چکیده (انگلیسی):

Background:In the Netherlands, primary out-of-hours (OOH) care is provided by large scale General Practitioner
(GP) cooperatives. GP cooperatives can be contacted by patients living in the area surrounding the GP cooperative
(catchment area) at hours when the patient’s own general practice is closed. The frequency of primary OOH care
use substantially differs between GP cooperative catchment areas. To enable a better match between supply and
demand of OOH services, understanding of the factors associated with primary OOH care use is essential. The
present study evaluated the contribution of sociodemographic composition of the neighbourhood in explaining
differences in primary OOH care use between GP cooperative catchment areas.
Methods:Data about patients’ contacts with primary OOH services (n = 1,668,047) were derived from routine
electronic health records of 21 GP cooperatives participating in the NIVEL Primary Care Database in 2012. The study
sample is representative for the Dutch population (for age and gender). Data were matched with
sociodemographic characteristics (e.g. gender, age, low-income status, degree of urbanisation) on postcode level.
Multilevel linear regression models included postcode level (first level), nested within GP cooperative catchment
areas (second level). We investigated whether contacts in primary OOH care were associated with neighbourhood
sociodemographic characteristics.
Results:The demand of primary OOH care was significantly higher in neighbourhoods with more women, low-income
households, non-Western immigrants, neighbourhoods witha higher degree of urbanisation, and low neighbourhood
socioeconomic status. Conversely, lower demand was associated with neighbourhoods with more 5 to 24 year old
inhabitants. Sociodemographic neighbourhood characteristics explained a large part of the variation between
GP cooperatives (R-squared ranging from 8% to 52%). Nevertheless, the multilevel models also showed that a
considerable amount of variation in demand between GP cooperatives remained unexplained by sociodemographic
characteristics, particularly regarding high-urgency contacts.
Conclusions:Although part of the variation between GP cooperatives could not be attributed to neighbourhood
characteristics, the sociodemographic composition of the neighbourhood is a fair predictor of the demand of primary
OOH care. Accordingly, this study provides a useful starting point for an improved planning of the supply of primary
OOH care.