Department of Clinical Medicine, Centre for Prehospital and Emergency Research, Aalborg University, Søndre Skovvej 15, 9000, Aalborg, Denmark.
Research Unit for General Practice, Aarhus University, Aarhus, Denmark.
BMC Health Serv Res. 2020 Feb 27;20(1):146. doi: 10.1186/s12913-020-4994-0.
In Western countries, patients with acute illness or injury out-of-hours (OOH) can call either emergency medical services (EMS) for emergencies or primary care services (OOH-PC) in less urgent situations. Callers initially choose which service to contact; whether this choice reflect the intended differences in urgency and severity is unknown. Hospital diagnoses and admission rates following an OOH service contact could elucidate this. We aimed to investigate and compare the prevalence of patient contacts, subsequent hospital contacts, and the age-related pattern of hospital diagnoses following an out-of-hours contact to EMS or OOH-PC services in Denmark.
Population-based observational cohort study including patients from two Danish regions with contact to EMS or OOH-PC in 2016. Hospital contacts were defined as short (< 24 h) or admissions (≥24 h) on the date of OOH service contact. Both regions have EMS, whereas the North Denmark Region has a general practitioner cooperative (GPC) as OOH-PC service and the Capital Region of Copenhagen the Medical Helpline 1813 (MH-1813), together representing all Danish OOH service types. Calling an OOH service is mandatory prior to a hospital contact outside office hours.
OOH-PC handled 91% (1,107,297) of all contacts (1,219,963). Subsequent hospital contacts were most frequent for EMS contacts (46-54%) followed by MH-1813 (41%) and GPC contacts (9%). EMS had more admissions (52-56%) than OOH-PC. For both EMS and OOH-PC, short hospital contacts often concerned injuries (32-63%) and non-specific diagnoses (20-45%). The proportion of circulatory disease was almost twice as large following EMS (13-17%) compared to OOH-PC (7-9%) in admitted patients, whereas respiratory diseases (11-14%), injuries (15-22%) and non-specific symptoms (22-29%) were more equally distributed. Generally, admitted patients were older.
EMS contacts were fewer, but with a higher percentage of hospital contacts, admissions and prevalence of circulatory diseases compared to OOH-PC, perhaps indicating that patients more often contact EMS in case of severe disease. However, hospital diagnoses only elucidate severity of diseases to some extent, and other measures of severity could be considered in future studies. Moreover, the socio-demographic pattern of patients calling OOH needs exploration as this may play an important role in choice of entrance.
在西方国家，急性病或外伤患者可以在非工作时间拨打紧急医疗服务（EMS）或初级保健服务（OOH-PC）。患者在最初选择联系哪种服务；这种选择是否反映了紧急程度和严重程度的差异尚不清楚。医院诊断和入院率可以阐明这一点。我们旨在调查和比较丹麦两个地区的患者在非工作时间接触 EMS 或 OOH-PC 服务后的患者接触率、随后的医院接触率以及与年龄相关的医院诊断模式。
这是一项基于人群的观察性队列研究，纳入了 2016 年在丹麦两个地区接触 EMS 或 OOH-PC 的患者。医院接触被定义为 OOH 服务接触日期的短期（<24 小时）或入院（≥24 小时）。这两个地区都有 EMS，而北丹麦地区有一个全科医生合作组织（GPC）作为 OOH-PC 服务，哥本哈根首都地区有医疗热线 1813（MH-1813），共同代表了丹麦所有的 OOH 服务类型。在非工作时间外的医院接触之前，拨打 OOH 服务是强制性的。
OOH-PC 处理了所有接触者的 91%（1,107,297）（1,219,963）。EMS 接触者的后续医院接触率最高（46-54%），其次是 MH-1813（41%）和 GPC 接触者（9%）。EMS 的入院人数（52-56%）多于 OOH-PC。对于 EMS 和 OOH-PC，短期医院接触通常涉及伤害（32-63%）和非特异性诊断（20-45%）。与 OOH-PC（7-9%）相比，EMS 入院患者中循环系统疾病的比例几乎高出一倍（13-17%），而呼吸系统疾病（11-14%）、伤害（15-22%）和非特异性症状（22-29%）的分布更为均匀。一般来说，入院患者年龄较大。
与 OOH-PC 相比，EMS 接触者较少，但医院接触、入院率和循环系统疾病的患病率较高，这可能表明患者在疾病严重时更倾向于联系 EMS。然而，医院诊断仅在一定程度上阐明了疾病的严重程度，未来的研究可以考虑其他严重程度的衡量标准。此外，需要探索拨打 OOH 的患者的社会人口统计学模式，因为这可能在选择入口方面发挥重要作用。
