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Sexton V, Dale J, Bryce C, Barry J, Sellers E, Atherton H. Service use, clinical outcomes and user experience associated with urgent care services that use telephone-based digital triage: a systematic review. BMJ Open 2022; 12:e051569. [PMID: 34980613 PMCID: PMC8724705 DOI: 10.1136/bmjopen-2021-051569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To evaluate service use, clinical outcomes and user experience related to telephone-based digital triage in urgent care. DESIGN Systematic review and narrative synthesis. DATA SOURCES Medline, Embase, CINAHL, Web of Science and Scopus were searched for literature published between 1 March 2000 and 1 April 2020. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Studies of any design investigating patterns of triage advice, wider service use, clinical outcomes and user experience relating to telephone based digital triage in urgent care. DATA EXTRACTION AND SYNTHESIS Two reviewers extracted data and conducted quality assessments using the mixed methods appraisal tool. Narrative synthesis was used to analyse findings. RESULTS Thirty-one studies were included, with the majority being UK based; most investigated nurse-led digital triage (n=26). Eight evaluated the impact on wider healthcare service use following digital triage implementation, typically reporting reduction or no change in service use. Six investigated patient level service use, showing mixed findings relating to patients' adherence with triage advice. Evaluation of clinical outcomes was limited. Four studies reported on hospitalisation rates of digitally triaged patients and highlighted potential triage errors where patients appeared to have not been given sufficiently high urgency advice. Overall, service users reported high levels of satisfaction, in studies of both clinician and non-clinician led digital triage, but with some dissatisfaction over the relevance and number of triage questions. CONCLUSIONS Further research is needed into patient level service use, including patients' adherence with triage advice and how this influences subsequent use of services. Further evaluation of clinical outcomes using larger datasets and comparison of different digital triage systems is needed to explore consistency and safety. The safety and effectiveness of non-clinician led digital triage also needs evaluation. Such evidence should contribute to improvement of digital triage tools and service delivery. PROSPERO REGISTRATION NUMBER CRD42020178500.
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Affiliation(s)
- Vanashree Sexton
- Unit of Academic Primary Care, Warwick Medical School, University of Warwick, Coventry, UK
| | - Jeremy Dale
- Unit of Academic Primary Care, Warwick Medical School, University of Warwick, Coventry, UK
| | - Carol Bryce
- Unit of Academic Primary Care, Warwick Medical School, University of Warwick, Coventry, UK
| | - James Barry
- Unit of Academic Primary Care, Warwick Medical School, University of Warwick, Coventry, UK
| | - Elizabeth Sellers
- Unit of Academic Primary Care, Warwick Medical School, University of Warwick, Coventry, UK
| | - Helen Atherton
- Unit of Academic Primary Care, Warwick Medical School, University of Warwick, Coventry, UK
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Jansen T, Verheij RA, Schellevis FG, Kunst AE. Use of out-of-hours primary care in affluent and deprived neighbourhoods during reforms in long-term care: an observational study from 2013 to 2016. BMJ Open 2019; 9:e026426. [PMID: 30872553 PMCID: PMC6429913 DOI: 10.1136/bmjopen-2018-026426] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 12/11/2018] [Accepted: 01/21/2019] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Major long-term care (LTC) reforms in the Netherlands in 2015 may specifically have disadvantaged socioeconomically deprived groups to acquire LTC, possibly impacting the use of acute care. We aimed to demonstrate whether LTC reforms coincided with changes in the use of out-of-hours (OOH) primary care services (PCSs), and to compare changes between deprived versus affluent neighbourhoods. DESIGN Ecological observational retrospective study using routinely recorded electronic health records data from 2013 to 2016 and population registry data. SETTING Data from 15 OOH PCSs participating in the Nivel Primary Care Database (covering approximately 6.5 million inhabitants) in the Netherlands. PCS utilisation data on neighbourhood level were matched with sociodemographic characteristics, including neighbourhood socioeconomic status (SES). PARTICIPANTS Electronic health records from 6 120 384 OOH PCS contacts in 2013-2016, aggregated to neighbourhood level. OUTCOME MEASURES AND ANALYSES Number of contacts per 1000 inhabitants/year (total, high/low-urgency, night/evening-weekend-holidays, telephone consultations/consultations/home visits).Multilevel linear regression models included neighbourhood (first level), nested within PCS catchment area (second level), to account for between-PCS variation, adjusted for neighbourhood characteristics (for instance: % men/women). Difference-in-difference in time-trends according to neighbourhood SES was assessed with addition of an interaction term to the analysis (year×neighbourhood SES). RESULTS Between 2013 and 2016, overall OOH PCS use increased by 6%. Significant increases were observed for high-urgency contacts and contacts during the night. The largest change was observed for the most deprived neighbourhoods (10% compared with 4%-6% in the other neighbourhoods; difference not statistically significant). The increasing trend in OOH PCS use developed practically similar for deprived and affluent neighbourhoods. A a stable gradient reflected more OOH PCS use for each lower stratum of SES. CONCLUSIONS LTC reforms coincided with an overall increase in OOH PCS use, with nearly similar trends for deprived and affluent neighbourhoods. The results suggest a generalised spill over to OOH PCS following LTC reforms.
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Affiliation(s)
- Tessa Jansen
- Department of Primary Care, Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Robert A Verheij
- Department of Primary Care, Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Francois G Schellevis
- Department of Primary Care, Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
- Department of General Practice & Elderly Care Medicine, Amsterdam Public Health Research Institute Amsterdam University Medical Centers | Location VUmc, Amsterdam, The Netherlands
| | - Anton E Kunst
- Department of Public Health, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands
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Ebert JF, Huibers L, Christensen B, Lippert FK, Christensen MB. Giving callers the option to bypass the telephone waiting line in out-of-hours services: a comparative intervention study. Scand J Prim Health Care 2019; 37:120-127. [PMID: 30712448 PMCID: PMC6452808 DOI: 10.1080/02813432.2019.1569427] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE Acute out-of-hours (OOH) healthcare is challenged by potentially long waiting time for callers in acute need of medical aid. OOH callers must usually wait in line, even when contacting for highly urgent or life-threatening conditions. We tested an emergency access button (EAB), which allowed OOH callers to bypass the waiting line if they perceived their health problem as severe. We aimed to investigate EAB use and patient characteristics associated with this use. DESIGN Comparative intervention study. SETTING OOH services in two major Danish healthcare regions. INTERVENTION Giving callers the option to bypass the telephone waiting line by introducing an EAB. PARTICIPANTS OOH service callers contacting during end of October to mid-December 2017. MAIN OUTCOME MEASURES Proportions of EAB use, waiting time and background information on participants in two settings differing on organisation structure, waiting time and triage personnel. RESULTS In total, 97,791 out of 158,784 callers (61.6%) chose to participate. The EAB was used 2905 times out of 97,791 (2.97%, 95%CI 2.86; 3.08). Patient characteristics associated with increased EAB use were male gender, higher age, low education, being retired, and increasing announced estimated waiting time. In one region, immigrants used the EAB more often than native Danish callers. CONCLUSION Only about 3% of all callers chose to bypass the waiting line in the OOH service when given the option. This study suggests that the EAB could serve as a new and simple tool to reduce the waiting time for severely ill patients in an OOH service telephone triage setting. Key Points Acute out-of-hours healthcare is challenged by overcrowding and increasing demand for services. This study shows that only approximately 3% of callers chose to bypass the telephone waiting queue when given the opportunity through an emergency access button. An emergency access button may serve as a new tool to help reduce the triage waiting time for severely ill patients in out-of-hours medical facilities.
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Affiliation(s)
- J. F. Ebert
- Section for General Medical Practice, Department of Public Health, Aarhus University, Aarhus C, Denmark;
- Research Unit for General Practice, Aarhus C, Denmark;
- CONTACT Jonas F. Ebert Research Unit for General Practice, Bartholins Allé 2, DK-8000Aarhus C, Denmark
| | - L. Huibers
- Research Unit for General Practice, Aarhus C, Denmark;
| | - B. Christensen
- Section for General Medical Practice, Department of Public Health, Aarhus University, Aarhus C, Denmark;
| | - F. K. Lippert
- Emergency Medical Services Copenhagen, University of Copenhagen, Copenhagen, Denmark
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Keizer E, Christensen MB, Carlsen AH, Smits M, Wensing M, Senn O, Huibers L. Factors related to out-of-hours help-seeking for acute health problems: a survey study using case scenarios. BMC Public Health 2019; 19:33. [PMID: 30621741 PMCID: PMC6323727 DOI: 10.1186/s12889-018-6332-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 12/17/2018] [Indexed: 12/01/2022] Open
Abstract
Background The acute out-of-hours healthcare services are challenged by increasing demand in many countries. We aimed to examine factors influencing the intended help-seeking in out-of-hours care for acute health problems during evenings, nights, and weekends. Methods We conducted a survey study based on data from parents of children (aged 0–4 years) and adults (aged 30–39 and 50–59 years) in Denmark, the Netherlands and Switzerland. Intended help-seeking behaviour was measured by six hypothetical case scenarios. We used Andersen’s Behavioural Model to categorise potentially influential factors and applied multiple binomial regression to assess the influence of selected factors. Results A total of 1015 parents and 2942 adults participated. We identified several significant influential factors. Parents holding a low education (OR 1.56), having migrant background (western: OR 1.23; non-western: OR 1.93), having one child (OR 1.24), perceiving few barriers to using out-of-hours primary care (OR 1.59), perceiving difficulties with organising childcare (OR 1.13), and having a history of frequent contacts with out-of-hours care (OR 1.55) were more inclined to contact out-of-hours care, whereas female (OR 0.85) and non-anxious parents (OR 0.77) were less inclined. Adults who were older (OR 1.01), holding a medical education (OR 1.13), having non-western background (OR 1.28), being unemployed (OR 1.17), perceiving few barriers to using out-of-hours primary care (OR 1.37), and having a history of frequent contacts with a GP (few: OR 1.15; more: OR 1.22) and/or with out-of-hours care (one: OR 1.20; more: OR 1.49) were more inclined to contact out-of-hours care, whereas adults with no or little social support (OR 0.84) and adults with high health literacy level on health information (OR 0.91) were less inclined. Dutch parents were less inclined than Danish parents to contact out-of-hours care (OR 0.62), whereas Swiss adults were more inclined than Danish adults to contact out-of-hours care (OR 1.16). Conclusion We identified several factors related to intended help-seeking in out-of-hours care. These results could be used to develop targeted interventions, but more research is needed to examine the underlying explanations for the identified differences. Electronic supplementary material The online version of this article (10.1186/s12889-018-6332-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ellen Keizer
- Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands. .,Institute of Primary Care, University of Zurich and University Hospital of Zurich, Pestalozzistrasse 24, 8091, Zurich, Switzerland.
| | | | - Anders Helles Carlsen
- Research Unit for General Practice, Aarhus, Bartholins Alle 2, DK-8000, Aarhus, Denmark
| | - Marleen Smits
- Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands
| | - Michel Wensing
- Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands
| | - Oliver Senn
- Institute of Primary Care, University of Zurich and University Hospital of Zurich, Pestalozzistrasse 24, 8091, Zurich, Switzerland
| | - Linda Huibers
- Research Unit for General Practice, Aarhus, Bartholins Alle 2, DK-8000, Aarhus, Denmark
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Schinasi LH, Auchincloss AH, Forrest CB, Diez Roux AV. Using electronic health record data for environmental and place based population health research: a systematic review. Ann Epidemiol 2018; 28:493-502. [PMID: 29628285 DOI: 10.1016/j.annepidem.2018.03.008] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 03/13/2018] [Accepted: 03/16/2018] [Indexed: 12/21/2022]
Abstract
PURPOSE We conducted a systematic review of literature published on January 2000-May 2017 that spatially linked electronic health record (EHR) data with environmental information for population health research. METHODS We abstracted information on the environmental and health outcome variables and the methods and data sources used. RESULTS The automated search yielded 669 articles; 128 articles are included in the full review. The number of articles increased by publication year; the majority (80%) were from the United States, and the mean sample size was approximately 160,000. Most articles used cross-sectional (44%) or longitudinal (40%) designs. Common outcomes were health care utilization (32%), cardiometabolic conditions/obesity (23%), and asthma/respiratory conditions (10%). Common environmental variables were sociodemographic measures (42%), proximity to medical facilities (15%), and built environment and land use (13%). The most common spatial identifiers were administrative units (59%), such as census tracts. Residential addresses were also commonly used to assign point locations, or to calculate distances or buffer areas. CONCLUSIONS Future research should include more detailed descriptions of methods used to geocode addresses, focus on a broader array of health outcomes, and describe linkage methods. Studies should also explore using longitudinal residential address histories to evaluate associations between time-varying environmental variables and health outcomes.
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Affiliation(s)
- Leah H Schinasi
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, PA; Urban Health Collaborative, Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA.
| | - Amy H Auchincloss
- Urban Health Collaborative, Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA; Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA
| | | | - Ana V Diez Roux
- Urban Health Collaborative, Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA; Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA
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Moth G, Huibers L, Ovesen A, Christensen MB, Vedsted P. Preschool children in out-of-hours primary care - a questionnaire-based cross-sectional study of factors related to the medical relevance of health problems. BMC FAMILY PRACTICE 2017; 18:112. [PMID: 29281986 PMCID: PMC5746005 DOI: 10.1186/s12875-017-0702-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 12/18/2017] [Indexed: 11/15/2022]
Abstract
Background Out-of-hours primary care (OOH-PC) is intended to provide medical care services for health problems that cannot wait until normal office hours. Children under five years of age represent about 19% of all OOH-PC contacts in Denmark, and the frequency of calls assessed as severe by health professionals is markedly lower for children than for other age groups. Several studies have questioned the appropriateness of the parents’ use of OOH-PC. We aimed to identify factors associated with calls from parents of pre-school children concerning perceived non-severe health problems that were ranked by the triaging GPs as more appropriate for GP office hours (defined as ‘medically irrelevant’). Methods We used data from a cross-sectional study performed in the Central Denmark Region for a 1-year period during 2010–2011. GPs in the OOH-PC assessed random contacts, and a questionnaire was subsequently sent to registered patients. Associations between different factors and the medical irrelevance of contacts were estimated with a generalised linear model to calculate the prevalence ratio (PR). Results Among all included 522 telephone consultations and 1226 face-to-face consultations, we identified 71 (13.6%) telephone consultations and 95 (7.8%) face-to-face consultations that were both assessed as non-severe by the parents and more appropriate for GP office hours by the GPs. For telephone consultations, contacts at other times than 4–8 pm on weekdays were statistically significantly associated with medical irrelevance. Additionally, symptoms of longer duration than 24 h were statistically significantly associated medical irrelevance. Conclusions A large part of the calls to the Danish OOH-PC concern children. The results indicate that some of these calls are made for other than strictly medical reasons. To achieve more effective use of available resources, it might seem relevant to aim at directing more contacts directly to daytime care. However, future studies to enhance our knowledge on parents’ motivation and behaviour would be recommendable.
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Affiliation(s)
- Grete Moth
- Research Unit for General Practice, Department of Public Health, Aarhus University, Bartholins Alle 2, 8000, Aarhus, Denmark. .,Section for General Medical Practice, Department of Public Health, Aarhus University, Bartholins Alle 2, 8000, Aarhus, Denmark.
| | - Linda Huibers
- Research Unit for General Practice, Department of Public Health, Aarhus University, Bartholins Alle 2, 8000, Aarhus, Denmark.,Section for General Medical Practice, Department of Public Health, Aarhus University, Bartholins Alle 2, 8000, Aarhus, Denmark
| | - Astrid Ovesen
- Research Unit for General Practice, Department of Public Health, Aarhus University, Bartholins Alle 2, 8000, Aarhus, Denmark.,Section for General Medical Practice, Department of Public Health, Aarhus University, Bartholins Alle 2, 8000, Aarhus, Denmark
| | - Morten Bondo Christensen
- Research Unit for General Practice, Department of Public Health, Aarhus University, Bartholins Alle 2, 8000, Aarhus, Denmark.,Section for General Medical Practice, Department of Public Health, Aarhus University, Bartholins Alle 2, 8000, Aarhus, Denmark
| | - Peter Vedsted
- Research Unit for General Practice, Department of Public Health, Aarhus University, Bartholins Alle 2, 8000, Aarhus, Denmark.,Section for General Medical Practice, Department of Public Health, Aarhus University, Bartholins Alle 2, 8000, Aarhus, Denmark
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Out of hours care in Germany - High utilization by adult patients with minor ailments? BMC FAMILY PRACTICE 2017; 18:42. [PMID: 28327082 PMCID: PMC5361861 DOI: 10.1186/s12875-017-0609-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 01/05/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Family practitioners (FPs) who work in Out-Of-Hours Care (OOHC) - especially in rural areas - complain about high workload related to low urgency and potentially unnecessary patient presentations with minor ailments. The aim of this study was to describe Reasons for Encounter (RFEs) in primary OOHC taken into account the doctor's perspective in the context of high workload without knowing patients' motives for visiting an OOHC-centre. METHODS Within this descriptive study, OOHC data from 2012 were evaluated from a German statutory health insurance company in the federal state of Baden-Wuerttemberg. 1.53 Million of the 10.5 Million inhabitants of Baden-Wuerttemberg were covered. The frequency of the ICD-10 diagnoses was determined at the three- and four-digit-level. The rate of hospitalizations was used to estimate the severity of the evaluated cases. RESULTS Taken as a whole, 163,711 reasons for encounter with 1,174 ICD-10 single diagnoses were documented, of these 62.2% were on weekends. Less than 5.0% of the examined patients were hospitalized. Low back pain-dorsalgia (M54) was the most common diagnosis in OOHC, with 10,843 cases. Injuries were found twelve times in the list of the 30 most frequent diagnoses. The most frequent infectious disease was acute upper respiratory infection of multiple and unspecified sites (J06). By analysing the ICD codes to four-digits and looking at the rate of hospitalizations, it can be assumed that many RFEs were of less urgency in terms of the prompt need for medical treatment. CONCLUSION While it is acknowledged that it can be difficult to make an exact diagnosis in an OOHC setting, after analysing the ICD-10 diagnoses, the majority of reasons for encounter in OOHC were determined to be of low urgency, meaning that patients could have waited until regular consultation hours. In the OOHC setting, it is important to understand RFEs from both the patient perspective and the family practitioner perspective. Additionally, results like these can be used in staff education especially improving triage methods and medical recommendations and in developing specific guidelines for OOHC in Germany. Analysis of routine data, such as in this study, contributes to this understanding and contributes to resolving problems of coding.
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Telephone triage by GPs in out-of-hours primary care in Denmark: a prospective observational study of efficiency and relevance. Br J Gen Pract 2016; 66:e667-73. [PMID: 27432608 DOI: 10.3399/bjgp16x686545] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 05/10/2016] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND In the UK, telephone triage in out-of-hours primary care is mostly managed by nurses, whereas GPs perform triage in Denmark. AIM To describe telephone contacts triaged to face-to-face contacts, GP-assessed relevance, and factors associated with triage to face-to-face contact. DESIGN AND SETTING A prospective observational study in Danish out-of-hours primary care, conducted from June 2010 to May 2011. METHOD Information on patients was collected from the electronic patient administration system and GPs completed electronic questionnaires about the contacts. The GPs conducting the face-to-face contacts assessed relevance of the triage to face-to-face contacts. The authors performed binomial regression analyses, calculating relative risk (RR) and 95% confidence intervals. RESULTS In total, 59.2% of calls ended with a telephone consultation. Factors associated with triage to a face-to-face contact were: patient age >40 years (40-64: RR = 1.13; >64: RR = 1.34), persisting problem for 12-24 hours (RR = 1.15), severe problem (RR = 2.60), potentially severe problem (RR = 5.81), and non-severe problem (RR = 2.23). Face-to-face contacts were assessed as irrelevant for 12.7% of clinic consultations and 11.7% of home visits. A statistically significantly higher risk of irrelevant face-to-face contact was found for a persisting problem of >24 hours (RR = 1.25), contact on weekday nights (RR = 1.25), and contact <2 hours before the patient's own GP's opening time (RR = 1.80). CONCLUSION Around 12% of all face-to-face consultations in the study are assessed as irrelevant by GP colleagues, suggesting that GP triage is efficient. Knowledge of the factors influencing triage can provide better education for GPs, but future studies are needed to investigate other quality aspects of GP telephone triage.
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