Raknes Guttorm, Morken Tone, Hunskår Steinar
Nasjonalt kompetansesenter for legevaktmedisin Uni Research Helse og RELIS Nord-Norge Universitetssykehuset Nord-Norge.
Nasjonalt kompetansesenter for legevaktmedisin Uni Research Helse og Institutt for global helse og samfunnsmedisin Universitetet i Bergen.
Tidsskr Nor Laegeforen. 2014 Nov 25;134(22):2151-5. doi: 10.4045/tidsskr.14.0443. eCollection 2014 Nov.
It has been documented from a number of out-of-hours primary health care services that the utilisation of the services declines with increasing travel distances. In this study we have investigated the correlation between travel distances and the use of out-of-hours medical services for all Norwegian municipalities that provide such services at a single permanent casualty clinic round the clock. In addition, we have sought to reveal any differences in consultation rates between municipalities that maintain single-municipality or inter-municipal out-of-hours services, as well as between municipalities in which the casualty clinics are co-located with a hospital or located separately.
Information on the types of out-of-hours services existing in 2011 was retrieved from the Norwegian Emergency Primary Health Care Registry, and 315 municipalities with single permanent casualty clinic premises were included. Rates for various types of utilisation of these clinics were calculated on the basis of statistics generated from reimbursement claims.
The number of medical consultations and house calls per inhabitant fell by 48 % and 55 % respectively when average travel distance increased from 0 to 50 kilometres. The use of telephone/letter contact was not significantly associated with distances. Single-municipality casualty clinics located outside hospitals had the highest consultation rate for out-of-hours medical services when adjusted for distance.
This supports previous findings to the fact that distance is a crucial factor for the utilisation of out-of-hours medical services. Establishing inter-municipal casualty clinics and co-locating them with hospitals may contribute to a lower rate of use of out-of-hours medical services.
多项非工作时间基层医疗服务的记录表明，随着出行距离增加，这些服务的利用率会下降。在本研究中，我们调查了挪威所有在单一常设急诊诊所提供全天候此类服务的市政当局的出行距离与非工作时间医疗服务使用之间的相关性。此外，我们试图揭示维持单一市政当局或跨市政当局非工作时间服务的市政当局之间，以及急诊诊所与医院位于同一地点或单独设立的市政当局之间的会诊率差异。
从挪威紧急基层医疗登记处获取了2011年现有非工作时间服务类型的信息，并纳入了315个设有单一常设急诊诊所的市政当局。根据报销申请产生的统计数据计算了这些诊所各类使用情况的比率。
当平均出行距离从0公里增加到50公里时，人均医疗会诊次数和上门出诊次数分别下降了48%和55%。电话/信件联系的使用与距离没有显著关联。排除距离因素后，位于医院外的单一市政当局急诊诊所在非工作时间医疗服务方面的会诊率最高。
这支持了先前的研究结果，即距离是影响非工作时间医疗服务利用率的关键因素。建立跨市政当局急诊诊所并使其与医院位于同一地点可能有助于降低非工作时间医疗服务的使用率。
