The effect of an out-of-hours reform on attendance at casualty wards.The Danish example

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Abstract
A reorganisation of the out-of-hours general practice service in Denmark was launched in January 1992. The biggest changes were in a mandatory telephone triage staffed by GPs and the replacement of small rota systems with county-based health centres. We aimed to analyse the effect of this out-of-hours reform on the number of contacts with the casualty wards. A register-based ecologic time-trend study of the mean number of annual contacts per inhabitant from 1988 to 1997. The County of Aarhus. All 630000 inhabitants in the county. Mean number of annual contacts with casualty wards per inhabitant. Intercepts derived from two regression models. The mean number of contacts with casualty wards rose significantly during the whole period. Given this constant increase in contact rates, a regression model showed that the increase in the attendance rate with casualty wards after the reform was statistically insignificant. The decrease in the total number of contacts with the out-of-hours primary health care after the reform was not met by a corresponding increase in casualty ward contacts. A clear-cut significant increase in the use of casualty wards following the out-of-hours reform could not be demonstrated.

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