Smits Marleen, Peters Yvonne, Broers Sanne, Keizer Ellen, Wensing Michel, Giesen Paul
Radboud university medical center, Radboud Institute for Health Sciences, IQ healthcare, PO Box 9101, IQ healthcare 114 6500 HB, Nijmegen, The Netherlands.
BMC Fam Pract. 2015 May 1;16:52. doi: 10.1186/s12875-015-0266-1.
The use of out-of-hours healthcare services for non-urgent health problems is believed to be related to the organisation of daytime primary care but insight into underlying mechanisms is limited. Our objective was to examine the association between daytime general practice characteristics and the use of out-of-hours care GP cooperatives.
A cross-sectional observational study in 100 general practices in the Netherlands, connected to five GP cooperatives. In each GP cooperative, we took a purposeful sample of the 10 general practices with the highest use of out-of-hours care and the 10 practices with the lowest use. Practice and population characteristics were obtained by questionnaires, interviews, data extraction from patient registration systems and telephone accessibility measurements. To examine which aspects of practice organisation were associated with patients' use of out-of-hours care, we performed logistic regression analyses (low versus high out-of-hours care use), correcting for population characteristics.
The mean out-of-hours care use in the high use group of general practices was 1.8 times higher than in the low use group. Day time primary care practices with more young children and foreigners in their patient populations and with a shorter distance to the GP cooperative had higher out-of-hours primary care use. In addition, longer telephone waiting times and lower personal availability for palliative patients in daily practice were associated with higher use of out-of-hours care. Moreover, out-of-hours care use was higher when practices performed more diagnostic tests and therapeutic procedures and had more assistant employment hours per 1000 patients. Several other aspects of practice management showed some non-significant trends: high utilising general practices tended to have longer waiting times for non-urgent appointments, lower availability of a telephone consulting hour, lower availability for consultations after 5 p.m., and less frequent holiday openings.
Besides patient population characteristics, organisational characteristics of general practices are associated with lower use of out-of-hours care. Improving accessibility and availability of day time primary day care might be a potential effective way to improve the efficient use of out-of-hours care services.
人们认为，利用非工作时间的医疗服务来解决非紧急健康问题与日间初级医疗的组织方式有关，但对其潜在机制的了解有限。我们的目的是研究日间全科医疗特征与非工作时间医疗服务全科医生合作社的使用之间的关联。
在荷兰的100家全科诊所进行了一项横断面观察性研究，这些诊所与5个全科医生合作社相关联。在每个全科医生合作社中，我们有目的地抽取了10家非工作时间医疗服务使用量最高的诊所和10家使用量最低的诊所。通过问卷调查、访谈、从患者登记系统中提取数据以及电话可及性测量来获取诊所和人群特征。为了研究诊所组织的哪些方面与患者使用非工作时间医疗服务有关，我们进行了逻辑回归分析（低非工作时间医疗服务使用量组与高使用量组），并对人群特征进行了校正。
全科诊所高使用量组的非工作时间医疗服务平均使用量比低使用量组高1.8倍。患者群体中幼儿和外国人较多且距离全科医生合作社较近的日间初级医疗诊所，其非工作时间初级医疗服务的使用量较高。此外，日常实践中电话等待时间较长以及姑息治疗患者的个人可及性较低与非工作时间医疗服务的较高使用量相关。而且，当诊所进行更多诊断测试和治疗程序且每1000名患者的助理工作时长更多时，非工作时间医疗服务的使用量更高。诊所管理的其他几个方面显示出一些不显著的趋势：高使用量的全科诊所非紧急预约等待时间往往更长、电话咨询时段的可及性较低、下午5点后咨询的可及性较低以及节假日开放频率较低。
除了患者群体特征外，全科诊所的组织特征与非工作时间医疗服务的较低使用量有关。提高日间初级医疗服务的可及性和可获得性可能是改善非工作时间医疗服务有效利用的一种潜在有效方法。
