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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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2
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Smith S, Carragher L. Prioritization and management of calls from older people to GP out-of-hours services. Int J Qual Health Care 2021; 33:6126507. [PMID: 33528500 DOI: 10.1093/intqhc/mzab021] [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: 10/13/2020] [Revised: 01/18/2021] [Accepted: 02/02/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Urgent out-of-hours medical care is necessary to ensure people can remain living at home into older age. However, older people experience multiple barriers to using out-of-hours services including poor awareness about the general practitioner (GP) out-of-hours (GPOOH) service and how to access it. In particular, older people are reluctant users of GPOOH services because they expect either their symptoms will not be taken seriously or they will simply be referred to hospital accident and emergency services. The aim of this study was to examine if this expectation was borne out in the manner of GPOOH service provision. OBJECTIVE The objective was to establish the urgency categorization and management of calls to GPOOH , for community dwelling older people in Ireland. METHODS An 8-week sample of 770 calls, for people over 65 years, to a GPOOH service in Ireland, was analysed using Excel and Nvivo software. RESULTS Urgency categorization of older people shows 40% of calls categorized as urgent. Recognition of the severity of symptoms, prompting calls to the GPOOH service, is also reflected in a quarter of callers receiving a home visit by the GP and referral of a third of calls to emergency services. The findings also show widespread reliance on another person to negotiate the GPOOH system, with a third party making 70% of calls on behalf of the older person seeking care. CONCLUSION Older people are in urgent need of medical services when they contact GPOOH service, which plays an effective and patient-centred gatekeeping role, particularly directing the oldest old to the appropriate level of care outside GP office hours. The promotion of GPOOH services should be enhanced to ensure older people understand their role in supporting community living.
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Affiliation(s)
- Suzanne Smith
- NetwellCASALA, The Bright Room, Dundalk Institute of Technology, Dublin Road, Dundalk, County Louth A91K584, Ireland
| | - Lucia Carragher
- NetwellCASALA, The Bright Room, Dundalk Institute of Technology, Dublin Road, Dundalk, County Louth A91K584, Ireland
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Adhikari M, Paudel NR, Mishra SR, Shrestha A, Upadhyaya DP. Patient satisfaction and its socio-demographic correlates in a tertiary public hospital in Nepal: a cross-sectional study. BMC Health Serv Res 2021; 21:135. [PMID: 33579283 PMCID: PMC7881603 DOI: 10.1186/s12913-021-06155-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 02/04/2021] [Indexed: 12/15/2022] Open
Abstract
Background Patient satisfaction is one proxy indicator of the health care quality; however, enhancing patient satisfaction in low-income settings is very challenging due to the inadequacy of resources as well as low health literacy among patients. In this study, we assess patient satisfaction and its correlates in a tertiary public hospital in Nepal. Methods We conducted a cross sectional study at outpatient department of Bhaktapur Hospital of Nepal. To recruit participants for the study, we applied a systematic random sampling method. Our study used a validated Patient Satisfaction Questionnaire III (PSQ-III) developed by RAND Corporation including various contextual socio-demographic characteristics. We calculated mean score and percentages of satisfaction across seven dimensions of patient satisfaction. To determine the association between various dimensions of patient satisfaction and socio-demographic characteristics of the patient, we used a multi-ordinal logistic regression. Results Among 204 patients, we observed a wide variation in patient satisfaction across seven dimensions. About 39% of patients were satisfied in the dimension of general satisfaction, 92% in interpersonal manner, and 45% in accessibility and convenience. Sociodemographic factors such as age (AOR: 6.42; CI: 1.30–35.05), gender (AOR: 2.81; CI: 1.41–5.74), and ethnicity (AOR: 0.26; CI: 0.08–0.77) were associated with general satisfaction of the patients. Other sociodemographic variables such as education, occupation, and religion were associated with a majority of the dimensions of patient satisfaction (p < 0.05). Age was found to be the strongest predictor of patient satisfaction in five out of seven dimensions. Conclusions We concluded that patient satisfaction varies across different dimensions. Therefore, targeted interventions that direct to improve the dimensions of patient satisfaction where the proportion of satisfaction is low are needed. Similar studies should be conducted regularly at different levels of health facilities across the country to capture a wider picture of patient satisfaction at various levels. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06155-3.
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Affiliation(s)
- Mukesh Adhikari
- Department of Health Services, Ministry of Health and Population, Kathmandu, Nepal. .,Department of Health Policy and Management, Yale School of Public Health, Yale University, New Haven, CT, USA. .,Institute for Implementation Science and Health, Kathmandu, Nepal.
| | | | - Shiva Raj Mishra
- World Heart Federation Rue de Malatrex 32, 1201, Geneva, Switzerland.,Nepal Development Society, Bharatpur-10, Chitwan, Nepal
| | - Archana Shrestha
- Institute for Implementation Science and Health, Kathmandu, Nepal.,Department of Public Health, Kathmandu University, Kathmandu, Nepal
| | - Dipak Prasad Upadhyaya
- Central Department of Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.,School of Medicine, Case Western Reserve University, Cleveland, OH, USA
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Ebert JF, Huibers L, Christensen B, Collatz Christensen H, Christensen MB. Does an emergency access button increase the patients' satisfaction and feeling of safety with the out-of-hours health services? A randomised controlled trial in Denmark. BMJ Open 2020; 10:e030267. [PMID: 32998912 PMCID: PMC7528355 DOI: 10.1136/bmjopen-2019-030267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To investigate if the option to bypass the telephone queue can increase satisfaction and feeling of safety in callers. DESIGN Randomised controlled parallel superiority trial. Data from questionnaire survey. SETTING Two out-of-hours (OOH) services in Denmark. PARTICIPANTS 217 510 citizens who called the OOH services between 4 September 2017 and 30 November 2017. RANDOMISATION Two-faze study period: First half with randomisation of participants based on their date of birth; even date randomised to intervention, uneven date randomised to control group. Second half with all participants included in intervention group. INTERVENTION Providing randomised callers (intervention group n=146 355) with the option to bypass the telephone waiting line through an emergency access button (EAB), while the rest got the normal service (control group n=71 155). All EAB users were invited to a questionnaire survey as well as random participants who did not use the EAB (of whom approximately 50% did not have the EAB option). MAIN OUTCOME MEASURES Satisfaction and feeling of safety in callers. RESULTS 2208 of 6704 (32.9%) invited callers answered the questionnaire (intervention group n=1415 (users n=621, non-users n=794); control group n=793). The OR for answering in the two categories with highest satisfaction when provided with the EAB option was 1.34 (95% CI 1.07 to 1.68) for satisfaction with the waiting time, 1.21 (95% CI 0.91 to 1.60) for overall satisfaction and 1.46 (95% CI 1.12 to 1.89) for feeling of safety. Approximately 72% (441/621) of EAB users reported that the EAB option increased their feeling of safety with the OOH services 'to a high degree' compared with 25% (197/794) of callers who had the EAB option without using it. CONCLUSIONS The EAB can provide fast access to OOH telephone advice in case of severe illness. It favours citizens perceived in most need of urgent healthcare and significantly increases both feeling of safety and patient satisfaction. TRIAL REGISTRATION DETAILS NCT02572115 (5 October 2015).
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Affiliation(s)
- Jonas Fynboe Ebert
- Research Unit for General Practice, Aarhus Universitet Health, Aarhus, Denmark
| | - L Huibers
- Research Unit for General Practice, Aarhus Universitet, Aarhus, Denmark
| | | | - Helle Collatz Christensen
- Copenhagen Emergency Medical Services, Copenhagen, Denmark
- Danish Clinical Quality Program (RKKP), National Clinical Registries, Frederiksberg, Denmark
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Arntsen B, Torjesen DO, Karlsen TI. Associations between structures, processes and outcomes in inter-municipal cooperation in out-of-hours services in Norway: A survey study. Soc Sci Med 2020; 258:113067. [PMID: 32521412 DOI: 10.1016/j.socscimed.2020.113067] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/16/2020] [Accepted: 05/13/2020] [Indexed: 11/28/2022]
Abstract
Inter-municipal cooperation (IMC) has gained widespread recognition as a beneficial strategy for improving efficiency and quality in the provision of out-of-hours emergency care services (OOH services). Little attention, however, has been given to the additional costs of cooperation and the relational processes through which benefits and costs are likely to result. Based on survey data from 266 (77%) Norwegian municipalities involved in IMC in OOH services in 2015, this study aimed to investigate how the structure (governance form, complexity and stability) and quality (trust and consensus) of cooperation processes interact to influence the perceived outcomes (benefits and costs) of IMC in OOH services. Using Structural equation modeling, we found trust and consensus fully mediated the association between the structure and outcomes of IMC. More specifically, the results suggest that cooperation structures characterized by centralized governance, stability over time, and reduced complexity were likely to enhance the benefits and reduce the costs of IMC through trust and consensus.
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Affiliation(s)
- Bjørnulf Arntsen
- Faculty of Health and Sport Science, Center for Care Research - Southern Norway, University of Agder, Jon Lilletuns vei 13, 4879, Grimstad, Norway.
| | - Dag Olaf Torjesen
- Department of Political Science and Management, University of Agder, Universitetsveien 25, 4630, Kristiansand, Norway
| | - Tor-Ivar Karlsen
- Faculty of Health and Sport Science, University of Agder, Jon Lilletuns vei 13, 4879, Grimstad, Norway
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Substitution of general practitioners by nurse practitioners in out-of-hours primary care home visits: A quasi-experimental study. Int J Nurs Stud 2020; 104:103445. [DOI: 10.1016/j.ijnurstu.2019.103445] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 09/20/2019] [Accepted: 09/24/2019] [Indexed: 11/20/2022]
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Lous J, Moth G, Huibers L, Vedsted P, Christensen MB. Preschool children in Danish out-of-hours primary care: a one-year descriptive study of face-to-face consultations. BMC FAMILY PRACTICE 2019; 20:36. [PMID: 30808295 PMCID: PMC6390329 DOI: 10.1186/s12875-019-0922-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 02/15/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND The demand for out-of-hours (OOH) primary care has increased during the last decades, with a considerable amount of contacts for young children. This study aims to describe the reasons for encounter (RFE), the most common diagnoses, the provided care, and the parental satisfaction with the general practitioner (GP) led OOH service in a Danish population of children (0-5 years). METHODS We conducted a one-year cross-sectional study based on data for 2363 randomly selected contacts concerning children from a survey on OOH primary care including 21,457 patients in Denmark. For each contact, the GPs completed an electronic pop-up questionnaire in the patient's medical record. Questionnaire items focussed on RFE, health problem severity, diagnosis, provided care, and satisfaction. The parents subsequently received a postal questionnaire. RESULTS The most common RFE was non-specific complaints (40%), followed by respiratory tract symptoms (23%), skin symptoms (9%), and digestive organ symptoms (8%). The most common diagnosis group was respiratory tract diseases (41%), followed by general complaints (19%) and ear diseases (16%). Prescriptions were dispensed for 27% of contacts, and about ¾ were for antibiotics. A total of 12% contacts concerned acute otitis media; antibiotics were prescribed in 70%. A total of 38% of contacts concerned fever, and ¼ got antibiotics. A total of 7.4% were referred for further evaluation. The parental satisfaction was generally high, but 7.0% were dissatisfied. Dissatisfaction was correlated with low prescription rate. CONCLUSION Respiratory tract diseases were the most common diagnoses. The GPs at the OOH primary care service referred children to hospital in 7.4% of the face-to-face consultations, and the provided care was evaluated as non-satisfying by only 7.0% of the parents. Clinical implications of the findings mean room for less prescription of antibiotic to children with ear diseases and a need for research in factors related to dissatisfaction.
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Affiliation(s)
- Jørgen Lous
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Jagtvej 20A, DK-8270, Højbjerg, Denmark.
| | - Grete Moth
- Research Unit for General Practice, Aarhus University, Aarhus, Denmark
| | - Linda Huibers
- Research Unit for General Practice, Aarhus University, Aarhus, Denmark
| | - Peter Vedsted
- Research Unit for General Practice, Aarhus University, Aarhus, Denmark.,Research Unit for General Practice & section for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
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Keizer E, Bakker P, Giesen P, Wensing M, Atsma F, Smits M, van den Muijsenbergh M. Migrants' motives and expectations for contacting out-of-hours primary care: a survey study. BMC FAMILY PRACTICE 2017; 18:92. [PMID: 29162044 PMCID: PMC5699192 DOI: 10.1186/s12875-017-0664-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 11/15/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Migrants are more likely to use out-of-hours primary care, especially for nonurgent problems. Their motives and expectations for help-seeking are as yet unknown. The objective of this study is to examine the motives and expectations of migrants for contacting out-of-hours primary care. METHODS We used data from a survey study of 11,483 patients who contacted a General Practitioner (GP) cooperative in the Netherlands between 2009 and 2014 (response rate 45.6%). Logistic regression analysis was used to test differences in motives and expectations between non-western and western migrants and native Dutch patients. RESULTS The main motives for contacting a GP cooperative for non-western and western migrants were an urgent need for contact with a GP (54.9%-52.4%), worry (49.3%-43.0%), and a need for medical information (21.3%-26.2%). These were also the most important motives for native Dutch patients. Compared to native Dutch patients, non-western migrants more often perceived an urgent need for a GP (OR 1.65; 99% CI 1.27-2.16), less often needed information (OR 0.59; 99% CI 0.43-0.81), and more often experienced problems contacting their own GP during office hours (OR 1.71; 99% CI 1.21-2.43). Western migrants also reported experiencing problems more often in contacting their own GP (OR 1.38; 99% CI 1.04-1.84). As well as for natives, most non-western and western migrants expected to see a doctor (46.2%-46.6%) or get advice (39.6%-41.5%). Non-western migrants expected more often to get physical examination (OR 1.53; 99% CI 1.14-2.04), and prescription (OR 1.37; 99% CI 1.00-1.88). We found no differences in expectations between western migrants and native Dutch patients. CONCLUSION The main motives and expectations of migrants are similar to native Dutch patients, yet non-western migrants more often wanted action from the GP, e.g. examination or prescription, and less often passive forms of assistance such as giving information. At the same time they experience problems accessing their own GP. We recommend stimulation of self-care, education about the purpose of a GP cooperative, and examination and improvement of accessibility of daytime primary care.
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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.
| | - Peter Bakker
- 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.,Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - Paul Giesen
- 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
| | - Femke Atsma
- 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
| | - 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
| | - Maria van den Muijsenbergh
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500, HB, Nijmegen, The Netherlands.,Pharos, Centre of Expertise of Health Disparities, P.O. Box 13318, 3507, LH, Utrecht, The Netherlands
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Ramos P, Alves H, Guimarães P, Ferreira MA. Junior doctors' medical specialty and practice location choice: simulating policies to overcome regional inequalities. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2017; 18:1013-1030. [PMID: 27812746 DOI: 10.1007/s10198-016-0846-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 10/20/2016] [Indexed: 06/06/2023]
Abstract
There are nowadays over 1 million Portuguese who lack a primary care physician. By applying a discrete choice experiment to a large representative sample of Portuguese junior doctors (N = 503) in 2014, we provide an indication that this shortage may be addressed with a careful policy design that mixes pecuniary and non-pecuniary incentives for these junior physicians. According to our simulations, a policy that includes such incentives may increase uptake of general practitioners (GPs) in rural areas from 18% to 30%. Marginal wages estimated from our model are realistic and close to market prices: an extra hour of work would require an hourly wage of 16.5€; moving to an inland rural setting would involve an increase in monthly income of 1.150€ (almost doubling residents' current income); a shift to a GP career would imply an 849€ increase in monthly income. Additional opportunities to work outside the National Health Service overcome an income reduction of 433€. Our simulation predicts that an income increase of 350€ would lead to a 3 percentage point increase in choice probability, which implies an income elasticity of 3.37, a higher estimation compared to previous studies.
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Affiliation(s)
- Pedro Ramos
- Medical Director Office, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255, Cerqueira César, São Paulo, SP, 05403-000, Brazil.
- Faculty of Medicine of the University of Porto, University of Porto, Porto, Portugal.
| | - Hélio Alves
- Faculty of Medicine of the University of Porto, University of Porto, Porto, Portugal
| | - Paulo Guimarães
- Bank of Portugal, Porto, Portugal
- Faculty of Economics, University of Porto, Porto, Portugal
| | - Maria A Ferreira
- Faculty of Medicine of the University of Porto, University of Porto, Porto, Portugal
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Payne K, Dutton T, Weal K, Earle M, Wilson R, Bailey J. An after hours gp clinic in regional Australia: appropriateness of presentations and impact on local emergency department presentations. BMC FAMILY PRACTICE 2017; 18:86. [PMID: 28893200 PMCID: PMC5594615 DOI: 10.1186/s12875-017-0657-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 09/05/2017] [Indexed: 11/21/2022]
Abstract
Background After hours general practice clinics provide medical attention for clients with non-emergency situations but are seeking immediate treatment and unable to wait for a general practitioner during routine opening hours. Evidence on the impact that after hours clinics have on emergency department presentations is equivocal. This study explored outcomes of the Bathurst After Hours General Practice Clinic (BAHGPC). Specifically it examined: clients’ perceived urgency of, and satisfaction with their presentation to the BAHGPC; general practitioners’ perception of the appropriateness of presentations to the BAHGPC; and whether the frequency of non-urgent and semi-urgent emergency department presentations at Bathurst Base Hospital has changed since the opening of the BAHGPC. Methods Clients presenting to the BAHGPC from 01/02/2015 to 30/06/2015 were asked to participate in the client presentation survey and follow-up satisfaction survey. General practitioner surveys were completed for individual clients from 01/12/2014 to 30/06/2015 to document the appropriateness of each presentation. Descriptive statistics are used to describe survey responses. Thematic analysis was applied for qualitative responses. Emergency department presentations were retrieved from the Emergency Department Data Collection. A comparison of presentations in the two years prior and subsequent to the opening of the BAHGPC was conducted using independent T-tests and Chi-square tests to compare mean presentations and proportional data for the different time periods examined. Results Most clients (76%) presenting to the BAHGPC classified their visit as essential. General practitioners considered most presentations to be appropriate (87%). Sixty percent (60%) of clients would have gone to the emergency department had the BAHGPC not been operational. Client satisfaction was high and 99% would use the clinic again. A significant reduction in total non-urgent presentations to the Emergency Department occurred in the two years since the opening of the BAHGPC clinic compared to the two years prior (418.5 vs. 245.5; P < 0.05). Conclusions There was concordance between general practitioners and clients regarding the appropriateness of presentations to the BAHGPC. The findings of this study highlight that after hours general practitioner clinics are an essential service in regional areas and contribute to reducing the burden of non-urgent presentations to the local emergency department. Electronic supplementary material The online version of this article (10.1186/s12875-017-0657-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kristy Payne
- Bathurst Rural Clinical School, School of Medicine, Western Sydney University, Bathurst, NSW, Australia
| | - Tegan Dutton
- Bathurst Rural Clinical School, School of Medicine, Western Sydney University, Bathurst, NSW, Australia
| | - Kate Weal
- Marathon Health, Bathurst, NSW, Australia
| | | | - Ross Wilson
- Bathurst Rural Clinical School, School of Medicine, Western Sydney University, Bathurst, NSW, Australia
| | - Jannine Bailey
- Bathurst Rural Clinical School, School of Medicine, Western Sydney University, Bathurst, NSW, Australia.
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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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Ifediora CO, Rogers GD. Levels and predictors of patient satisfaction with doctor home-visit services in Australia. Fam Pract 2017; 34:63-70. [PMID: 27587567 DOI: 10.1093/fampra/cmw092] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The Australian after-hours house-call (AHHC) services has grown rapidly in the past few years. Even though recent studies have looked at aspects of the service as it concerns the medical personnel involved, no national study has explored patient satisfaction with the service. OBJECTIVE This study aims to assess patient satisfaction with Australian AHHC services and its predictors, with the hope of improving quality and patient outcomes. The findings might also have international relevance, given the developing nature of the AHHC in most countries. METHODS A cross-sectional survey of all 10838 patients known to have patronized the AHHC service in Australia over a 1-week period. The main outcome measure was the Patient Satisfaction Questionnaire 18 (PSQ-18). RESULTS A total of 1228 questionnaires were returned. General Satisfaction (GS) level was found to be 85.2% (mean 4.16/5). Other Scales of Satisfaction, in decreasing order, were 'Financial Aspects, FA' (87.4%; 4.36/5), 'Communication, CM' (87.3%; 4.18), 'Technical Quality, TA' (82.1%; 4.09), 'Time Spent with Doctor, TSD' (77.7%; 3.91), 'Interpersonal Manner, IM' (75.7%; 3.87) and 'Accessibility and Convenience, A&C' (72.9%; 3.82). The major predictor of increased satisfaction was the time it took the doctor to arrive, with increased satisfaction on GS (T < 4 hours; P < 0.01), IM (T < 30 minutes; P = 0.03), FA (T < 2 hours; P = 0.01), TSD (T < 2 hours; P < 0.01) and A&C (T < 4 hours; P < 0.01). Other positive predictors of aspects of satisfaction included 'being a student', 'age of patient ≤ 16' and 'being Australian born', while 'being on a pension' was negatively associated with Communication (P = 0.03). No associations were found with gender, marital status, employment status, family income or having children in the household. CONCLUSIONS This study concludes that satisfaction in Australian AHHC is high on all scales but recommends that the service providers should aim to attend to patients within 4 hours of their initial calls.
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Affiliation(s)
- Chris O Ifediora
- School of Medicine, Griffith University, Gold Coast Campus, Southport, Queensland, Australia.
| | - Gary D Rogers
- School of Medicine, Griffith University, Gold Coast Campus, Southport, Queensland, Australia
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Campbell JL, Fletcher E, Britten N, Green C, Holt T, Lattimer V, Richards DA, Richards SH, Salisbury C, Taylor RS, Calitri R, Bowyer V, Chaplin K, Kandiyali R, Murdoch J, Price L, Roscoe J, Varley A, Warren FC. The clinical effectiveness and cost-effectiveness of telephone triage for managing same-day consultation requests in general practice: a cluster randomised controlled trial comparing general practitioner-led and nurse-led management systems with usual care (the ESTEEM trial). Health Technol Assess 2015; 19:1-212, vii-viii. [PMID: 25690266 DOI: 10.3310/hta19130] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Telephone triage is proposed as a method of managing increasing demand for primary care. Previous studies have involved small samples in limited settings, and focused on nurse roles. Evidence is limited regarding the impact on primary care workload, costs, and patient safety and experience when triage is used to manage patients requesting same-day consultations in general practice. OBJECTIVES In comparison with usual care (UC), to assess the impact of GP-led telephone triage (GPT) and nurse-led computer-supported telephone triage (NT) on primary care workload and cost, patient experience of care, and patient safety and health status for patients requesting same-day consultations in general practice. DESIGN Pragmatic cluster randomised controlled trial, incorporating economic evaluation and qualitative process evaluation. SETTING General practices (n = 42) in four regions of England, UK (Devon, Bristol/Somerset, Warwickshire/Coventry, Norfolk/Suffolk). PARTICIPANTS Patients requesting same-day consultations. INTERVENTIONS Practices were randomised to GPT, NT or UC. Data collection was not blinded; however, analysis was conducted by a statistician blinded to practice allocation. MAIN OUTCOME MEASURES Primary - primary care contacts [general practice, out-of-hours primary care, accident and emergency (A&E) and walk-in centre attendances] in the 28 days following the index consultation request. Secondary - resource use and costs, patient safety (deaths and emergency hospital admissions within 7 days of index request, and A&E attendance within 28 days), health status and experience of care. RESULTS Of 20,990 eligible randomised patients (UC n = 7283; GPT n = 6695; NT n = 7012), primary outcome data were analysed for 16,211 patients (UC n = 5572; GPT n = 5171; NT n = 5468). Compared with UC, GPT and NT increased primary outcome contacts (over 28-day follow-up) by 33% [rate ratio (RR) 1.33, 95% confidence interval (CI) 1.30 to 1.36] and 48% (RR 1.48, 95% CI 1.44 to 1.52), respectively. Compared with GPT, NT was associated with a marginal increase in primary outcome contacts by 4% (RR 1.04, 95% CI 1.01 to 1.08). Triage was associated with a redistribution of primary care contacts. Although GPT, compared with UC, increased the rate of overall GP contacts (face to face and telephone) over the 28 days by 38% (RR 1.38, 95% CI 1.28 to 1.50), GP face-to-face contacts were reduced by 39% (RR 0.61, 95% CI 0.54 to 0.69). NT reduced the rate of overall GP contacts by 16% (RR 0.84, 95% CI 0.78 to 0.91) and GP face-to-face contacts by 20% (RR 0.80, 95% CI 0.71 to 0.90), whereas nurse contacts increased. The increased rate of primary care contacts in triage arms is largely attributable to increased telephone contacts. Estimated overall patient-clinician contact time on the index day increased in triage (GPT = 10.3 minutes; NT = 14.8 minutes; UC = 9.6 minutes), although patterns of clinician use varied between arms. Taking account of both the pattern and duration of primary outcome contacts, overall costs over the 28-day follow-up were similar in all three arms (approximately £75 per patient). Triage appeared safe, and no differences in patient health status were observed. NT was somewhat less acceptable to patients than GPT or UC. The process evaluation identified the complexity associated with introducing triage but found no consistency across practices about what works and what does not work when implementing it. CONCLUSIONS Introducing GPT or NT was associated with a redistribution of primary care workload for patients requesting same-day consultations, and at similar cost to UC. Although triage seemed to be safe, investigation of the circumstances of a larger number of deaths or admissions after triage might be warranted, and monitoring of these events is necessary as triage is implemented. TRIAL REGISTRATION Current Controlled Trials ISRCTN20687662. FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 19, No. 13. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- John L Campbell
- Primary Care Research Group, University of Exeter Medical School, Exeter, UK
| | - Emily Fletcher
- Primary Care Research Group, University of Exeter Medical School, Exeter, UK
| | - Nicky Britten
- Institute of Health Service Research, University of Exeter Medical School, Exeter, UK
| | - Colin Green
- Institute of Health Service Research, University of Exeter Medical School, Exeter, UK
| | - Tim Holt
- Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Valerie Lattimer
- School of Nursing Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - David A Richards
- Institute of Health Service Research, University of Exeter Medical School, Exeter, UK
| | - Suzanne H Richards
- Primary Care Research Group, University of Exeter Medical School, Exeter, UK
| | - Chris Salisbury
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Rod S Taylor
- Primary Care Research Group, University of Exeter Medical School, Exeter, UK
| | - Raff Calitri
- Primary Care Research Group, University of Exeter Medical School, Exeter, UK
| | - Vicky Bowyer
- Department of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Katherine Chaplin
- Institute of Health Service Research, University of Exeter Medical School, Exeter, UK
| | - Rebecca Kandiyali
- Primary Care Research Group, University of Exeter Medical School, Exeter, UK
| | - Jamie Murdoch
- School of Nursing Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Linnie Price
- Primary Care Research Group, University of Exeter Medical School, Exeter, UK
| | - Julia Roscoe
- Department of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Anna Varley
- School of Nursing Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Fiona C Warren
- Primary Care Research Group, University of Exeter Medical School, Exeter, UK
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14
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Allemann Iseli M, Kunz R, Blozik E. Instruments to assess patient satisfaction after teleconsultation and triage: a systematic review. Patient Prefer Adherence 2014; 8:893-907. [PMID: 25028538 PMCID: PMC4077851 DOI: 10.2147/ppa.s56160] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Patient satisfaction is crucial for the acceptance, use, and adherence to recommendations from teleconsultations regarding health care requests and triage services. OBJECTIVES Our objectives are to systematically review the literature for multidimensional instruments that measure patient satisfaction after teleconsultation and triage and to compare these for content, reliability, validity, and factor analysis. METHODS We searched Medline, the Cumulative Index to Nursing and Allied Health Literature, and PsycINFO for literature on these instruments. Two reviewers independently screened all obtained references for eligibility and extracted data from the eligible articles. The results were presented using summary tables. RESULTS We included 31 publications, describing 16 instruments in our review. The reporting on test development and psychometric characteristics was incomplete. The development process, described by ten of 16 instruments, included a review of the literature (n=7), patient or stakeholder interviews (n=5), and expert consultations (n=3). Four instruments evaluated factor structure, reliability, and validity; two of those four demonstrated low levels of reliability for some of their subscales. CONCLUSION A majority of instruments on patient satisfaction after teleconsultation showed methodological limitations and lack rigorous evaluation. Users should carefully reflect on the content of the questionnaires and their relevance to the application. Future research should apply more rigorously established scientific standards for instrument development and psychometric evaluation.
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Affiliation(s)
| | - Regina Kunz
- Academy of Swiss Insurance Medicine, University of Basel, Basel, Switzerland
| | - Eva Blozik
- Swiss Center for Telemedicine Medgate, Basel, Switzerland
- Department of Primary Medical Care, University Medical Center Hamburg–Eppendorf, Martinistrasse, Hamburg, Germany
- Correspondence: Eva Blozik, Department of Primary Medical Care, University Medical Center Hamburg–Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany, Tel +49 40 741 052 400, Fax +49 40 741 053 681, Email
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