Factors related to out-of-hours help-seeking for acute health problems: a survey study using case scenarios

Abstract

BackgroundThe acute out-of-hours healthcare services are challenged by increasing demand in many countries. We aimed to examine factors influencing the intended help-seeking in out-of-hours care for acute health problems during evenings, nights, and weekends.MethodsWe conducted a survey study based on data from parents of children (aged 0–4 years) and adults (aged 30–39 and 50–59 years) in Denmark, the Netherlands and Switzerland. Intended help-seeking behaviour was measured by six hypothetical case scenarios. We used Andersen’s Behavioural Model to categorise potentially influential factors and applied multiple binomial regression to assess the influence of selected factors.ResultsA total of 1015 parents and 2942 adults participated. We identified several significant influential factors. Parents holding a low education (OR 1.56), having migrant background (western: OR 1.23; non-western: OR 1.93), having one child (OR 1.24), perceiving few barriers to using out-of-hours primary care (OR 1.59), perceiving difficulties with organising childcare (OR 1.13), and having a history of frequent contacts with out-of-hours care (OR 1.55) were more inclined to contact out-of-hours care, whereas female (OR 0.85) and non-anxious parents (OR 0.77) were less inclined. Adults who were older (OR 1.01), holding a medical education (OR 1.13), having non-western background (OR 1.28), being unemployed (OR 1.17), perceiving few barriers to using out-of-hours primary care (OR 1.37), and having a history of frequent contacts with a GP (few: OR 1.15; more: OR 1.22) and/or with out-of-hours care (one: OR 1.20; more: OR 1.49) were more inclined to contact out-of-hours care, whereas adults with no or little social support (OR 0.84) and adults with high health literacy level on health information (OR 0.91) were less inclined. Dutch parents were less inclined than Danish parents to contact out-of-hours care (OR 0.62), whereas Swiss adults were more inclined than Danish adults to contact out-of-hours care (OR 1.16).ConclusionWe identified several factors related to intended help-seeking in out-of-hours care. These results could be used to develop targeted interventions, but more research is needed to examine the underlying explanations for the identified differences.Electronic supplementary materialThe online version of this article (10.1186/s12889-018-6332-6) contains supplementary material, which is available to authorized users.

Help-seeking behaviour outside office hours in Denmark, the Netherlands and Switzerland: a questionnaire study exploring responses to hypothetical cases

“… 13 Simultaneously, a second paper has been written on factors related to intended help-seeking OOH. 14 We included a random selection of individuals from three age groups (ie, parents of children aged 0–4 years, adults aged 30–39 years and adults aged 50–59 years). Predefined age groups were preferred to ensure construction of explicit cases and to obtain sufficient power for identifying differences for each separate age group.…”

<p>Sociodemographic Characteristics Associated with Contacts to Emergency Medical Services and Out-of-Hours Primary Care: An Observational Study of 2.3 Million Citizens</p>

“…The included sociodemographic variables were chosen based on existing literature reporting the importance of age, sex, ethnicity, family type, education level, income and socioeconomic classification (labor market affiliation) in relation to health care utilization. 5,13,15,[24][25][26][27] We used each citizen's unique PIN for linkage to numerous registries and databases. Age (divided into five groups), sex, residence, family type (collapsed into cohabiting or living alone) and ethnicity (Danish, Western, non-western) were gathered from the Civil Registration System.…”

“…Although using a different methodology, they found older age, female sex, ethnicity, low education and low income to be associated with OOH care contact, which is supported by our study. 13 Another larger survey study including data from 34 countries investigated the propensity to seek health care (GP during daytime) and found that older age, female sex, ethnicity (first-generation migrants) were predisposing factors for seeking health care. 14 Although the study investigated GP contact during daytime, their findings are in good agreement with our findings for OOH care.…”

“…A number of studies have found that sociodemographic characteristics such as low education, ethnicity and older age and factors regarding the health-care system itself (organization of access to primary care) were associated with help-seeking, but no large-scale cohort studies have investigated differences in these characteristics for patients contacting EMS and OOH-PC. [13][14][15] Concurrently, all OOH services are experiencing an increasing demand and workload, emphasizing the importance of understanding patient help-seeking behavior and the development in contact patterns with these services. 16,17 More insight into sociodemographic characteristics associated with seeking OOH health care and choosing one service over the other could contribute to the understanding of patient utilization of OOH health care service.…”

Contacting out-of-hours primary care or emergency medical services for time-critical conditions - impact on patient outcomes

“…age, gender, ethnicity, employment status, income, education length and comorbidity). These factors have been found to relate to patient’s help-seeking behaviour and choice of entrance [24] as well as to mortality [25, 26]. Information on potential confounders was retrieved from Statistics Denmark [27] and the Danish National Patient Registry (i.e.…”