Does distance matter? Geographical variation in GP out-of-hours service use: an observational study

Abstract

BackgroundGP cooperatives are typically based in emergency primary care centres, and patients are frequently required to travel to be seen. Geography is a key determinant of access, but little is known about the extent of geographical variation in the use of out-ofhours services. AimTo examine the effects of distance and rurality on rates of out-of-hours service use. Design of studyGeographical analysis based on routinely collected data on telephone calls in June (n = 14 482) and December (n = 19 747), and area-level data. SettingOut-of-hours provider in Devon, England serving nearly 1 million patients. MethodStraight-line distance measured patients' proximity to the primary care centre. At area level, rurality was measured by Office for National Statistics Rural and Urban Classification (2004) ResultsCall rates decreased with increasing distance: 172 (95% confidence interval [CI] = 170 to 175) for the first (nearest) distance quintile, 162 (95% CI = 159 to 165) for the second, and 159 (95% CI = 156 to 162) per thousand patients/year for the third quintile. Distance and deprivation predicted call rate. Rates were highest for urban areas and lowest for sparse villages and hamlets. The greatest urban/rural variation was in patients aged 0-4 years. Rates were higher in deprived areas, but the effect of deprivation was more evident in urban than rural areas. ConclusionThere is geographical variation in out-of-hours service use. Patients from rural areas have lower call rates, but deprivation appears to be a greater determinant in urban areas. Geographical barriers must be taken into account when planning and delivering services.

The work, workforce, technology and organisational implications of the ‘111’ single point of access telephone number for urgent (non-emergency) care: a mixed-methods case study

“…in over-riding call dispositions and translating information provided by the caller). 26 However, staff recognised the fine line between 'probing using the supporting information' and 'following the system.' We suggest that the work carried out by NHS 111 call advisers has more in common with clinical health-care work than with other generic call centre work that it superficially resembles.…”

“…Typically, staff reported higher volumes of calls from certain populations, such as parents of young children and more elderly patients, consistent with the literature on out-of-hours and unscheduled care. 26 Calls were received about a broad range of issues including requests for health information (e.g. contraception advice or medication advice) or a repeat prescription.…”

“…Some of the existing 999 call centre workforce, who mainly worked full-time, were trained to take NHS 111 calls and additional full-time and part-time call advisers were recruited, which introduced a less homogeneous workforce (in terms of age, qualifications and career aspirations). 26 Additionally, both paramedics and nurses were recruited to clinical adviser roles, offering different professional backgrounds and expertise and diversifying the clinical expertise at site 1 by introducing significant numbers of nurses to the organisation for the first time.…”

Designing a model to minimize inequities in hemodialysis facilities distribution

“…Locations for new hemodialysis facilities resulting from the application of the model. *Municipalities served by the new center must lack a hemodialysis center of their own and also be located closer to the new center than to any other existing ones; **the number of estimated cases were calculated using prevalence data from 2008. may change rapidly because there may not exist any association between prevalence and incidence at any given time; and (iii) the use of health care increases when they become available and better situated (Turnbull et al, 2008). This has indeed been reported for renal replacement therapy (White et al, 2006).…”

Monitoring access to out-of-hours care services in Scotland – a review

“…Findings from a study by Turnbull et al found that patients from urban areas had higher call rates, while Campbell found those in rural areas often delayed seeking help until their own GP was available. 9,10 In England, Knowles et al found less use of the telephone service NHS Direct by certain groups within the population; men, older people, those without car or telephone, lower education levels, communication difficulties, and non-home owners in relation to their needs. 11 A study of data from the British General Household Study found higher A&E use by poorer individuals, while NHS Direct use was higher in more affluent populations.…”