Flarup Lone, Moth Grete, Christensen Morten Bondo, Vestergaard Mogens, Olesen Frede, Vedsted Peter
Research Unit for General Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, Aarhus DK-8000, C, Denmark.
BMC Fam Pract. 2014 Jun 9;15:114. doi: 10.1186/1471-2296-15-114.
The general practitioner (GP) plays an important role for chronic disease care. Continuous and close contact with daytime general practice is intended to prevent medical problems arising outside office hours due to already diagnosed chronic disease. However, previous studies indicate that patients with chronic diseases are frequent users of out-of-hours primary care services (OOH), but knowledge is limited on reasons for encounter (RFE), severity of symptoms, and OOH patient handling. We aimed to describe contacts to the OOH services from patients with chronic heart disease, lung disease, severe psychiatric disorders, diabetes, and cancer in terms of RFE, OOH GP diagnosis, assessed severity of symptoms, and actions taken by the GP.
Eligible patients (aged 18 years and older) were randomly sampled from a one-year cross-sectional study comprising 15,229 contacts to the OOH services in the Central Denmark Region. A cohort of patients with one or more of the five selected chronic diseases were identified by linking data on the Danish civil registration number (CPR) through specific nationwide Danish health registers.
Out of 13,930 identified unique patients, 4,912 had at least one of the five chronic diseases. In total, 25.9% of all calls to the OOH services came from this chronic disease patient group due to an acute exacerbation; 32.6% of these calls came from patients with psychiatric diagnoses. Patients with chronic disease were more likely to receive a face-to-face contact than the remaining group of patients, except for calls from patients with a psychiatric disorder who were more often completed through a telephone consultation. Patients with heart disease calling due to a new health problem formed the largest proportion of all OOH referrals to hospital (13.3%) compared to calls from the other groups with chronic disease (3.4-6.7%).
A third of the patients randomly sampled by their OOH call had one or more of the five selected chronic diseases (i.e. chronic lung disease, heart disease, diabetes, psychiatric disease, or cancer). Patients with chronic disease were more often managed by OOH GPs than other patients.
全科医生在慢性病护理中发挥着重要作用。与日间全科医疗的持续密切接触旨在预防因已确诊的慢性病在办公时间以外出现医疗问题。然而，先前的研究表明，慢性病患者是非工作时间初级保健服务（OOH）的频繁使用者，但关于就诊原因（RFE）、症状严重程度和OOH患者处理的知识有限。我们旨在从就诊原因、OOH全科医生诊断、评估的症状严重程度以及全科医生采取的行动等方面描述患有慢性心脏病、肺病、严重精神障碍、糖尿病和癌症的患者与OOH服务的接触情况。
符合条件的患者（年龄18岁及以上）从一项为期一年的横断面研究中随机抽样，该研究包括丹麦中部地区与OOH服务的15229次接触。通过丹麦特定的全国性健康登记册将丹麦民事登记号码（CPR）数据相链接，确定了患有五种选定慢性病中一种或多种的患者队列。
在13930名确定的独特患者中，4912名患有五种慢性病中的至少一种。由于急性加重，所有拨打OOH服务电话的25.9%来自这个慢性病患者群体；其中32.6%的电话来自患有精神疾病诊断的患者。慢性病患者比其余患者群体更有可能接受面对面接触，但患有精神疾病的患者拨打的电话更多是通过电话咨询完成的。因新的健康问题拨打OOH服务电话的心脏病患者在所有转诊至医院的OOH病例中占比最大（13.3%），而其他慢性病组拨打的电话占比为3.4 - 6.7%。
通过OOH电话随机抽样的患者中有三分之一患有五种选定慢性病中的一种或多种（即慢性肺病、心脏病、糖尿病、精神疾病或癌症）。与其他患者相比，慢性病患者更常由OOH全科医生进行管理。
