Abstract
Introduction. General practitioners (GP) answer calls to the Danish out-of-hours primary care service (OOH) in Denmark, and this is a subject of discussions about quality and cost-effectiveness. The aim of this study was to estimate changes in fee costs if nurses substituted the GPs. Methods. We applied experiences from The Netherlands on nurse performance in the OOH triage concerning the number of calls per hour. Using the 2011 number of calls in one region, we examined three hypothetical scenarios with nurse triage and calculated the differences in fee costs. Results. A new organisation with 97 employed nurses would be needed. Fewer telephone consultations may result in an increase of face-to-face contacts, resulting in an increase of 23.6% in costs fees. Under optimal circumstances (e.g., a lower demand for OOH services, a high telephone termination rate, and unchanged GP fees) the costs could be reduced by 26.2% though excluding administrative costs of a new organisation. Conclusion. Substituting GPs with nurses in OOH primary care may increase the cost in fees compared to a model with only GPs. Further research is needed involving more influencing factors, such as costs due to nurse training and running the organisation.
Highlights
General practitioners (GP) answer calls to the Danish out-of-hours primary care service (OOH) in Denmark, and this is a subject of discussions about quality and cost-effectiveness
In a scenario with nurses substituting GPs in the OOH primary care telephone triage with the same number of contacts to the OOH primary care service and an 18 percent decrease in contacts terminated on the phone, the costs would increase by 23.6% compared with the existing situation
This study suggests that the cost-economic consequences of substituting GPs with nurses in the Danish OOH service are dependent on a range of factors
Summary
General practitioners (GP) answer calls to the Danish out-of-hours primary care service (OOH) in Denmark, and this is a subject of discussions about quality and cost-effectiveness. In Denmark, a reform of the OOH primary care services in 1992 resulted in a considerable substitution of home visits by general practitioner (GP) telephone consultations and local GP clinic consultations [3, 4]. Supervised by a GP, the nurses/nurse assistants decide whether the patients are to be given a telephone advice or are to be examined by a GP at a subsequent clinic consultation or home visit. They are qualified and certified through training in communicative and practical triage skills and have access to a guideline-based computer-assisted decision tool to support the triage [7, 8]. Concerning the level of urgency of calls in the two countries a study of patient safety in The Netherlands showed that 59.9% of calls were noneurgent (routine, no time pressure), and in Denmark a survey on reasons for encounter in the OOH primary care showed that 59.1% of calls were considered noneurgent (not severe, not ill) [9, 10]
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