The organisation of out-of-hours primary care in OECD countries

Berchet, Caroline; Nader, Carol

doi:10.1787/5jlr3czbqw23-en

Cited by 14 publications

(14 citation statements)

References 56 publications

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“…Physicians had a significantly higher RR of a poor quality than GPs for four items (i.e. 6,7,8,9). Table 5 additionally, shows the RR estimates adjusted for evaluator background (GPC, MH-1813) (i.e.…”

Section: Populationmentioning

confidence: 94%

“…Securing a safe and efficient telephone triage is a challenge as it must balance a minimum of undertriage securing high patient safety, while keeping overtriage at an acceptably low level. Existing OOH-PC services vary and use different triage models [5,6], and involvement of general practitioners (GPs) is debated [1,4,7]. Many countries experience increasing shortage of GPs [8,9], and GPs report high selfperceived stress and multiple burnout symptoms [10,11].…”

Section: Introductionmentioning

confidence: 99%

“…Many countries experience increasing shortage of GPs [8,9], and GPs report high selfperceived stress and multiple burnout symptoms [10,11]. In most countries, telephone triage in OOH-PC services is performed by nurses using a computerised decision support system (CDSS) [6]. In Denmark, GPs primarily perform the telephone triage [3].…”

Section: Introductionmentioning

confidence: 99%

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Safety, efficiency and health-related quality of telephone triage conducted by general practitioners, nurses, or physicians in out-of-hours primary care: a quasi-experimental study using the Assessment of Quality in Telephone Triage (AQTT) to assess audio-recorded telephone calls

et al. 2020

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Background: To explore and compare safety, efficiency, and health-related quality of telephone triage in out-ofhours primary care (OOH-PC) services performed by general practitioners (GPs), nurses using a computerised decision support system (CDSS), or physicians with different medical specialities. Methods: Natural quasi-experimental cross-sectional study conducted in November and December 2016. We randomly selected 1294 audio-recorded telephone triage calls from two Danish OOH-PC services triaged by GPs (n = 423), nurses using CDSS (n = 430), or physicians with different medical specialities (n = 441). An assessment panel of 24 physicians used a validated assessment tool (Assessment of Quality in Telephone Triage-AQTT) to assess all telephone triage calls and measured health-related quality, safety, and efficiency of triage.

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Section: Populationmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

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Safety, efficiency and health-related quality of telephone triage conducted by general practitioners, nurses, or physicians in out-of-hours primary care: a quasi-experimental study using the Assessment of Quality in Telephone Triage (AQTT) to assess audio-recorded telephone calls

et al. 2020

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“…[1][2][3] The United States and Canada, however, are the least likely among Organization for Economic Cooperation and Development nations to offer after-hours access arrangements (35% of American and 45% of Canadian practices). [4][5][6] Sixty-three percent of Canadians and 51% of Americans report that they find it very or somewhat difficult to get care after hours without going to an emergency department. 7 Furthermore, increasing frailty in the community underlines the importance of providing care at patients' homes and in long-term care facilities as well as in hospitals, and emergency departments.…”

Section: Introductionmentioning

confidence: 99%

Trends in Providing Out-of-Office, Urgent After-Hours, and On-Call Care in British Columbia

et al. 2019

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PURPOSE Providing care in alternative (non-office) locations and outside office hours are important elements of access and comprehensiveness of primary care. We examined the trends in and determinants of the services provided in a cohort of primary care physicians in British Columbia, Canada. METHODS We used physician-level payments for all primary care physicians practicing in British Columbia from 2006-2007 through 2011-2012. We examined the association between physician demographics and practice characteristics and payment for care in alternative locations and after hours across rural, urban, and metropolitan areas using longitudinal mixed-effects models. RESULTS The proportion of physicians who provided care in alternative locations and after hours declined significantly during the period, in rural, urban, and metropolitan practices. Declines ranged from 5% for long-term care facility visits to 22% for after-hours care. Female physicians, and those in the oldest age category, had lower odds of providing care at alternative locations and for urgent after-hours care. Compared with those practicing in metropolitan centers, physicians working in rural areas had significantly higher odds of providing care both in alternative locations and after hours. CONCLUSION Care provided in non-office locations and after office hours declined significantly during the study period. Jurisdictions where providing these services are not mandated, and where similar workforce demographic shifts are occurring, may experience similar accessibility challenges.

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“…During evenings, nights, and weekends, such care is provided by the out-of-hours services in primary care (OHS-PC). Similar to other European countries, Australia, and New Zealand, the initial contact is by telephone, and trained nurses perform triage while supervised by GPs (11)(12)(13). The aims of standardized telephone triage are to assess the severity of patients' complaints and to allocate adequate urgencies based on a decision tree.…”

Section: Introductionmentioning

confidence: 99%

Call Characteristics of Patients Suspected of Transient Ischemic Attack (TIA) or Stroke During Out-of-Hours Service: A Comparison Between Men and Women

et al. 2021

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Background: In the Netherlands, a digital decision support system for telephone triage at out-of-hours services in primary care (OHS-PC) is used. Differences in help-seeking behavior between men and women when transient ischemic attack (TIA) or stroke is suspected could potentially affect telephone triage and allocation of urgency.Aim: To assess patient and call characteristics and allocated urgencies between women and men who contacted OHS-PC with suspected TIA/stroke.Methods: A cross-sectional study of 1,266 telephone triage recordings of subjects with suspected neurological symptoms calling the OHS-PC between 2014 and 2016. The allocated urgencies were derived from the electronic medical records of the OHS-PC and the final diagnosis from the patient's own general practitioner, including diagnoses based on hospital specialist letters.Results: Five hundred forty-six men (mean age = 67.3 ± 17.1) and 720 women (mean age = 69.6 ± 19.5) were included. TIA/stroke was diagnosed in 294 men (54%) (mean age = 72.3 ± 13.6) and 366 women (51%) (mean age = 78.0 ± 13.8). In both genders, FAST (face-arm-speech test) symptoms were common in TIA/stroke (men 78%, women 82%) but also in no TIA/stroke (men 63%, women 62%). Men with TIA/stroke had shorter call durations than men without TIA/stroke (7.10 vs. 8.20 min, p = 0.001), whereas in women this difference was smaller and not significant (7.41 vs. 7.56 min, p = 0.41). Both genders were allocated high urgency in 75% of the final TIA/stroke cases.Conclusion: Overall, patient and call characteristics are mostly comparable between men and women, and these only modestly assist in identifying TIA/stroke. There were no gender differences in allocated urgencies after telephone triage in patients with TIA/stroke.

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The organisation of out-of-hours primary care in OECD countries

Cited by 14 publications

References 56 publications

Safety, efficiency and health-related quality of telephone triage conducted by general practitioners, nurses, or physicians in out-of-hours primary care: a quasi-experimental study using the Assessment of Quality in Telephone Triage (AQTT) to assess audio-recorded telephone calls

Safety, efficiency and health-related quality of telephone triage conducted by general practitioners, nurses, or physicians in out-of-hours primary care: a quasi-experimental study using the Assessment of Quality in Telephone Triage (AQTT) to assess audio-recorded telephone calls

Trends in Providing Out-of-Office, Urgent After-Hours, and On-Call Care in British Columbia

Call Characteristics of Patients Suspected of Transient Ischemic Attack (TIA) or Stroke During Out-of-Hours Service: A Comparison Between Men and Women

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