Abstract
BackgroundAs the proportion of older people increases, so will the consumption of health services. The aim of this study was to describe the contact characteristics among older people and to identify factors associated with the degree of urgency at the Norwegian out-of-hours (OOH) emergency primary health care services.MethodsInhabitants aged ≥70 years who contacted the OOH service during 2014–2017 in seven OOH districts in Norway were included. We investigated the variables sex, age, time of contact, mode of contact, ICPC-2 based reason for encounter (RFE), priority degree and initial response. We also performed frequency analyses, rate calculations and a log-binomial regression.ResultsA total of 38,293 contacts were registered. The contact rate/1000 inhabitants/year was three times higher in the oldest age group (≥90 years) compared to the youngest age group (70–74 years). Direct attendance accounted for 8.4% of the contacts and 32.8% were telephone contacts from health professionals. The most frequent RFE chapter used was “A General and unspecified” (21.0%) which also showed an increasing rate with higher age. 6.0% of the contacts resulted in a home visit from a doctor. Variables significantly associated with urgent priority degree were RFEs regarding cardiovascular (Relative risk (RR) 1.85; CI 1.74–1.96), neurological (RR 1.55; CI 1.36–1.77), respiratory (RR 1.40; CI 1.30–1.51) and digestive (RR 1.22; CI 1.10–1.34) issues. In addition, telephone calls from health professionals (RR 1.21; CI 1.12–1.31), direct attendance (RR 1.13; CI 1.04–1.22), contacts on weekdays (RR 1.13; CI 1.06–1.20) and contacts from men (RR 1.13; CI 1.09–1.17) were significantly associated with urgent priority degree.ConclusionsThis study provides important information about the Norwegian older inhabitants’ contact with the OOH emergency primary health care services. There are a wide variety of RFEs, and the contact rate is high and increases with higher age. Telephone contact is most common. The OOH staff frequently identify older people as having “general and unspecified” reasons for encounters. OOH nursing staff would benefit from having screening tools and enhanced geriatric training to best support this vulnerable group when these individuals call the OOH service.
Highlights
As the proportion of older people increases, so will the consumption of health services
The aim of this study was to investigate the contact characteristics among people 70 years and older including time and mode of contact, reason for encounter (RFE), priority degree, and initial response, as well as identifying factors associated with urgent priority degree
The reported Relative risks (RR), confidence interval (CI) and p-values for this variable were adjusted for a modified RFE-variable in addition to the other variables
Summary
As the proportion of older people increases, so will the consumption of health services. Older patients often present with diffuse symptoms or an atypical presentation of acute illness or trauma, which makes them vulnerable for possible undertriage, delayed evaluation and worsened outcome [11,12,13,14,15,16,17,18,19]. Another characteristic of older patients is the reluctance to seek help when needed [20]. Worries about their perception of the degree of urgency being appropriate, and about travelling at night are frequently barriers that make older people hesitant about using out-of-hours (OOH) services, even when such use is necessary [21]
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