Out of hours service in Denmark: evaluation five years after reform

Christensen, Morten Bondo; Olesen, Frede

doi:10.1136/bmj.316.7143.1502

Cited by 120 publications

(95 citation statements)

References 6 publications

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“…134 A RCT by Lattimer et al 68 reported a 38% reduction in primary care appointments and a 23% reduction in home visits, whereas another study reported no change in primary care appointments but home visits reduced by 18%. 70 A number of studies reported that doctor workload fell after the introduction of a telephone service. One study reported a reduction in workload of 54% compared with the previous 3 months 69 and that nurses were able to handle 26% of requests for GP appointments by telephone, whereas another study reported a 39% reduction in demand.…”

Section: Service Impactsmentioning

confidence: 99%

“…Seventeen studies reported impacts on their own service or other services, either from increased or reduced service use and or increased or reduced staff workload [68][69][70]86,95,98,99,[101][102][103]105,109,112,114,122,126,134 One study found that NHS Direct referred a higher proportion of patients to other services when compared with general practice. 134 A RCT by Lattimer et al 68 reported a 38% reduction in primary care appointments and a 23% reduction in home visits, whereas another study reported no change in primary care appointments but home visits reduced by 18%.…”

Section: Service Impactsmentioning

confidence: 99%

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What evidence is there on the effectiveness of different models of delivering urgent care? A rapid review

Turner

Coster

Chambers

et al. 2015

Health Serv Deliv Res

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BackgroundIn 2013 NHS England set out its strategy for the development of an emergency and urgent care system that is more responsive to patients’ needs, improves outcomes and delivers clinically excellent and safe care. Knowledge about the current evidence base on models for provision of safe and effective urgent care, and the gaps in evidence that need to be addressed, can support this process.ObjectiveThe purpose of the evidence synthesis is to assess the nature and quality of the existing evidence base on delivery of emergency and urgent care services and identify gaps that require further primary research or evidence synthesis.Data sourcesMEDLINE, EMBASE, The Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and the Web of Science.MethodsWe have conducted a rapid, framework-based, evidence synthesis approach. Five separate reviews linked to themes in the NHS England review were conducted. One general and five theme-specific database searches were conducted for the years 1995–2014. Relevant systematic reviews and additional primary research papers were included and narrative assessment of evidence quality was conducted for each review.ResultsThe review was completed in 6 months. In total, 45 systematic reviews and 102 primary research studies have been included across all five reviews. The key findings for each review are as follows: (1) demand – there is little empirical evidence to explain increases in demand for urgent care; (2) telephone triage – overall, these services provide appropriate and safe decision-making with high patient satisfaction, but the required clinical skill mix and effectiveness in a system is unclear; (3) extended paramedic roles have been implemented in various health settings and appear to be successful at reducing the number of transports to hospital, making safe decisions about the need for transport and delivering acceptable, cost-effective care out of hospital; (4) emergency department (ED) – the evidence on co-location of general practitioner services with EDs indicates that there is potential to improve care. The attempt to summarise the evidence about wider ED operations proved to be too complex and further focused reviews are needed; and (5) there is no empirical evidence to support the design and development of urgent care networks.LimitationsAlthough there is a large body of evidence on relevant interventions, much of it is weak, with only very small numbers of randomised controlled trials identified. Evidence is dominated by single-site studies, many of which were uncontrolled.ConclusionsThe evidence gaps of most relevance to the delivery of services are (1) a requirement for more detailed understanding and mapping of the characteristics of demand to inform service planning; (2) assessment of the current state of urgent care network development and evaluation of the effectiveness of different models; and (3) expanding the current evidence base on existing interventions that are viewed as central to delivery of the NHS England plan by assessing the implications of increasing interventions at scale and measuring costs and system impact. It would be prudent to develop a national picture of existing pilot projects or interventions in development to support decisions about research commissioning.FundingThe National Institute for Health Research Health Services and Delivery Research Programme.

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Section: Service Impactsmentioning

confidence: 99%

Section: Service Impactsmentioning

confidence: 99%

What evidence is there on the effectiveness of different models of delivering urgent care? A rapid review

Turner

Coster

Chambers

et al. 2015

Health Serv Deliv Res

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“…5,6 Telephone consulting in other services is less well researched. No reports of telephone-based care for renal transplant recipients were found, although telemedicine for dialysis patients has been described.…”

Section: Discussionmentioning

confidence: 99%

The follow-up of renal transplant recipients by telephone consultation: three years experience from a single UK renal unit

2011

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-Although telephone consulting is increasingly used by clinicians seeking to balance rising caseloads, heightened patient expectation and the desire to ensure continued improvements in the quality, convenience and accessibility of the care they provide, its use to provide care to renal transplant recipients has not previously been described. Climate change is a major global public health threat. However, the provision of healthcare itself has a significant environmental impact. A transformation to lower carbon clinical care must be achieved without detriment to the quality of the patient care. This article reports the use of telephone consultation clinics to provide follow-up to renal transplant recipients over a three-year period. The benefits of this service to patients, providers and the environment are outlined, the existing literature regarding the provision of virtual care to patients with kidney disease is reviewed, and the possibilities of more widespread adoption are discussed. KEY WORDS: climate change, renal transplant, telephone clinic IntroductionTelephone consulting offers clinicians a means by which to meet the challenge of improving quality and accessibility despite rising caseloads and heightened patient expectation. 1 It is now utilised to triage patients, manage acute and chronic conditions, enhance compliance and communicate results. When used appropriately, telephone consulting offers the patient and clinician multiple benefits, including enhanced access to healthcare, heightened continuity of care, reduced travelling and considerable time savings. Climate change has been described as 'the biggest global health threat of the 21st century' . 2 However, the provision of healthcare itself has a significant environmental impact; the carbon footprint of NHS England is 21.2 MtCO 2 eq per year. 3 Telephone consulting offers the further benefit of reducing the 18% of emissions attributable to patient and staff travel. 3 UK guidelines do not offer a follow-up timetable for stable renal transplant recipients, although most services offer threeto six-monthly appointments. This is in keeping with the guidance of the American Society of Transplantation, which notes that there are virtually no scientific data on which to base decisions regarding the optimal frequency (or type) of follow-up of these patients. 4 This article reports the use of telephone consulting to provide three-monthly follow-up to renal transplant recipients in a single UK renal unit over a three-year period. Case studyThe University Hospital of Coventry and Warwickshire (UHCW) renal service began to offer telephone consultations to provide routine follow-up to renal transplant recipients in 2006.The service now provides approximately 350 appointments per year, facilitating follow-up to 123 of the 360 patients in whom transplantation was undertaken more than one year previously.The service is offered to patients at their physician's discretion. Most patients are well known to the department and all must have demonstrated stable...

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“…all during weekends and public holidays (15). The present study was conducted in the county of Northern Jutland (490 000 inhabitants).…”

Section: Methodsmentioning

confidence: 99%

Intervention among frequent attenders of the out-of-hours service: A stratified cluster randomized controlled trial

Christensen

Mortensen

et al. 2004

Scandinavian Journal of Primary Health Care

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Out of hours service in Denmark: evaluation five years after reform

Cited by 120 publications

References 6 publications

What evidence is there on the effectiveness of different models of delivering urgent care? A rapid review

What evidence is there on the effectiveness of different models of delivering urgent care? A rapid review

The follow-up of renal transplant recipients by telephone consultation: three years experience from a single UK renal unit

Intervention among frequent attenders of the out-of-hours service: A stratified cluster randomized controlled trial

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