Patient motives for contacting out-of-hours care in Denmark: a cross-sectional study

Abstract

Background Patients in need of acute healthcare do not always contact the most suitable healthcare service provider. Contacting out-of-hours primary care for an urgent problem may delay care, whereas contacting emergency medical services for a non-urgent problem could ultimately affect patient safety. More insight into patient motives for contacting a specific healthcare provider may help optimise patient flows. This study aims to explore patient motives for contacting out-of-hours primary care and the emergency medical services in Denmark. Methods We conducted a cross-sectional observational study by sending a questionnaires to patients contacting out-of-hours primary care and emergency medical services, both of which can be directly contacted by patients, in two of five Danish regions in 2015. As we aimed to focus on the first access point, the emergency department was not included. The questionnaire included items on patient characteristics, health problem and 26 pre-defined motives. Descriptive analyses of patient characteristics and motives were conducted, stratified by the two healthcare service providers. Factors associated with contacting each of the two service providers were explored in a modified Poisson regression analysis, and adjusted risk ratios were calculated. Results Three key motives for contacting the two service providers were identified: ‘unpleasant symptoms’, ‘perceived need for prompt action’ and ‘perceived most suitable healthcare provider’. Other important motives were ‘need arose outside office hours’ and ‘wanted to talk to a physician’ (out-of-hours primary care) and ‘expected need for ambulance’ and ‘worried’ (emergency medical services). Higher probability of contacting the emergency medical services versus out-of-hours primary care was seen for most motives relating to own assessment and expectations, previous experience and knowledge, and own needs and wishes. Lower probability was seen for most motives relating to perceived barriers and benefits. Conclusions Patient motives for contacting the two healthcare service providers were partly overlapping. The study contributes with new knowledge on the complex decision-making process of patients in need of acute healthcare. This knowledge could help optimise existing healthcare services, such as patient safety and the service level, without increasing healthcare costs.

Age-related differences in motives for contacting out-of-hours primary care: a cross-sectional questionnaire study in Denmark

“…The final version was validated in three small-scale pilot studies. This procedure has been thoroughly described elsewhere [18].…”

Effect of an educational intervention for telephone triage nurses on out-of-hours attendance: a pragmatic randomized controlled study

“…An introduction of school requirement for a sick leave certificate for teenagers led to increased list-holding GP attendance and may contribute to out-ofhours health seeking behaviour [35]. Convenience considerations and GPs' low capacity for urgent, same-day consultations may be other reasons for seeking help outof-hours [31,36,37]. Moreover, social network is also an important determinant for help seeking behaviour regarding antibiotic use [38].…”

Initial symptoms of myocardial infarction – Consequences and methodological approach

“…Nurses can either consult or pass on the call to a medical doctor on call if in doubt of medical condition or optimal triage. 64,65 The nurses (and to some extent the medical doctors) at the 1813-medical helpline use a computerized decision support system that was developed locally for this helpline specifically. This decision support system guides the call-taker in deciding on the most appropriate triage according to presented symptoms and condition of the patients.…”