Contacts with out-of-hours primary care for nonurgent problems: patients’ beliefs or deficiencies in healthcare?

BMC Family Practice

Research Article

Paul Giesen¹  Michel Wensing¹  Marleen Smits¹  Ellen Keizer¹  Yvonne Peters¹  Linda Huibers² 

[1] Radboud University Medical Center, Radboud Institute for Health Sciences, P.O. Box 9101, 114 IQ Healthcare, 6500 HB, Nijmegen, The Netherlands;Radboud University Medical Center, Radboud Institute for Health Sciences, P.O. Box 9101, 114 IQ Healthcare, 6500 HB, Nijmegen, The Netherlands;Aarhus University, Research Unit for General Practice, Aarhus, Denmark;

关键词: After hours care;    Primary health care;    Medical necessity;    Motivation;    Nonurgent;   

DOI  :  10.1186/s12875-015-0376-9

 received in 2015-06-23, accepted in 2015-10-21,  发布年份 2015

来源: Springer

【 摘 要 】

BackgroundIn the Netherlands, about half of the patient contacts with a general practitioner (GP) cooperative are nonurgent from a medical perspective. A part of these problems can wait until office hours or can be managed by the patient himself without further professional care. However, from the patient’s perspective, there may be a need to contact a physician immediately. Our objective was to determine whether contacts with out-of-hours primary care made by patients with nonurgent problems are the result of patients’ beliefs or of deficiencies in the healthcare system.MethodsWe performed a survey among 2000 patients with nonurgent health problems in four GP cooperatives in the Netherlands. Two GPs independently judged the medical necessity of the contacts of all patients in this study. We examined characteristics, views and motives of patients with medically necessary contacts and those without medically necessary contacts. Descriptive statistics were used to describe the characteristics, views and reasons of the patients with medically unnecessary contacts and medically necessary contacts. Differences between these groups were tested with chi-square tests.ResultsThe response rate was 32.3 % (N = 646). Of the nonurgent contacts 30.4 % were judged as medically necessary (95 % CI 27.0-34.2). Compared to patients with nonurgent but medically necessary contacts, patients with medically unnecessary contacts were younger and were more often frequent attenders. They had longer-existing problems, lower self-assessed urgency, and more often believed GP cooperatives are intended for all help requests. Worry was the most frequently mentioned motive for contacting a GP cooperative for patients with a medically unnecessary contact (45.3 %) and a perceived need to see a GP for patients with a medically necessary contact (44.2 %). Perceived availability (5.8 %) and accessibility (8.3 %) of a patient’s own GP played a role for some patients.ConclusionMotives for contacting a GP cooperative are mostly patient-related, but also deficiencies in access to general practice may partly explain medically unnecessary use. Efforts to change the use of GP cooperatives should focus on education of subgroups with an increased likelihood of contact for medically unnecessary problems. Improvement of access to daytime primary care may also decrease use of the GP cooperative.

【 授权许可】

CC BY   
© Keizer et al. 2015