Association between general practice characteristics and use of out-of-hours GP cooperatives

Abstract

BackgroundThe 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.MethodsA 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.ResultsThe 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.ConclusionsBesides 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.

Characteristics of customary non‐attenders in general practice who are diagnosed with cancer: A cross‐sectional study in Denmark

“…The reasons for this could be differences in study design and populations. Our findings of lower likelihood of OOH use among non‐attenders are in line with other studies reporting that higher use of OOH services is more likely among frequent attenders in general practice (Flarup et al, ; Smits et al, ; ). Furthermore, this is also associated with comorbidity (Flarup et al, ; ).…”

“…Structural factors, such as city size, list size and use of OOH services, have been shown to be associated with frequent attendance in general practice (de Graaf‐Ruizendaal, van der Hoek, & de Bakker, ; Smits et al, ; Vedsted, Sørensen, Nielsen, & Olesen, ). Our findings of city size is in line with a previous Danish study reporting that frequent attendance in general practice was more likely in medium‐ and small‐sized city areas (Vedsted et al, ).…”

“…The factors associated with customary non‐attendance in general practice are generally opposite to the factors associated with frequent attendance in general practice (Dinkel et al, ; Ferrari et al, ; Flarup et al, ; Gili et al, ; Hauswaldt et al, ; Smits et al, ; ; Vedsted et al, ; Vedsted & Olesen, ; Patel et al, ; Jørgensen et al, ; de Graaf‐Ruizendaal et al, ). This is intuitively reasonable as non‐attendance and frequent attendance are opposite extremes of attendance rates in general practice.…”

Telephone triage by GPs in out-of-hours primary care in Denmark: a prospective observational study of efficiency and relevance

“…The current study does not explain the reason(s) for this finding, but several factors could play a role, such as worsening of a problem, problem first identified when picking up a child from day care, inability to visit own GP during the day due to work, problems with accessibility, limited availability of own GP, 16,17 and the possibility of getting a direct telephone contact with a GP outside office hours.…”

Reducing the use of out-of-hours primary care services: A survey among Dutch general practitioners

“…In contrast, data on patient contacts show that practices with limited telephone accessibility generate a higher number of patient contacts at the GP cooperatives as opposed to practices that can be more easily contacted by telephone. [20] A previous Dutch study among 1022 GPs showed that 77% would prefer co-payment for patients visiting the GP cooperative. [21] In many other Western countries co-payment for primary care occurs.…”