease | 868 (16.3) | 246 (19.4) | 28.3 (25.4–31.5) |
Other | 345 (6.5) | 160 (12.6) | 46.4 (41.0–51.8) |
Duration of symptoms | |||
< 5 h | 1712 (32.1) | 215 (17.0) | 12.6 (11.0–14.2) |
5–12 h | 1158 (21.7) | 171 (13.5) | 14.8 (12.8–16.9) |
12–24 h | 782 (14.7) | 170 (13.4) | 19.3 (16.7–22.0) |
> 24 h | 1251 (23.5) | 525 (41.5) | 42.0 (39.2–44.8) |
Don’t know | 223 (4.2) | 75 (5.9) | 33.6 (27.5–40.2) |
Not relevant | 207 (3.9) | 110 (8.7) | 53.1 (46.1–60.1) |
GP-assessed severity | |||
Potentially severe | 1646 (30.9) | 113 (8.9) | 6.9 (5.7–8.2) |
Not severe, but the patient is ill | 2777 (52.1) | 747 (59.0) | 26.9 (25.3–28.5) |
Patient is not ill | 635 (11.9) | 331 (26.1) | 52.1 (48.2–56.1) |
Don’t know | 275 (5.2) | 75 (5.9) | 27.3 (22.1–32.9) |
Time of contact (health service perspective) | |||
Weekday vs. weekend/public holiday | |||
Weekday | 2829 (53.0) | 829 (65.5) | 29.3 (27.6–31.0) |
Weekend/public holiday | 2504 (47.0) | 437 (34.5) | 17.5 (15.0–19.0) |
Time in relation to own GP’s regular office hours | |||
< 3 h after office hours | 720 (13.5) | 269 (21.3) | 37.4 (33.8–41.0) |
≥ 3 h after/before office hours | 4193 (78.6) | 852 (67.3) | 20.3 (19.1–21.6) |
< 3 h before office hours | 420 (7.9) | 145 (11.5) | 34.5 (30.0–39.3) |
Patient questionnaire
OOH electronic registration system
Analysis
Results
Contacts assessed by triage GPs as medically inappropriate
Factors related to GP assessed medical inappropriateness
Contacts assessed by triage GP as medically inappropriate | ||||
---|---|---|---|---|
OR (95% CI) | P | Adj. OR (95% CI)b
| PAdj.
| |
Patient characteristics | ||||
Sex | ||||
Male | 1 | 1 | ||
Female | 1.07 (0.94–1.21) | 0.313 | 1.09 (0.94–1.26) | 0.275 |
Age (years) | ||||
18–30 | 1 | 1 | ||
31–40 | 0.85 (0.70–1.02) | 0.076 | 0.81 (0.65–0.99) | 0.046 |
41–60 | 0.88 (0.74–1.04) | 0.137 | 0.86 (0.70–1.04) | 0.116 |
61–75 | 0.70 (0.57–0.86) | 0.001 | 0.65 (0.51–0.82) | < 0.001 |
> 75 | 0.39 (0.31–0.50) | < 0.001 | 0.38 (0.29–0.50) | < 0.001 |
Symptom characteristics | ||||
Duration of symptoms | ||||
< 5 h | 1 | 1 | ||
5–12 h | 1.21 (0.97–1.50) | 0.089 | 1.32 (1.05–1.64) | 0.015 |
12–24 h | 1.93 (1.55–2.41) | < 0.001 | 2.42 (1.92–3.05) | < 0.001 |
> 24 h | 5.04 (4.20–6.04) | < 0.001 | 6.10 (5.02–7.40) | < 0.001 |
Reason for contact | ||||
New episode (including symptoms of long duration) | 1 | 1 | ||
Exacerbation of chronic disease | 1.50 (1.27–1.77) | < 0.001 | 1.29 (1.06–1.56) | 0.010 |
Other | 3.28 (2.62–4.10) | < 0.001 | 2.26 (1.60–3.21) | < 0.001 |
Time of contact | ||||
Weekday vs. weekend/public holiday | ||||
Weekday | 1 | 1 | ||
Weekend/public holiday | 0.51 (0.48–0.58) | < 0.001 | 0.36 (0.31–0.42) | < 0.001 |
Time in relation to own GP’s regular office hours | ||||
< 3 h after office hours | 2.33 (1.98–2.77) | < 0.001 | 1.63 (1.31–2.02) | < 0.001 |
≥ 3 h after/before office hours | 1 | 1 | ||
< 3 h before office hours | 2.07 (1.67–2.56) | < 0.001 | 1.87 (1.44–2.42) | < 0.001 |
Patient-assessed severity and fulfilment of expectations
All OOH-PC contacts | Contacts assessed by triage GP as medically inappropriate | |||||
---|---|---|---|---|---|---|
N (%) | n (%) | OR (95% CI) | p | Adj. OR (95% CI)a
| pAdj. | |
Patient-assessed severity | ||||||
Severe | 1011 (59.0) | 187 (53.4) | 0.77 (0.61–0.99) | 0.038 | 0.80 (0.63–1.02) | 0.077 |
Not severe | 671 (39.2) | 152 (43.4) | 1 | 1 | ||
Not ill, but had some questions | 31 (1.8) | 11 (3.1) | 1.88 (0.88–4.00) | 0.103 | 1.84 (0.86–3.94) | 0.119 |
Fulfilment of expectations | ||||||
A lot/completely | 1266 (73.9) | 217 (62.0) | 1 | 1 | ||
A little/some | 325 (19.0) | 80 (22.9) | 1.58 (1.18–2.11) | 0.002 | 1.47 (1.09–2.00) | 0.012 |
Not at all | 122 (7.1) | 53 (15.1) | 3.71 (2.52–5.47) | < 0.001 | 3.25 (2.13–4.85) | < 0.001 |