General practice cooperatives: long waiting times for home visits due to long distances?

Paul Giesen,Wil Van Den Bosch,Richard Grol,Nieke Van Lin,Henk Mokkink

doi:10.1186/1472-6963-7-19

Paul Giesen, Wil Van Den Bosch + Show 3 more

Open Access

https://doi.org/10.1186/1472-6963-7-19

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Abstract

BackgroundThe introduction of large-scale out-of-hours GP cooperatives has led to questions about increased distances between the GP cooperatives and the homes of patients and the increasing waiting times for home visits in urgent cases. We studied the relationship between the patient's waiting time for a home visit and the distance to the GP cooperative. Further, we investigated if other factors (traffic intensity, home visit intensity, time of day, and degree of urgency) influenced waiting times.MethodsCross-sectional study at four GP cooperatives. We used variance analysis to calculate waiting times for various categories of traffic intensity, home visit intensity, time of day, and degree of urgency. We used multiple logistic regression analysis to calculate to what degree these factors affected the ability to meet targets in urgent cases.ResultsThe average waiting time for 5827 consultations was 30.5 min. Traffic intensity, home visit intensity, time of day and urgency of the complaint all seemed to affect waiting times significantly. A total of 88.7% of all patients were seen within 1 hour. In the case of life-threatening complaints (U1), 68.8% of the patients were seen within 15 min, and 95.6% of those with acute complaints (U2) were seen within 1 hour. For patients with life-threatening complaints (U1) the percentage of visits that met the time target of 15 minuts decreased from 86.5% (less than 2.5 km) to 16.7% (equals or more than 20 km).Discussion and conclusionAlthough home visits waiting times increase with increasing distance from the GP cooperative, it appears that traffic intensity, home visit intensity, and urgency also influence waiting times. For patients with life-threatening complaints waiting times increase sharply with the distance.

Highlights

The introduction of large-scale out-of-hours general practice (GP) cooperatives has led to questions about increased distances between the GP cooperatives and the homes of patients and the increasing waiting times for home visits in urgent cases
Patients living 20 km or more from the GP cooperative had to wait an average of 13.4 min longer for a home visit than patients living in the immediate neighbourhood of the GP cooperative (Table 4)
Home visit business, and urgency of the complaint all had a significant influence on this waiting time

Summary

Introduction

The introduction of large-scale out-of-hours GP cooperatives has led to questions about increased distances between the GP cooperatives and the homes of patients and the increasing waiting times for home visits in urgent cases. We see more and more largescale general practice (GP) cooperatives with central triage and sometimes a combination of primary care and accident and emergency (A&E) departments in hospitals [16]. These changes are due in part to increased workload and the changing needs and attitudes of general practitioners related to their work [1,5]. The IGZ advocated the setting up of satellite cooperatives[7]

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