Abstract
BackgroundThe importance of proactive chronic care has become increasingly evident. Yet, it is unknown whether the use of general practice (GP) during daytime may affect the use of Out-of-Hours (OOH) Primary Care Service for people with chronic disease. We aimed to analyse the association between use of daytime general practice (GP) and use of OOH services for heart disease, lung disease, diabetes, psychiatric disease, or cancer. In particular, we intended to study the association between OOH contacts due to chronic disease exacerbation and recent use of daytime GP.MethodsData comprised a random sample of contacts to the OOH services (‘LV-KOS2011’). Included patients were categorised into the following chronic diseases: heart disease, lung disease, diabetes, psychiatric disease, or cancer. Information on face-to-face contacts to daytime GP was obtained from the Danish National Health Insurance Service Registry and information about exacerbation or new episodes from the LVKOS2011 survey. Associations between number of regular daytime consultations and annual follow-up consultations during one, three, six, and 12 months prior to index contacts, and outcomes of interest were estimated by using logistic regression.ResultsIn total, 11,897 patients aged ≥ 18 years were included. Of these, 2,665 patients (22.4%) were identified with one of the five selected chronic diseases; 673 patients (5.7%) had two or more. A higher odds ratio (OR) for exacerbation as reason for encounter (RFE) at the index contact was observed among patients with psychiatric disease (OR = 2.15) and cancer (OR = 2.17) than among other patients for ≥2 daytime recent contacts. When receiving an annual follow-up, exacerbation OR at index contact lowered for patients with lung disease (OR = 0.68), psychiatric disease (OR = 0.42), or ≥2 diseases (OR = 0.61).ConclusionRecent and frequent use of daytime GP for patients with the selected chronic diseases was associated with contacts to the OOH services due to exacerbation. These findings indicate that the most severely chronically ill patients tend to make more use of general practice. The provision of an annual follow-up daytime GP consultation may indicate a lower risk of contacting OOH due to exacerbation.
Highlights
The importance of proactive chronic care has become increasingly evident
In a random sample of contacts to the OOH, we found that patients who contacted the OOH due to an exacerbation of a chronic disease had often recently been examined by a daytime general practice (GP)
We found an association between frequent use of daytime general practice and use of OOH services due to an exacerbation of chronic disease
Summary
The importance of proactive chronic care has become increasingly evident It is unknown whether the use of general practice (GP) during daytime may affect the use of Out-of-Hours (OOH) Primary Care Service for people with chronic disease. Proactive and comprehensive health care for people with chronic diseases has recently received increased focus. It would be expected that the more people with chronic disease use daytime general practice, the more they would use the OOH services due to their general high need of medical attention at all hours [8]. Associations between daytime GP use and OOH use for people with different chronic diseases remains unknown, but more knowledge about this area is needed as e.g. implementation of more proactive daytime care targeting patients with chronic diseases has considerable implications for future health-care planning
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