چکیده (انگلیسی):

Background:The use of out-of-hours healthcare services for non-urgent health problems is believed to be related
to the organisation of daytime primary care but insight into underlying mechanisms is limited. Our objective was to
examine the association between daytime general practice characteristics and the use of out-of-hours care GP
cooperatives.
Methods:A cross-sectional observational study in 100 general practices in the Netherlands, connected to five GP
cooperatives. In each GP cooperative, we took a purposeful sample of the 10 general practices with the highest use
of out-of-hours care and the 10 practices with the lowest use.
Practice and population characteristics were obtained by questionnaires, interviews, data extraction from patient
registration systems and telephone accessibility measurements. To examine which aspects of practice organisation
were associated with patients’ use of out-of-hours care, we performed logistic regression analyses (low versus high
out-of-hours care use), correcting for population characteristics.
Results:The mean out-of-hours care use in the high use group of general practices was 1.8 times higher than in the
low use group. Day time primary care practices with more young children and foreigners in their patient populations
and with a shorter distance to the GP cooperative had higher out-of-hours primary care use. In addition, longer
telephone waiting times and lower personal availability for palliative patients in daily practice were associated with
higher use of out-of-hours care. Moreover, out-of-hours care use was higher when practices performed more diagnostic
tests and therapeutic procedures and had more assistant employment hours per 1000 patients.
Several other aspects of practice management showed some non-significant trends: high utilising general practices
tended to have longer waiting times for non-urgent appointments, lower availability of a telephone consulting hour,
lower availability for consultations after 5 p.m., and less frequent holiday openings.
Conclusions:Besides patient population characteristics, organisational characteristics of general practices are
associated with lower use of out-of-hours care. Improving accessibility and availability of day time primary day care
might be a potential effective way to improve the efficient use of out-of-hours care services.