Out of Hours

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Abstract
Objectives: To investigate the necessity of out-of-hours calls and patient satisfaction with out-of-hours care. To assess the distribution between emergency care at a primary care emergency clinic and a hospital emergency department. Methods: In a prospective population-based study, over five weeks, all out-of-hour calls were registered: home visits, telephone advice, visits at the primary care emergency clinic, referrals by the general practitioner (GP) and self-referrals to the hospital emergency department. The primary care clinic in this study functions as an out-of-hours emergency clinic for a community with 23,000 inhabitants. The centre is staffed by a nurse or assistant, with the GP on duty being on call. The hospital emergency department is located in a different part of the city. Distribution of all emergency calls across the settings, necessity of primary care calls as judged by the provider, satisfaction of the patients of out-of-hours primary care were investigated. Results: The incidence of all out-of-hours calls was 260/1000/year (n=576). The self-referral rate to the hospital was 13%; 4% were referred to the hospital by the GP, 1% attended the emergency department by ambulance, 2% were referred by other GPs, and 80% were treated in the primary care setting exclusively. Of the 485 primary care patients, 363 were interviewed (response 74%). Of the interviewed patients, 87% were (very) satisfied with the service, 84% with the GP, 97% with the nurse. The GP or nurse judged 33% of the visits as unnecessary though understandable and 12% were judged as totally unnecessary. There was no relation between necessity and satisfaction, nor was satisfaction related to not getting a home visit, nor to seeing a nurse instead of a doctor. Conclusions: A low threshold primary care emergency clinic can function adequately in the vicinity of a freeaccess hospital emergency department. It is well accepted by patients and GPs.