Out-of-hours demand for GP care and emergency services: patients' choices and referrals by general practitioners and ambulance services

BMC Fam Pract. 2007 Aug 1;8:46. doi: 10.1186/1471-2296-8-46.

Abstract

Background: Over the last five years, Dutch provision of out-of-hours primary health care has shifted from practice-based services towards large-scale general practitioner (GP) cooperatives. Only few population-based studies have been performed to assess the out-of-hours demand for GP and emergency care, including the referral patterns to the Accident and Emergency Department (AED) by GPs and ambulance services.

Method: During two four-month periods (five-year interval), a prospective cross-sectional study was performed for a Dutch population of 62,000 people. Data were collected on all patient contacts with one GP cooperative and three AEDs bordering the region.

Results: Overall, GPs handled 88% of all out-of-hours contacts (275/1000 inhabitants/year), while the AED dealt with the remaining 12% of contacts (38/1000 inhabitants/year). Within the AED, the self-referrals represented a substantial number of contacts (43%), although within the total out-of-hours demand they only represented 5% of all contacts. Self-referrals were predominantly young adult males presenting with an injury, nineteen percent of whom had a fracture. Compared to self-referrals, patients who were referred by the GP or brought in by the ambulance services were generally older and were more frequently admitted for both injury and non-injury (p < 0.01 for all differences).

Conclusion: The GP cooperative deals with the large majority of out-of-hours problems presented. Within the total demand, self-referrals constitute a stable, yet small group of patients, many of whom seem to have made a reasonable choice to attend the AED. The GPs and the ambulance services appear to be effectively selecting the problems that are presented to the AED.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • After-Hours Care / statistics & numerical data*
  • Aged
  • Ambulances / statistics & numerical data*
  • Child
  • Child, Preschool
  • Choice Behavior
  • Cross-Over Studies
  • Emergency Service, Hospital / statistics & numerical data*
  • Family Practice / statistics & numerical data*
  • Female
  • Health Services Needs and Demand / statistics & numerical data
  • Humans
  • Infant
  • Male
  • Middle Aged
  • Netherlands
  • Patient Satisfaction / statistics & numerical data*
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Referral and Consultation / statistics & numerical data*