چکیده (انگلیسی):

Background:In the Netherlands, about half of the patient contacts with a general practitioner (GP) cooperative are
nonurgent from a medical perspective. A part of these problems can wait until office hours or can be managed by
the patient himself without further professional care. However, from the patient’s perspective, there may be a need
to contact a physician immediately. Our objective was to determine whether contacts with out-of-hours primary
care made by patients with nonurgent problems are the result of patients’ beliefs or of deficiencies in the
healthcare system.
Methods:We performed a survey among 2000 patients with nonurgent health problems in four GP cooperatives in
the Netherlands. Two GPs independently judged the medical necessity of the contacts of all patients in this study. We
examined characteristics, views and motives of patients with medically necessary contacts and those without medically
necessary contacts. Descriptive statistics were used to describe the characteristics, views and reasons of the patients
with medically unnecessary contacts and medically necessary contacts. Differences between these groups were tested
with chi-square tests.
Results:Theresponseratewas32.3%(N= 646). Of the nonurgent contacts 30.4 % were judged as medically necessary
(95 % CI 27.0-34.2). Compared to patients with nonurgent but medically necessary contacts, patients with medically
unnecessary contacts were younger and were more often frequent attenders. They had longer-existing problems, lower
self-assessed urgency, and more often believed GP cooperatives are intended for all help requests. Worry was the most
frequently mentioned motive for contacting a GP cooperative for patients with a medically unnecessary contact (45.3 %)
and a perceived need to see a GP for patients with a medicallynecessary contact (44.2 %). Perceived availability (5.8 %)
and accessibility (8.3 %) of a patient’s own GP played a role for some patients.
Conclusion:Motives for contacting a GP cooperative are mostly patient-related, but also deficiencies in access to
general practice may partly explain medically unnecessary use. Efforts to change the use of GP cooperatives should
focus on education of subgroups with an increased likelihood of contact for medically unnecessary problems.
Improvement of access to daytime primary care may also decrease use of the GP cooperative.