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Bomholt KB, Nebsbjerg MA, Burau V, Mygind A, Christensen MB, Huibers L. Task shifting from general practitioners to other health professionals in out-of-hours primary care - a systematic literature review on content and quality of task shifting. Eur J Gen Pract 2024; 30:2351807. [PMID: 38779917 PMCID: PMC11123461 DOI: 10.1080/13814788.2024.2351807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 04/15/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Task shifting from general practitioners (GPs) to other health professionals could solve the increased workload, but an overview of the evidence is lacking for out-of-hours primary care (OOH-PC). OBJECTIVES To evaluate the content and quality of task shifting from GPs to other health professionals in clinic consultations and home visits in OOH-PC. METHODS Four database literature searches were performed on 13 December 2021, and updated in August 2023. We included articles that studied content (patient characteristics, reason for encounter) and/or quality (patient satisfaction, safety, efficiency) of task shifting in face-to-face contacts at OOH-PC. Two authors independently screened articles for inclusion and assessed the methodological quality of included articles using the JBI critical appraisal checklist. Data was extracted and results were synthesised in a narrative summary. RESULTS The search identified 1,829 articles, resulting in the final inclusion of seven articles conducted in the UK or the Netherlands. Studies compared GPs with other health professionals (mainly nurses). These other health professionals saw patients with less urgent health problems, younger patients, and patients with less complex health problems than GPs. Most studies concluded that other health professionals provided safe and vastly efficient care corresponding to the level of GPs but findings about productivity were inconclusive. CONCLUSION The level of safety and efficiency of care provided by other health professionals in OOH-PC seems like that of GPs, although they mainly see patients presenting with less urgent and less complex health problems.
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Affiliation(s)
| | | | - Viola Burau
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Anna Mygind
- Research Unit for General Practice, Aarhus University, Aarhus, Denmark
| | - Morten Bondo Christensen
- Research Unit for General Practice, Aarhus University, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Linda Huibers
- Research Unit for General Practice, Aarhus University, Aarhus, Denmark
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Meer A, Rahm P, Schwendinger M, Vock M, Grunder B, Demurtas J, Rutishauser J. Safety of patient self-triage: real-life prospective evaluation of a symptom-checker in adult patients visiting an interdisciplinary emergency care center. J Med Internet Res 2024. [PMID: 38809606 DOI: 10.2196/58157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND Symptom-checkers have become important tools for self-triage, assisting patients to determine the urgency of medical care. To be safe and effective, these tools must be validated, particularly to avoid potential hazardous undertriage without leading to inefficient overtriage. Only limited safety data from studies including small sample sizes have been available so far. OBJECTIVE The objective of our study was to prospectively investigate the safety of patients' self-triage in a large patient sample. We used SMASS pathfinder, a symptom-checker based on a computerized transparent neural network. METHODS We recruited 2543 patients into this single centre, prospective clinical trial conducted at the cantonal hospital of Baden, Switzerland. Patients with an Emergency Severity Index of 1-2 were treated by the team of the emergency department, while those with an index of 3-5 were seen at the walk-in clinic by general physicians. We compared the triage recommendation obtained by the patients' self-triage with the assessment of the clinical urgency made by three successive interdisciplinary panels of physicians (Panel A, B, C). Using a Clopper-Pearson confidence interval, we assumed that in order to confirm the symptom-checkers safety, the upper confidence bound for the probability of a potentially hazardous undertriage should lie below 1%. A potentially hazardous undertriage was defined as a triage in which either all (consensus criterion) or the majority (majority criterion) of the experts of the last panel (Panel C) rated the triage of the symptom-checker to be "rather likely" or "likely" life-threatening or harmful. RESULTS Of the 2543 patients, 1227 (48.3%) were female and 1316 (51.7%) male. None of the patients reached the pre-specified consensus criterion for a potentially hazardous undertriage. This resulted in an upper 95% confidence bound of 0.1184%. 4 cases met the majority criterion. This resulted in an upper 95% confidence bound for the probability of a potentially hazardous undertriage of 0.3616%. The two-sided 95% Clopper-Pearson confidence interval for the probability of overtriage (450 cases, 17.7%) was 16.23% to 19.24%, which is considerably lower than figures reported in the literature. CONCLUSIONS The symptom-checker proved to be a safe triage tool, avoiding potentially hazardous undertriage in a real-life clinical setting of emergency consultations at a WIC/ED, whithout causing undesirable overtriage. Our data suggest the symptom-checker may be safely used in clinical routine. CLINICALTRIAL ClinicalTrials.gov identifier NCT04055298.
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Affiliation(s)
| | - Philipp Rahm
- Emergency Department, Cantonal Hospital Baden, Baden, CH
| | | | - Michael Vock
- Institute of Mathematical Statistics and Actuarial Science, University of Berne, Berne, CH
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Pask S, Omoruyi A, Mohamed A, Chambers RL, McFarlane PG, Johansson T, Kumar R, Woodhead A, Okamoto I, Barclay S, Higginson IJ, Sleeman KE, Murtagh FEM. Telephone advice lines for adults with advanced illness and their family carers: a qualitative analysis and novel practical framework. Palliat Med 2024; 38:555-571. [PMID: 38600058 PMCID: PMC11107135 DOI: 10.1177/02692163241242329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
BACKGROUND Telephone advice lines have been recommended internationally to support around-the-clock care for people living at home with advanced illness. While they undoubtedly support care, there is little evidence about what elements are needed for success. A national picture is needed to understand, improve and standardise service delivery/care. AIM To explore telephone advice lines for people living at home with advanced illness across the four UK nations, and to construct a practical framework to improve services. DESIGN A cross-national evaluation of telephone advice lines using structured qualitative interviews. A patient and public involvement workshop was conducted to refine the framework. SETTING/PARTICIPANTS Professionals with responsibilities for how palliative care services are delivered and/or funded at a local or regional level, were purposively sampled. RESULTS Seventy-one interviews were conducted, covering 60 geographical areas. Five themes were identified. Availability: Ten advice line models were described. Variation led to confusion about who to call and when. Accessibility, awareness and promotion: It was assumed that patients/carers know who to call out-of-hours, but often they did not. Practicalities: Call handlers skills/expertise varied, which influenced how calls were managed. Possible responses ranged from signposting to organising home visits. Integration/continuity of care: Integration between care providers was limited by electronic medical records access/information sharing. Service structure/commissioning: Sustained funding was often an issue for charitably funded organisations. CONCLUSIONS Our novel evidence-based practical framework could be transformative for service design/delivery, as it presents key considerations relating to the various elements of advice lines that may impact on the patient/carer experience.
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Affiliation(s)
- Sophie Pask
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
| | - Allen Omoruyi
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Ahmed Mohamed
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Rachel L Chambers
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
| | - Phillippa G McFarlane
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
| | - Therese Johansson
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
| | - Rashmi Kumar
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
| | - Andy Woodhead
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
| | - Ikumi Okamoto
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Stephen Barclay
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Irene J Higginson
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
- King’s College Hospital NHS Foundation Trust, London, UK
| | - Katherine E Sleeman
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
- King’s College Hospital NHS Foundation Trust, London, UK
| | - Fliss EM Murtagh
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
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Nebsbjerg MA, Vestergaard CH, Bomholt KB, Christensen MB, Huibers L. Use of Video in Telephone Triage in Out-of-Hours Primary Care: Register-Based Study. JMIR Med Inform 2024; 12:e47039. [PMID: 38596835 PMCID: PMC11007381 DOI: 10.2196/47039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 02/07/2024] [Accepted: 02/10/2024] [Indexed: 04/11/2024] Open
Abstract
Background Out-of-hours primary care (OOH-PC) is challenging due to high workloads, workforce shortages, and long waiting and transportation times for patients. Use of video enables triage professionals to visually assess patients, potentially ending more contacts in a telephone triage contact instead of referring patients to more resource-demanding clinic consultations or home visits. Thus, video use may help reduce use of health care resources in OOH-PC. Objective This study aimed to investigate video use in telephone triage contacts to OOH-PC in Denmark by studying rate of use and potential associations between video use and patient- and contact-related characteristics and between video use and triage outcomes and follow-up contacts. We hypothesized that video use could serve to reduce use of health care resources in OOH-PC. Methods This register-based study included all telephone triage contacts to OOH-PC in 4 of the 5 Danish regions from March 15, 2020, to December 1, 2021. We linked data from the OOH-PC electronic registration systems to national registers and identified telephone triage contacts with video use (video contact) and without video use (telephone contact). Calculating crude incidence rate ratios and adjusted incidence rate ratios (aIRRs), we investigated the association between patient- and contact-related characteristics and video contacts and measured the frequency of different triage outcomes and follow-up contacts after video contact compared to telephone contact. Results Of 2,900,566 identified telephone triage contacts to OOH-PC, 9.5% (n=275,203) were conducted as video contacts. The frequency of video contact was unevenly distributed across patient- and contact-related characteristics; it was used more often for employed young patients without comorbidities who contacted OOH-PC more than 4 hours before the opening hours of daytime general practice. Compared to telephone contacts, notably more video contacts ended with advice and self-care (aIRR 1.21, 95% CI 1.21-1.21) and no follow-up contact (aIRR 1.08, 95% CI 1.08-1.09). Conclusions This study supports our hypothesis that video contacts could reduce use of health care resources in OOH-PC. Video use lowered the frequency of referrals to a clinic consultation or a home visit and also lowered the frequency of follow-up contacts. However, the results could be biased due to confounding by indication, reflecting that triage GPs use video for a specific set of reasons for encounters.
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Affiliation(s)
| | | | | | - Morten Bondo Christensen
- Research Unit for General Practice, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus C, Denmark
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Blinkenberg J, Hetlevik Ø, Sandvik H, Baste V, Hunskaar S. The impact of variation in out-of-hours doctors' referral practices: a Norwegian registry-based observational study. Fam Pract 2023; 40:728-736. [PMID: 36801994 PMCID: PMC10745277 DOI: 10.1093/fampra/cmad014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/20/2023] Open
Abstract
BACKGROUND In a gatekeeping system, the individual doctor's referral practice is an important factor for hospital activity and patient safety. OBJECTIVE The aim of the study was to investigate the variation in out-of-hours (OOH) doctors' referral practice, and to explore these variations' impact on admissions for selected diagnoses reflecting severity, and 30-day mortality. METHODS National data from the doctors' claims database were linked with hospital data in the Norwegian Patient Registry. Based on the doctor's individual referral rate adjusted for local organizational factors, the doctors were sorted into quartiles of low-, medium-low-, medium-high-, and high-referral practice. The relative risk (RR) for all referrals and for selected discharge diagnoses was calculated using generalized linear models. RESULTS The OOH doctors' mean referral rate was 110 referrals per 1,000 consultations. Patients seeing a doctor in the highest referring practice quartile had higher likelihood of being referred to hospital and diagnosed with the symptom of pain in throat and chest, abdominal pain, and dizziness compared with the medium-low quartile (RR 1.63, 1.49, and 1.95). For the critical conditions of acute myocardial infarction, acute appendicitis, pulmonary embolism, and stroke, we found a similar, but weaker, association (RR 1.38, 1.32, 1.24, and 1.19). The 30-day mortality among patients not referred did not differ between the quartiles. CONCLUSIONS Doctors with high-referral practice referred more patients who were later discharged with all types of diagnoses, including serious and critical conditions. With low-referral practice, severe conditions might have been overlooked, although the 30-day mortality was not affected.
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Affiliation(s)
- Jesper Blinkenberg
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre AS, Årstadveien 17, 5009 Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Årstadveien 17, 5009 Bergen, Norway
| | - Øystein Hetlevik
- Department of Global Public Health and Primary Care, University of Bergen, Årstadveien 17, 5009 Bergen, Norway
| | - Hogne Sandvik
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre AS, Årstadveien 17, 5009 Bergen, Norway
| | - Valborg Baste
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre AS, Årstadveien 17, 5009 Bergen, Norway
| | - Steinar Hunskaar
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre AS, Årstadveien 17, 5009 Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Årstadveien 17, 5009 Bergen, Norway
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Moore A, Knutsen Glette M. Nurses' experience with presenteeism and the potential consequences on patient safety: a qualitative study among nurses at out-of-hours emergency primary care facilities. BMJ Open 2023; 13:e076136. [PMID: 37989382 PMCID: PMC10668197 DOI: 10.1136/bmjopen-2023-076136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 10/31/2023] [Indexed: 11/23/2023] Open
Abstract
OBJECTIVES This study aimed to gain new insight and knowledge on out-of-hours emergency primary care nurses' experience of presenteeism in their workplace and their outlook on the impact they recognised the phenomenon to have on patient safety when caring for acute patients. DESIGN An explorative qualitative study. SETTING The study was conducted at three out-of-hours primary care facilities in southwest Norway. PARTICIPANTS A total of 10 female nurses were recruited as interviewees. Nurses providing direct patient care were included in the study. RESULTS The analysis resulted in four major themes: strong work ethics influence the decision to attend work unwell; work environment factors have a negative impact on nurses' health; nurses' awareness of consequences on the quality of care and patient safety and nurses make use of coping strategies when engaging in presenteeism. CONCLUSION Presenteeism is a common experience among nurses at out-of-hours emergency primary care clinics, with work-related stress being a significant contributing factor. Despite recognising a decrease in performance while engaging in presenteeism, nurses displayed adaptive behaviour. They were confident that their suboptimal health issues did not significantly impact patient safety while caring for acute patients. However, the true impact of presenteeism on patient safety in an out-of-hours emergency care setting remains uncertain due to the reliance on subjective reporting systems as quality indicators. More research is needed to understand the phenomenon and its implications on patient safety fully.
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Affiliation(s)
- Angelena Moore
- Department of Caring and Ethics, University of Stavanger, Faculty of Health Sciences, Department of Caring and Ethics, Stavanger, Norway
| | - Malin Knutsen Glette
- SHARE - Center of Resilience in Healthcare, University of Stavanger, Faculty of Health Sciences, Stavanger, Norway
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Manten A, De Clercq L, Rietveld RP, Lucassen WAM, Moll van Charante EP, Harskamp RE. Evaluation of the Marburg Heart Score and INTERCHEST score compared to current telephone triage for chest pain in out-of-hours primary care. Neth Heart J 2023; 31:157-165. [PMID: 36580267 PMCID: PMC10033786 DOI: 10.1007/s12471-022-01745-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2022] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Chest pain is a common and challenging symptom for telephone triage in urgent primary care. Existing chest-pain-specific risk scores originally developed for diagnostic purposes may outperform current telephone triage protocols. METHODS This study involved a retrospective, observational cohort of consecutive patients evaluated for chest pain at a large-scale out-of-hours primary care facility in the Netherlands. We evaluated the performance of the Marburg Heart Score (MHS) and INTERCHEST score as stand-alone triage tools and compared them with the current decision support tool, the Netherlands Triage Standard (NTS). The outcomes of interest were: C‑statistics, calibration and diagnostic accuracy for optimised thresholds with major events as the reference standard. Major events are a composite of all-cause mortality and both cardiovascular and non-cardiovascular urgent underlying conditions occurring within 6 weeks of initial contact. RESULTS We included 1433 patients, 57.6% women, with a median age of 55.0 years. Major events occurred in 16.4% (n = 235), of which acute coronary syndrome accounted for 6.8% (n = 98). For predicting major events, C‑statistics for the MHS and INTERCHEST score were 0.74 (95% confidence interval: 0.70-0.77) and 0.76 (0.73-0.80), respectively. In comparison, the NTS had a C-statistic of 0.66 (0.62-0.69). All had appropriate calibration. Both scores (at threshold ≥ 2) reduced the number of referrals (with lower false-positive rates) and maintained equal safety compared with the NTS. CONCLUSION Diagnostic risk stratification scores for chest pain may also improve telephone triage for major events in out-of-hours primary care, by reducing the number of unnecessary referrals without compromising triage safety. Further validation is warranted.
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Affiliation(s)
- A Manten
- Department of General Practice, Amsterdam UMC, Amsterdam Cardiovascular Sciences Research Institute, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - L De Clercq
- Department of General Practice, Amsterdam UMC, Amsterdam Cardiovascular Sciences Research Institute, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - R P Rietveld
- Huisartsenorganisatie Noord-Kennemerland, Alkmaar, The Netherlands
| | - W A M Lucassen
- Department of General Practice, Amsterdam UMC, Amsterdam Cardiovascular Sciences Research Institute, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - E P Moll van Charante
- Department of General Practice, Amsterdam UMC, Amsterdam Cardiovascular Sciences Research Institute, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam Public Health Research Institute, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - R E Harskamp
- Department of General Practice, Amsterdam UMC, Amsterdam Cardiovascular Sciences Research Institute, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
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Manten A, Rietveld RP, de Clercq L, van Hulst I, Lucassen WAM, Moll van Charante EP, Harskamp RE. Evaluation of telephone triage among chest pain patients in out-of-hours primary care in the Netherlands (TRACE). Fam Pract 2023; 40:23-29. [PMID: 35849343 PMCID: PMC9909662 DOI: 10.1093/fampra/cmac077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Telephone triage is fully integrated in Dutch out-of-hours primary care (OOH-PC). Patients presenting with chest pain are initially assessed according to a standardized protocol ("Netherlands Triage Standard" [NTS]). Nevertheless, little is known about its (diagnostic) performance, nor on the impact of subsequent clinical judgements made by triage assistants and general practitioners (GPs). OBJECTIVE To evaluate the performance of the current NTS chest pain protocol. METHODS Observational, retrospective cohort study of adult patients with chest pain who contacted a regional OOH-PC facility in the Netherlands, in 2017. The clinical outcome measure involved the occurrence of a "major event," which is a composite of all-cause mortality and urgent cardiovascular and noncardiovascular conditions, occurring ≤6 weeks of initial contact. We assessed the performance using diagnostic and discriminatory properties. RESULTS In total, 1,803 patients were included, median age was 54.0 and 57.5% were female. Major events occurred in 16.2% of patients with complete follow-up, including 99 (6.7%) cases of acute coronary syndrome and 22 (1.5%) fatal events. NTS urgency assessment showed moderate discriminatory abilities for predicting major events (c-statistic 0.66). Overall, NTS performance showed a sensitivity and specificity of 83.0% and 42.4% with a 17.0% underestimated major event rate. Triage assistants' revisions hardly improved urgency allocation. Further consideration of the clinical course following OOH-PC contact did generate a more pronounced improvement with a sensitivity of 89.4% and specificity of 61.9%. CONCLUSION Performance of telephone triage of chest pain appears moderate at best, with acceptable safety yet limited efficiency, even after including further work-up by GPs.
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Affiliation(s)
- Amy Manten
- Amsterdam UMC, University of Amsterdam, Academic Medical Center, Department of General Practice, Amsterdam Cardiovascular Sciences Research Institute, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Remco P Rietveld
- Huisartsenorganisatie Noord-Kennemerland, Hertog Aalbrechtweg 5A, 1823 DL Alkmaar, The Netherlands
| | - Lukas de Clercq
- Amsterdam UMC, University of Amsterdam, Academic Medical Center, Department of General Practice, Amsterdam Cardiovascular Sciences Research Institute, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Inge van Hulst
- Huisartsenorganisatie Noord-Kennemerland, Hertog Aalbrechtweg 5A, 1823 DL Alkmaar, The Netherlands
| | - Wim A M Lucassen
- Amsterdam UMC, University of Amsterdam, Academic Medical Center, Department of General Practice, Amsterdam Cardiovascular Sciences Research Institute, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Eric P Moll van Charante
- Amsterdam UMC, University of Amsterdam, Academic Medical Center, Department of General Practice, Amsterdam Cardiovascular Sciences Research Institute, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.,Amsterdam UMC, University of Amsterdam, Academic Medical Center, Department of Public & Occupational Health, Amsterdam Cardiovascular Sciences Research Institute, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Ralf E Harskamp
- Amsterdam UMC, University of Amsterdam, Academic Medical Center, Department of General Practice, Amsterdam Cardiovascular Sciences Research Institute, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
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Rebnord IK, Rortveit G, Huibers L, Dale JN, Smits M, Morken T. Pandemic preparedness and management in European out-of-hours primary care services - a descriptive study. BMC Health Serv Res 2023; 23:54. [PMID: 36658520 PMCID: PMC9849833 DOI: 10.1186/s12913-023-09059-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 01/11/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Primary care is the first point of contact for all acute health problems. As such, primary care was at the frontline in the COVID-19 pandemic, playing a significant role in clinical responses and information to the public. This study aimed to describe the variations in patient management strategies used in the out-of-hours services in different European countries during the first phase of the pandemic. METHOD We conducted a cross-sectional web-based survey in August 2020, selecting key informants from European countries using European networks. The questionnaire was developed in collaboration with researchers in the field of out-of-hours primary care. We performed descriptive analyses per region, structuring results into themes. RESULTS Key informants from 38 regions in 20 European countries responded. Seven regions reported that their out-of-hours services had a pandemic preparedness plan, three had trained on the plan, and two had stockpiles of personal protection equipment before the outbreak. Extension of telephone triage lines and establishment of local infection-control teams and clinics were the main patient management strategies. Other strategies for patient contacts were also used in the regions, such as video-consultations (13 regions), electronic consultations (21 regions), patient's car as alternative waiting room (19 regions), outside tents for testing (24 regions), "drive-through" testing (26 regions), and separate departments for infected patients (14 regions). CONCLUSION Few out-of-hours services were well prepared for a pandemic, but all expanded and reorganized rapidly, adopting new strategies for patient management and treatment. The results could be useful for planning of organization preparedness of out-of-hours primary care service for future pandemics.
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Affiliation(s)
- Ingrid Keilegavlen Rebnord
- grid.7914.b0000 0004 1936 7443Department of Global Public Health and Primary Care, University of Bergen, Bergen , Norway ,grid.509009.5National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen, Norway
| | - Guri Rortveit
- grid.7914.b0000 0004 1936 7443Department of Global Public Health and Primary Care, University of Bergen, Bergen , Norway ,grid.509009.5Research Unit for General Practice, NORCE Norwegian Research Centre, Bergen, Norway
| | - Linda Huibers
- grid.7048.b0000 0001 1956 2722Research Unit for General Practice, Aarhus University, Aarhus, Denmark
| | - Jonas Nordvik Dale
- grid.509009.5National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen, Norway
| | - Marleen Smits
- grid.10417.330000 0004 0444 9382Scientific Center for Quality of Healthcare (IQ healthcare), Radboud university medical center, Nijmegen, The Netherlands
| | - Tone Morken
- grid.509009.5National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen, Norway
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Lindberg BH, Rebnord IK, Høye S. Effect of an educational intervention for telephone triage nurses on out-of-hours attendance: a pragmatic randomized controlled study. BMC Health Serv Res 2023; 23:4. [PMID: 36597106 PMCID: PMC9807970 DOI: 10.1186/s12913-022-08994-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 12/20/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Telephone triage has been established in many countries as a response to the challenge of non-urgent use of out-of-hours primary care services. However, limited evidence is available regarding the effect of training interventions on clinicians' telephone consultation skills and patient outcomes. METHODS This was a pragmatic randomized controlled educational intervention for telephone triage nurses in 59 Norwegian out-of-hours general practitioners' (GPs) cooperatives, serving 59% of the Norwegian population. Computer-generated randomization was performed at the level of out-of-hours GP cooperatives, stratified by the population size. Thirty-two out-of-hours GP cooperatives were randomized to intervention. One cooperative did not accept the invitation to participate in the educational programme, leaving 31 cooperatives in the intervention group. The intervention comprised a 90-minute e-learning course and 90-minute group discussion about respiratory tract infections (RTIs), telephone communication skills and local practices. We aimed to assess the effect of the intervention on out-of-hours attendance and describe the distribution of RTIs between out-of-hours GP cooperatives and list-holding GPs. The outcome was the difference in the number of doctor's consultations per 1000 inhabitants between the intervention and control groups during the winter months before and after the intervention. A negative binomial regression model was used for the statistical analyses. The model was adjusted for the number of nurses who had participated in the e-learning course, the population size and patients' age groups, with the out-of-hours GP cooperatives defined as clusters. RESULTS The regression showed that the intervention did not change the number of consultations for RTIs between the two groups of out-of-hours GP cooperatives (incidence rate ratio 0.99, 95% confidence interval 0.91-1.07). The winter season's out-of-hours patient population was younger and had a higher proportion of RTIs than the patient population in the list-holding GP offices. Laryngitis, sore throat, and pneumonia were the most common diagnoses during the out-of-hours primary care service. CONCLUSIONS The intervention did not influence the out-of-hours attendance. This finding may be due to the intervention's limited scope and the intention-to-treat design. Changing a population's out-of-hours attendance is complicated and needs to be targeted at several organizational levels.
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Affiliation(s)
- Bent Håkan Lindberg
- grid.5510.10000 0004 1936 8921Antibiotic Centre for Primary Care, Department of General Practice, Institute of Health and Society, University of Oslo, 0315 Oslo, Norway
| | - Ingrid Keilegavlen Rebnord
- grid.509009.5National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen, Norway ,grid.7914.b0000 0004 1936 7443Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Sigurd Høye
- grid.5510.10000 0004 1936 8921Antibiotic Centre for Primary Care, Department of General Practice, Institute of Health and Society, University of Oslo, 0315 Oslo, Norway
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11
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Johannessen TR, Halvorsen S, Atar D, Munkhaugen J, Nore AK, Wisløff T, Vallersnes OM. Cost-effectiveness of a rule-out algorithm of acute myocardial infarction in low-risk patients: emergency primary care versus hospital setting. BMC Health Serv Res 2022; 22:1274. [PMID: 36271364 PMCID: PMC9587629 DOI: 10.1186/s12913-022-08697-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 10/18/2022] [Indexed: 11/24/2022] Open
Abstract
Aims Hospital admissions of patients with chest pain considered as low risk for acute coronary syndrome contribute to increased costs and crowding in the emergency departments. This study aims to estimate the cost-effectiveness of assessing these patients in a primary care emergency setting, using the European Society of Cardiology (ESC) 0/1-h algorithm for high-sensitivity cardiac troponin T, compared to routine hospital management. Methods A cost-effectiveness analysis was conducted. For the primary care estimates, costs and health care expenditure from the observational OUT-ACS (One-hoUr Troponin in a low-prevalence population of Acute Coronary Syndrome) study were compared with anonymous extracted administrative data on low-risk patients at a large general hospital in Norway. Patients discharged home after the hs-cTnT assessment were defined as low risk in the primary care cohort. In the hospital setting, the low-risk group comprised patients discharged with a non-specific chest pain diagnosis (ICD-10 codes R07.4 and Z03.5). Loss of health related to a potential increase in acute myocardial infarctions the following 30-days was estimated. The primary outcome measure was the costs per quality-adjusted life year (QALY) of applying the ESC 0/1-h algorithm in primary care. The secondary outcomes were health care costs and length of stay in the two settings. Results Differences in costs comprise personnel and laboratory costs of applying the algorithm at primary care level (€192) and expenses related to ambulance transports and complete hospital costs for low-risk patients admitted to hospital (€1986). Additional diagnostic procedures were performed in 31.9% (181/567) of the low-risk hospital cohort. The estimated reduction in health care cost when using the 0/1-h algorithm outside of hospital was €1794 per low-risk patient, with a mean decrease in length of stay of 18.9 h. These numbers result in an average per-person QALY gain of 0.0005. Increased QALY and decreased costs indicate that the primary care approach is clearly cost-effective. Conclusion Using the ESC 0/1-h algorithm in low-risk patients in emergency primary care appears to be cost-effective compared to standard hospital management, with an extensive reduction in costs and length of stay per patient.
Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08697-6.
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Affiliation(s)
- Tonje R Johannessen
- Department of General Practice, Institute of Health and Society, University of Oslo, 1130 Blindern, 0318, Oslo, NO, Norway. .,Oslo Accident and Emergency Outpatient Clinic, City of Oslo Health Agency, Oslo, Norway.
| | - Sigrun Halvorsen
- Department of Cardiology, Oslo University Hospital Ullevaal, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Dan Atar
- Department of Cardiology, Oslo University Hospital Ullevaal, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - John Munkhaugen
- Department of Medicine, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway.,Department of Behavioural Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Anne Kathrine Nore
- Oslo Accident and Emergency Outpatient Clinic, City of Oslo Health Agency, Oslo, Norway
| | - Torbjørn Wisløff
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Odd Martin Vallersnes
- Department of General Practice, Institute of Health and Society, University of Oslo, 1130 Blindern, 0318, Oslo, NO, Norway.,Oslo Accident and Emergency Outpatient Clinic, City of Oslo Health Agency, Oslo, Norway
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12
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Zinger ND, Blomberg SN, Lippert F, Krafft T, Christensen HC. Impact of integrating out-of-hours services into Emergency Medical Services Copenhagen: a descriptive study of transformational years. Int J Emerg Med 2022; 15:40. [PMID: 36008756 PMCID: PMC9414103 DOI: 10.1186/s12245-022-00442-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 08/19/2022] [Indexed: 11/18/2022] Open
Abstract
Background Many emergency medical services and out-of-hours systems are facing an increasing demand for primary, ambulance, and secondary care services caused by population aging and a higher prevalence of long-term and complex conditions. In order to ensure safety and efficiency for future demands, many systems are changing their dispersed healthcare services towards a more integrated care system. Therefore, an evaluation of the production and performance over time of such a unified system is desirable. Methods This retrospective quantitative study was performed with dispatch and financial accounting data of Copenhagen Emergency Medical Services for the period 2010–2019. Copenhagen Emergency Medical Services operates both an emergency number and a medical helpline for out-of-hours services. The number of calls to the emergency number, the centralized out-of-hours medical helpline, the number of dispatches, and the annual expenditure of the system are described for both the periods before and after the major reforms. Production of the emergency number and the centralized medical helpline were analyzed separately. Results The average number of dispatches increased from 328 per 10,000 inhabitants in 2010 to 361 per 10,000 inhabitants in 2019. The newly initiated medical helpline received 533 calls per 10,000 inhabitants in its first year and 5 years later 548 calls per 10,000 inhabitants. A cost increase of 10% was observed in the first year after the reforms, but it decreased again to 8% in the following year. Conclusions There is a population demand for a centralized telephone access point for (semi-)emergency medical services. A more integrated EMS system is promising for a sustainable healthcare provision for a growing population with complex healthcare demands and multi-morbidities.
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Affiliation(s)
- Nienke D Zinger
- Emergency Medical Services Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - Stig Nikolaj Blomberg
- Emergency Medical Services Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - Freddy Lippert
- Emergency Medical Services Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Krafft
- Department of Health, Ethics & Society, CAPHRI School of Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Helle Collatz Christensen
- Emergency Medical Services Copenhagen, University of Copenhagen, Copenhagen, Denmark. .,Danish Clinical Quality Program (RKKP), National Clinical Registries, Copenhagen, Denmark.
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13
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Cost effects of nurse led triage at an emergency department with the advice to consult the adjacent general practice cooperative for low-risk patients, a cluster randomised trial. Health Policy 2022; 126:980-987. [DOI: 10.1016/j.healthpol.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 06/20/2022] [Accepted: 08/02/2022] [Indexed: 11/19/2022]
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14
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Priority setting and cross-country learning: the relevance of TO-REACH for primary care. Prim Health Care Res Dev 2022; 23:e40. [PMID: 35866473 PMCID: PMC9309752 DOI: 10.1017/s1463423622000287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim: To inform the primary care community about priorities for research in primary care as came up from the European project TO-REACH and to discuss transferability of service and policy innovations between countries. Background: TO-REACH stands for Transfer of Organizational innovations for Resilient, Effective, equitable, Accessible, sustainable and Comprehensive Health services and systems. This EU-funded project has put health systems and services research higher on the European agenda and has led to the current development of a European ‘Partnership Transforming Health and Care Systems’. Methods: To identify research priorities, both qualitative and quantitative approaches were used. Policy documents and strategic roadmaps were searched, and priorities were mapped. Stakeholders were involved through national roundtable consultations and online consultations. Regarding transferability, we carried out a review of the literature, guided by a conceptual framework, and using a snowballing approach. Findings: Primary care emerged as an important priority from the inventory, as are areas that are conducive to strengthening primary care, such as workforce policies. The large variation in service organisation and policy around primary care in Europe is a huge potential for cross-country learning. However, the simple transfer of primary care service and policy arrangements from one health system to another has a big chance to fail, unless known conditions for successful transfer are taken into account and gaps in our knowledge about transfer are resolved.
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15
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MORROW J, LAHER AE. Financial burden associated with attendance at a public hospital emergency department in Johannesburg. Afr J Emerg Med 2022; 12:102-105. [PMID: 35251920 PMCID: PMC8886001 DOI: 10.1016/j.afjem.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 01/01/2022] [Accepted: 02/08/2022] [Indexed: 11/19/2022] Open
Abstract
Poverty and inequality are two of the most significant issues affecting people living in Africa Catastrophic health care expenditure (CHCE), which is out-of-pocket expenditure on medical care that leads to a severe financial burden for the individual or household, affects 44 million individuals from 150 million households globally Various expenses including transport costs, general practitioner fees acquired prior to the EC visit, loans and loss of usual daily income contribute to the financial burden associated with a visit to the EC
Introduction: More than half of South Africans live below the poverty line. Indirect medical costs can contribute significantly to the financial burden of patients seeking medical care. The aim of this study was to determine the expenses incurred by patients and/or their escorts during a visit to the emergency centre (EC). Methods: Patients and/or their escorts presenting to an EC in Johannesburg were asked to complete the study questionnaire relating to expenses incurred during a visit to the EC. Results: Of the total 396 participants that completed the questionnaire, 108 (27.2%) did not have any source of income, 146 (36.9%) were the sole breadwinner in their household and 36 (9.1%) belonged to zero-income households. Among those earning ≤R2000 per month, the mean expenses relating to the EC visit was R240 (SD R372), equating to an average of 33.2% of mean monthly income. Transport costs were the most common expense (n=302, 76.3%), while general practitioner (GP) fees incurred prior to the EC visit accounted for the bulk of the expenses (median R450, IQR 350-820). Participants that earned >R2000 per month were significantly more likely to incur GP fees (p =0.012), while those earning ≤R2000 per month were significantly more likely to take a loan to cover EC related expenses (p =0.014). Conclusion: A visit to the EC can have a substantial financial impact on patients and their accompanying escorts in South Africa. Strategies should be aimed at identifying and assisting those that are in need of financial assistance to cover indirect healthcare costs.
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16
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Svedahl ER, Pape K, Austad B, Vie GÅ, Anthun KS, Carlsen F, Bjørngaard JH. Effects of GP characteristics on unplanned hospital admissions and patient safety. A 9-year follow-up of all Norwegian out-of-hours contacts. Fam Pract 2022; 39:381-388. [PMID: 34694363 PMCID: PMC9155163 DOI: 10.1093/fampra/cmab120] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND There are substantial differences in hospital referrals between general practitioners (GPs); however, there is little research on the consequences for patient safety and further healthcare use. OBJECTIVE To investigate associations between out-of-hours GP characteristics, unplanned hospital admissions, and patient safety. METHODS This cohort study included all Norwegian out-of-hours services contacts from 2008 to 2016, linked to registry data on patient characteristics, healthcare use and death, and GP age, sex, specialist status, out-of-hours service experience, and prior admission proportion. We estimated the impact from GP characteristics on (i) immediate unplanned hospital admissions for "all conditions," (ii) immediate unplanned hospital admissions for "critical conditions," (iii) 30-day unplanned hospital admissions, (iv) 30-day hospital costs, and (v) 30-day risk of death. To limit confounding, we matched patients in groups by age, time, and location, with an assumption of random assignment of GPs to patients with this design. RESULTS Patients under the care of older and male GPs had fewer immediate unplanned hospital admissions, but the effects on cumulative 30-day unplanned hospital admissions and costs were small. The GPs' prior admission proportion was strongly associated with both immediate and 30-day unplanned hospital admissions. Higher prior admission proportion was also associated with admitting more patients with critical conditions. There was little evidence of any associations between GP characteristics and 30-day risk of death. CONCLUSIONS GPs' prior admission proportion was strongly associated with unplanned hospital admissions. We found little effects on 30-day mortality, but more restrictive referral practices may threaten patient safety through missing out on critical cases.
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Affiliation(s)
- Ellen Rabben Svedahl
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kristine Pape
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Bjarne Austad
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Gunnhild Åberge Vie
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kjartan Sarheim Anthun
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Health Research, SINTEF Digital, Trondheim, Norway
| | - Fredrik Carlsen
- Department of Economics, Norwegian University of Science and Technology, Trondheim, Norway
| | - Johan Håkon Bjørngaard
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.,Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
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17
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Heidet M, Tazarourte K, Mermet É, Freyssenge J, Mellouk A, Khellaf M, Lecarpentier É. Accessibilité aux soins en situation d’urgence : des déterminants complexes, un besoin d’outils novateurs. ANNALES FRANCAISES DE MEDECINE D URGENCE 2022. [DOI: 10.3166/afmu-2022-0426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Les délais d’accès aux soins sont directement associés au pronostic de nombreuses situations et pathologies urgentes telles que l’arrêt cardiaque extrahospitalier, l’accident vasculaire cérébral, l’infarctus du myocarde ou le traumatisme grave. Ils représentent ainsi un critère de qualité et d’efficacité du système préhospitalier. Or, les déterminants de l’accessibilité aux soins urgents, donc des délais de prise en charge préhospitalière jusqu’au soin définitif, sont multiples, intriquant notamment des dimensions organisationnelles, géographiques et socioéconomiques, captées par différentes définitions de l’accessibilité aux soins. La mesure de l’accessibilité aux soins urgents est donc complexe et nécessite l’emploi de méthodes spécifiques. Ses déterminants sont sujets à d’importantes disparités territoriales, tant sur le plan national que local, qui conduisent à de fortes inégalités de santé en situation urgente. L’organisation du système de soins préhospitaliers doit ainsi prendre en compte l’ensemble des définitions de l’accessibilité en vie réelle, afin de répondre à des objectifs de performance ajustés aux enjeux particuliers des pathologies traceuses les plus urgentes. Les prochaines évolutions organisationnelles et technologiques en médecine d’urgence devraient permettre de mieux appréhender les déterminants de l’accessibilité à toutes les phases de la prise en charge préhospitalière, vers un rééquilibrage de l’inadéquation entre les besoins réels et l’offre possible de soins urgents.
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18
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Rutten MH, Giesen PHJ, Assendelft WJJ, Westert G, Smits M. Effects of access to radiology in out-of-hours primary care on patient satisfaction and length of stay. Eur J Gen Pract 2021; 27:221-227. [PMID: 34369252 PMCID: PMC8354153 DOI: 10.1080/13814788.2021.1959911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Direct access to hospital radiology facilities by general practitioner (GP) cooperatives is known to decrease the number of emergency department referrals, but the effects on length of stay (LOS; time from patient arrival at GP cooperative till departure to home) and patient experiences are unclear. OBJECTIVES To provide insight into the LOS and experiences of trauma patients with an indication for radiology at GP cooperatives with and without access to radiology. METHODS A multi-methods observational study in April 2014-October 2015 at six GP cooperatives in The Netherlands, covering three organisational models for access to radiology: no direct access, limited access and unlimited access. Patient experiences were measured with a questionnaire. Patient records were analysed for background characteristics, radiology outcomes, referral and LOS. RESULTS In total 657 patients were included, 232 no direct access model, 307 limited access model and 118 unlimited access model. The mean LOS was 99 minutes, with a significant difference between GP cooperatives without access to radiology (121 minutes), with limited access (86 minutes), and with unlimited access (90 minutes). The differences were larger for patients without radiological abnormalities. On a ten-point scale, patients rated GP cooperatives with unlimited access to radiology higher (8.62) than those without access (8.36) or with limited access (8.39). CONCLUSION Access to radiology by GP cooperatives seems to reduce the length of stay and is slightly more appreciated by patients. GP cooperatives with unlimited access seem to provide the most efficient and best-valued care, contributing to more patient-centred care.
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Affiliation(s)
- Martijn H Rutten
- Radboud University Medical Centre, Radboud Institute for Health Sciences, Scientific Centre for Quality of Healthcare (IQ healthcare), Nijmegen, The Netherlands
| | - Paul H J Giesen
- Radboud University Medical Centre, Radboud Institute for Health Sciences, Scientific Centre for Quality of Healthcare (IQ healthcare), Nijmegen, The Netherlands
| | - Willem J J Assendelft
- Department of Primary and Community Care Nijmegen, Radboud University Medical Centre, Radboud Institute for Health Sciences, The Netherlands
| | - Gert Westert
- Radboud University Medical Centre, Radboud Institute for Health Sciences, Scientific Centre for Quality of Healthcare (IQ healthcare), Nijmegen, The Netherlands
| | - Marleen Smits
- Radboud University Medical Centre, Radboud Institute for Health Sciences, Scientific Centre for Quality of Healthcare (IQ healthcare), Nijmegen, The Netherlands
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19
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Exalto LG, van Doorn S, Erkelens DCA, Smit K, Rutten FH, Kappelle LJ, Zwart DLM. Call Characteristics of Patients Suspected of Transient Ischemic Attack (TIA) or Stroke During Out-of-Hours Service: A Comparison Between Men and Women. Front Neurol 2021; 12:669090. [PMID: 34194384 PMCID: PMC8238082 DOI: 10.3389/fneur.2021.669090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 04/13/2021] [Indexed: 11/30/2022] Open
Abstract
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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Affiliation(s)
- Lieza G Exalto
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Sander van Doorn
- Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - D Carmen A Erkelens
- Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Karin Smit
- Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Frans H Rutten
- Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - L Jaap Kappelle
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Dorien L M Zwart
- Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
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20
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Lindberg BH, Rebnord IK, Høye S. Phone triage nurses' assessment of respiratory tract infections - the tightrope walk between gatekeeping and service providing. A qualitative study. Scand J Prim Health Care 2021; 39:139-147. [PMID: 33792485 PMCID: PMC8293966 DOI: 10.1080/02813432.2021.1908715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Phone nurses triage callers to Norwegian out-of-hours cooperatives to estimate the appropriate urgency and level of care for the caller. Many callers with mild symptoms of respiratory tract infections receive a doctor's consultation, which may lead to busy sessions and in turn impair clinical decisions. OBJECTIVE This study explores how phone triage nurses assess callers with mild-to-moderate symptoms of respiratory tract infections and their views and experiences on triaging and counselling these callers. METHODS We conducted four focus groups with 22 nurses (five men and 17 women aged 24-66 years) in three different locations in Norway. The interviews were transcribed verbatim and analysed by systematic text condensation. RESULTS The informants were reluctant to call themselves gatekeepers. However, their description of their work indicates that they practice such a role. When nurses and callers disagreed about the right level of care, the informants sought consensus through strategies and negotiations. The informants described external factors such as organisational or financial issues as decisive for the population's use of out-of-hours services. They also described callers' characteristics, such as language deficiency and poor ability to describe symptoms, as determining their own clinical assessments. CONCLUSIONS Nurses perceive assessments of callers with respiratory tract infections as challenging. They need skills and time to reach a consensus with the callers and guide them to the right level of health care. This should be considered when planning nurse training and staffing of out-of-hours cooperatives.KEY-POINTSPhone triage nurses assess callers to the out-of-hours service and estimate the level of urgencyThis study explores how phone triage nurses assess callers with respiratory tract infections and their views and experiences on this taskThe nurses describe their professional role as a tightrope walk between gatekeeping and service providingThe nurses seek consensus with callers through strategies and negotiations.
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Affiliation(s)
- Bent Håkan Lindberg
- Antibiotic Centre for Primary Care, Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Ingrid Keilegavlen Rebnord
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Sigurd Høye
- Antibiotic Centre for Primary Care, Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
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Impact of a telephone triage service for non-critical emergencies in Switzerland: A cross-sectional study. PLoS One 2021; 16:e0249287. [PMID: 33798216 PMCID: PMC8018644 DOI: 10.1371/journal.pone.0249287] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 03/15/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Telephone triage services (TTS) play an increasing role in the delivery of healthcare. The objective of this study was to characterize the adult users of a TTS for non-critical emergencies, describe the types of advice given and their subsequent observation, and assess the influence of TTS on the use of the healthcare system in a sanitary region of Switzerland. METHODS Data from a TTS based in the French part of Switzerland were analyzed. This service consists of a medical contact center for non-critical emergencies, with trained nurses available 24/7. A random selection of 2,034 adult calls was performed between July and December 2018. Research students contacted users 2 to 4 weeks after the initial call and assessed sociodemographic and clinical data, as well as the impact of the advice received on the use of the healthcare system. RESULTS A sample of 412 users was included in the analyses. The average age was 49.0 (SD 20.4) years; 68.5% were women and 72.8% of Swiss origin. The two main recommendations provided by nurses were to consult the emergency department (ED) (44.6%, n = 184) and to contact a physician on duty (33.2%, n = 137). The majority of users followed the advice given by the nurses (substantial agreement [k = 0.79] with consulting the ED and perfect agreement [k = 0.87] with contacting a physician on duty). We calculated that calling the TTS could decrease the intention to visit the ED by 28.1%. CONCLUSION TTS for non-critical emergencies have the potential to decrease the use of ED services.
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Garattini L, Badinella Martini M, Mannucci PM. Improving primary care in Europe beyond COVID-19: from telemedicine to organizational reforms. Intern Emerg Med 2021; 16:255-258. [PMID: 33196973 PMCID: PMC7668282 DOI: 10.1007/s11739-020-02559-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 10/30/2020] [Indexed: 12/04/2022]
Abstract
The COVID-19 pandemic has put under pressure all the health national systems in Europe and telemedicine (TM) has been an almost unavoidable answer for primary care (PC) services to constrain the contagion. PC includes all the healthcare services that are the first level of contact for individuals. General practitioners (GPs) are the pivotal providers of PC throughout Europe. Although GP costs are mainly covered by public services or social insurances in Europe, they are still self-employed physicians everywhere, differently from their colleagues in hospitals who are traditionally employees. TM is a very general term open to various interpretations and definitions. TM can now be practiced by means of modern audio-visual devices and is an alternative to the traditional face-to-face consultation in general practice. Although the adoption of TM seems to be compelling in our era, its practical dissemination in PC has been quite slow so far, and many different concerns have been raised on it. On the whole, TM widespread adoption in PC seems to be more a matter of labor organization and health care funding than of technology and ethics. Larger-scale organizations comprising a wide range of health professionals have become a pressing priority for a modern PC, because working together is crucial to provide high-quality care to patients, and co-location should boost teamwork and facilitate the management of information technology. A national network of large organizations in PC could be rationally managed through local budgets and should increase efficiency by adopting tools such as TM.
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Affiliation(s)
- Livio Garattini
- Institute for Pharmacological Research Mario Negri IRCCS, Ranica, BG, Italy.
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23
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Garattini L, Badinella Martini M, Zanetti M. More room for telemedicine after COVID-19: lessons for primary care? THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2021; 22:183-186. [PMID: 33231825 PMCID: PMC7683583 DOI: 10.1007/s10198-020-01248-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/11/2020] [Indexed: 05/05/2023]
Affiliation(s)
- Livio Garattini
- Institute for Pharmacological Research Mario Negri IRCCS, Ranica, Italy.
| | | | - Michele Zanetti
- Institute for Pharmacological Research Mario Negri IRCCS, Ranica, Italy
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24
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Khan MB. “Review” a core pillar of urgent care provision in primary care. J Family Med Prim Care 2020; 9:5072-5073. [PMID: 33209850 PMCID: PMC7652142 DOI: 10.4103/jfmpc.jfmpc_894_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 06/16/2020] [Accepted: 07/01/2020] [Indexed: 11/17/2022] Open
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