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KCE reports vol. 19B Urgences 95
FIRST AUTHOR-
YR-CTRY.
VAN UDEN C-
2003-NL.
VAN UDEN C.-
2004-NL.
VAN UDEN C.-
2005-NL.
WASHINGTON
D.-2000-USA.
WEBER E.-
2005-USA.
TYPE STUDY OBJECTIVE(S) METHOD(S) RESULTS DISCUSSION
Comparative
case study.
Observational
before and after
in out of hours
service.
Comparative
case study with
peer reiewed
structured
questionnaires.
Prospective
cohort design in
a tertiary care
hospital.
National
population-based
study.
Investigating pats numbers and
characteristics usinf PC and
Ecarebecause of different out of
hours care models.
Investigating whether the
reorganisation of out of hours
(creation of 3 new GPCOÊs) PC
changes utilisation of primary and
hospital emergency care.
Determining pat. satisfaction with
current out-of hours care in
GPcooperatives.
Validating standardized clinical
criteria to identify pats whose care
can be safely deferred to a later date
in a nonemergency setting.
Determining whether having a usual
source of care or health insurance is
associated with the likelihood of an
ED-visit.
2 organistional models of GPCOÊs are
compared in annual contact rate, self
referral.One cooperative is city
centred,far from EDÊs(Heerlen),with
scheduled appointments(Maastricht).The
second is inside the local ED,free access.
Analysis of all pt. contacts with GPÊs and
EDÊs during a 4-week period before and
after the reorganisation of out of hours
care.(extraction of computerised data).
Cooperatives located nearby a ED.
Questionnaires base on reviewed and
published data and analyzed on 3
processes of consult in GPCO:tel.
advice,in site consult,home visit. This
questionnaire encompasses contactspecific
and general items. Likert
reponse scale.
Defined criteria developed by a
multidisciplinary physician panel.
Screening of > 1000 ambulatory pats.
responding or not to the criteria they
were referred to same day care or
deferred to an appointment(max. 1
week) in the ambulatory clinic.
Multivariate analysis of a nationally
representative Community tracking
study household survey assessing the
association of health status,insurance,
income with 1 or more ED-visits in the
previous yr
* Annual contact rate/1000 inhabitants at the
GPCO-Heerlen is significantly lower than in
Maastricht.
*Contact rate at EDÊs in both is not statist
significant.
* The self referral rate in EDÊs is significantly
higher in Heerlen than in Maastricht.
The total number of pats. during out of hours
care increased with 4,6 %,but an increase of 9,8
% in GPCOÊs.Selfreferrals diminished
significantly.(3,3 %).Significant shift of pats from
ED to GPCOÊs.(3,6%).
Pats receiving only tel. advice are less satisfied
than those who attend the GPCO, and those
who receive a home visit.·Various factors give
insight in the pat. opinion and satisfaction: first
tel. contact, or attitude og the doctor be it in site
or at home.
19 % met criteria to be deferred.0% related
nonelective hospitalisations within 7 days after
deferral. But 7 % of non deferred pats were
hospitalised and 0,5 % died.
Adults without usual source of care were less
likely to have had an ED visit.·Uninsured pats
were not more likely to have an ED visit than
insured pats.·Poor physical and mental health >
5 outpat. visits/yr ,changes in insurance coverage
were associated with ED visit.
The free access gatekeeper
function and the proxy of the
ED in Maastricht has
decreased significantly the self
referral rate at the
ED,compared with Heerlen.
The reorganisation of out of
hours PC into
GPCooperatives has reduced
ED-use and increased PC-use.
The study shows that patients
are generally satisfied with
out-of-hours care, but that
those with a only tel. advice
are less satisfied than those
attending the cooperatives.
This critria can safely screen
ambulatory care fot pats who
attend ED. They deserve
testing in other EDÊs.
The success of efforts to
decrease ED-use may depend
on improving delivery of
outpatient care.