OOH Service Research Articles

Retrospective observational study of antibiotic prescribing in an out-of-hours doctors service

Abstract Introduction Surveillance of antibiotic use is a key part of Ireland’s National Action Plan for Antimicrobial Resistance 2021-2025. A higher proportion of patients are reported to be prescribed antibiotics in out-of-hours (OOH) doctors services compared to daytime general practice.[1] Challenges with antibiotic prescribing in this setting include unfamiliarity between doctor and patient, lack of follow-up, access to medical history and diagnostics. Surveillance of antibiotic use in OOH services is important to develop tailored antimicrobial stewardship (AMS) interventions in this setting. In Ireland, a national Preferred Antibiotic Initiative encourages prescribers in community settings to avoid, where possible, a list of Red (less preferred) antibiotics, and choose from a Green (preferred) list, if an antibiotic is required. Aim To evaluate antibiotic prescribing patterns in OOH services in the Cork/Kerry region to inform future AMS interventions and to ascertain trends in prescribing of Red antibiotics. Methods A retrospective, observational study was conducted of all oral antibiotic prescriptions in OOH doctors’ consultations between 1st December 2019 and 31st December 2021 in the region. Data were gathered on age, gender, date and time of consultation, consultation method (in person, remote), antibiotic and its indication. Data were analysed using Microsoft Excel v2018 and SPSS v28. Results Overall, 17% (69,017 of 406,812) of the OOH doctors’ consultations resulted in an antibiotic prescription, with considerable variation over the study period just prior to and during the COVID-19 pandemic, ranging from 31% in December 2019 to less than 2% in April 2020 and 22% in December 2021. During the COVID-19 pandemic part of the study period (April 2020 to December 2021), 66% of antibiotics prescribed were from remote consultations, prior to which antibiotic prescribing from remote consultations was rare. Of the antibiotics prescribed, 21% were in children under 6 years old. Respiratory tract infections (RTIs) were the most common indication for antibiotics (60%). Amoxicillin was the most commonly prescribed antibiotic (40% of all prescriptions). Red (reserved) antibiotics accounted for 19% of all prescriptions, which is substantially lower than national figures reported for the study period (35-45%)[2] and the national target of less than 34% for 2021. Red antibiotics were more commonly prescribed during the overnight shifts and in older adults, and less commonly prescribed in remote consultations. Conclusion Low antibiotic prescribing levels during the early stages of the pandemic were not sustained. Antibiotic prescriptions from remote consultations were common. Red antibiotic prescribing proportion is lower than the national mean in this OOH service. Key opportunities for AMS are addressing the volume of antibiotic prescribing for RTIs, particularly in children, AMS in telemedicine and the higher proportion of Red antibiotics prescribed by the overnight shift doctors. This is the first study describing indications antibiotic prescriptions in the OOH setting in Ireland. A limitation of this study is clinical presentation was not available for all OOH consultations. This would have given opportunity to assess the proportion of infectious presentations resulting in an antibiotic prescription to identify further of areas for AMS intervention.

The impact on primary care of a large waterborne campylobacter outbreak in Norway: a controlled observational study

Objective Document the impact of an outbreak of gastroenteritis on local primary health care services, compared to a control period. Design Controlled observational study with data from the outbreak and a control period. Data obtained from electronic medical records (EMR) of general practitioners (GPs) and the out-of-hours (OOH) service. Telephone data from the OOH service’s telephone records. Setting Campylobacteriosis outbreak in Askøy municipality, Norway in 2019. Over 2000 individuals were infected. Subjects Patients in contact with GPs and the OOH service during the outbreak and a control period. Main outcome measures Patient contacts with GPs and the OOH service during the outbreak and a control period. Results There was a 36% increase in contacts during the outbreak compared to the control period (4798 vs. 3528), with the OOH service handling 78% of outbreak-related contacts. Telephone advice was the dominant method for managing the increase in contacts to primary care, both in OOH services and daytime general practice (OR 3.73 CI: [3.24–4.28]). Children aged 0–4 years had increased use of primary care during the outbreak (OR 1.51 CI: [1.28–1.78]). GPs referred 25% and OOH services referred 75% of 70 hospitalized cases. Conclusion The OOH service handled most of the patients during the outbreak, with support from daytime general practice. The outbreak caused a shift towards telephone advice as a means of providing care. Young children significantly increased their use of primary care during the outbreak.

Rural and Urban patients’ Requirements and Experiences of Out-of-hours medical care after cancer (RUREO): a questionnaire study

ObjectiveTo investigate how individuals diagnosed with cancer use out-of-hours (OOH) medical services, describe the behavioural determinants of OOH service use and explore whether there are differences between urban and rural...

Acute medical missions by helicopter medical service (HEMS) to municipalities with different approach for primary care physicians.

BackgroundThe prehospital emergency system in Norway involves out-of-hours (OOH) services with on-call physicians. Helicopter emergency medical service (HEMS) are used in cases of severe illness or trauma that require rapid transport and/or an anesthesiologist’s services. In recent years, on-call primary care physicians have been less available for call-outs in Norway, and HEMS may be requested for missions that could be adequately handled by on-call physicians. Here, we investigated how different availability of an on-call physician to attend emergency patients at site (call-out) impacted requests and use of HEMS.MethodsOur analysis included all acute medical missions in an urban and nearby rural OOH district, which had different approach regarding physician call-outs from the OOH service. For this prospective observational study, we used data from both HEMS and the OOH service from November 1st 2017 until November 30th 2018. Standard descriptive statistical analyses were used.ResultsThe rates of acute medical missions in the urban and rural OOH districts were similar (30 and 29 per 1000 inhabitants per year, respectively). The rate of HEMS requests was significantly higher in the rural OOH district than in the urban district (2.4 vs. 1.7 per 1000 inhabitants per year, respectively). Cardiac arrest and trauma were the major symptom categories in more than one half of the HEMS-attended patients, in both districts. Chest pain was the most frequent reason for an OOH call-out in the rural OOH district (21.1%). An estimated NACA score of 5–7 was found in 47.7% of HEMS patients from the urban district, in 40.0% of HEMS patients from the rural OOH district (p = 0.44), and 12.8% of patients attended by an on-call physician in the rural OOH district (p < 0.001). Advanced interventions were provided by an anesthesiologist to one-third of the patients attended by HEMS, of whom a majority had an NACA score of ≥ 5.ConclusionsHEMS use did not differ between the two compared areas, but the rate of HEMS requests was significantly higher in the rural OOH district. The threshold for HEMS use seems to be independent of on-call primary care physician involvement.

Variation in referral rates to emergency departments and inpatient services from a GP out of hours service and the potential impact of alternative staffing models

IntroductionOut of hours (OOHs) primary care is a critical component of the acute care system overnight and at weekends. Referrals from OOH services to hospital will add to the burden...

What is the demand for out-of-hours dermatology? A UK-based region-wide survey of dermatology demand and provision during the evenings and at weekends.

Little is known about the demand for out-of-hours (OOH) dermatology in the UK, and this can make commissioning of acute services difficult. The East Midlands region has a population of 4.5 million people, with variable access to OOH dermatology services. We sought to investigate the provision of, and demand for, OOH dermatology services across the region with a view to informing commissioning decisions for the future. We contacted all dermatology departments in the East Midlands region to establish what level of service was commissioned at evenings and weekends. At the sites providing any form of OOH service, we recorded all requests for advice received after 17.00h on weekdays, or at any time during weekends and bank holidays over a 3-month period from October to December 2019. The OOH services provided ranged from 24h/day cover 7days/week at one site, to no formal provision across much of the rest of the region. In total, 125 calls were received during the study period, averaging 1 call per day on weekday evenings, and 2 calls per day at weekends and on bank holidays. Of these 125 calls, 11 patients (9%) were prioritized and seen by the on-call dermatologist on the day of referral, and 9 of these had potentially life-threatening skin conditions. A further 39 (31%) were deemed to need review within 24h and 22 (18%) within 48h. The remaining 42% were given appointments within 7days or dealt with by telephone advice. The demand for OOH dermatology across the East Midlands is low, but access to timely dermatology advice is essential in some situations. Commissioning of a regional dermatology OOH service incorporating digital technology may help to improve the equity of access for all patients across the region.

Patient safety culture in Italian out-of-hours primary care service: a national cross-sectional survey study.

BackgroundOut-of-hours (OOH) services in Italy provide >10 million consultations every year. To the authors' knowledge, no data on patient safety culture (PSC) have been reported.AimTo assess PSC in the Italian OOH setting.Design & settingNational cross-sectional survey using the Safety Attitudes Questionnaire — Ambulatory Version (SAQ-AV).MethodThe SAQ-AV was translated into Italian and distributed in a convenience sample of OOH doctors in 2015. Answers were collected anonymously by Qualtrics. Stata (version 14) was used to estimate Cronbach’s alpha, perform exploratory and confirmatory factor analysis, correlate items to doctors’ characteristics, and to do item descriptive analysis.ResultsOverall, 692 OOH doctors were contacted, with a 71% response rate. In the exploratory factor analysis (EFA), four factors were identified: Communication and Safety Climate (14 items); Perceptions of Management (eight items); Workload and Clinical Risk (six items); and Burnout Risk (four items).These four factors accounted for 68% of the total variance (Kaiser–Meyer–Olkin [KMO] statistic = 0.843). Cronbach’s alpha ranged from 0.710–0.917. OOH doctors were often dissatisfied with their job; there is insufficient staff to provide optimal care and there is no training or supervision for new personnel and family medicine trainees. Service managers are perceived as distant, with particular issues concerning the communication between managers and OOH doctors. A large proportion of OOH doctors (56.8%) state that they do not receive adequate support.ConclusionThese findings could be useful for informing policies on how to improve PSC in Italian OOH service.

Helicopter emergency medical service (HEMS) activity after increased distance to out-of-hours services: an observational study from Norway

BackgroundOrganizational changes in out-of-hour (OOH) services may have unintended consequences for other prehospital services. Reports indicate an increased use of helicopter emergency medical services (HEMS) after changes in OOH services in Norway due to greater geographical distances for the on-call doctors. We investigated whether HEMS dispatches increased when nine municipalities in Sogn og Fjordane County merged into one large inter-municipal OOH district.MethodsAll primary dispatches of the HEMS in the county between 2004 and 2013 were included. We applied interrupted time series regression to monthly aggregated data to evaluate the impact of the organizational change 1 April 2009. The nine target municipalities were compared to the rest of the municipalities in the county, which served as a control group. A quasipoisson model adjusted for seasonality was found to be most applicable.ResultsWe included 8,751 dispatches, 5,009 (57.2%) of which were completed with a patient encounter. Overall, we found no alteration in requests for HEMS after 2009 (p = 0.251). Separate analyses of the target municipalities and control group revealed no significant increase after 2009 (p = 0.400 and p = 0.056, respectively). When categorizing the municipalities into urban or rural, we found a general increase in HEMS dispatches for the rural group over the 10-year span (p = 0.045) but no added increase after 2009 (p = 0.502). The urban subgroup showed no change. Distance from the OOH service in regards to travel increased within the nine municipalities after 2009, median [quartiles] (5.0[3.0, 6.2] km vs 26.5[5.0, 62.2] km, p < 0.001).ConclusionAfter relocating nine local OOH services into one large inter-municipal OOH district, we found no increase in requests for HEMS.

Referral rates for children with acute gastroenteritis: a retrospective cohort study.

BackgroundHospital admission rates are increasing for children with acute gastroenteritis. However, it is unknown whether this increase is accompanied by an increase in referral rates from GPs due to increased workloads in primary care out-of-hours (OOH) services.AimTo assess trends in referral rates from primary care OOH services to specialist emergency care for children presenting with acute gastroenteritis.Design & settingThis retrospective cohort study covered a period from September 2007–September 2014. Children aged 6 months to 6 years presenting with acute gastroenteritis to a primary care OOH service were included.MethodPseudonymised data were obtained, and children were analysed overall and by age category. Χ2 trend tests were used to assess rates of acute gastroenteritis, referrals, face-to-face contacts, and oral rehydration therapy (ORT) prescriptions.ResultsThe data included 12 455 children (6517 boys), with a median age of 20.2 months (interquartile range [IQR] 11.6 to 36.0 months). Over 7 years, incidence rates of acute gastroenteritis decreased significantly, and face-to-face contact rates increased significantly (both, P<0.01). However, there was no significant trend for referral rates (P = 0.87) or prescription rates for ORT (P = 0.82). Subgroup analyses produced comparable results, although there was an increase in face-to-face contact rates for the older children.ConclusionIncidence rates for childhood acute gastroenteritis presenting in OOH services decreased and referral rates did not increase significantly. These findings may be useful as a reference for the impact of new interventions for childhood acute gastroenteritis.

Prescriptions of antibiotics in out-of-hours primary care setting in Reykjavik capital area

Objective To describe antibiotic prescriptions in out-of-hour (OOH) service in primary care setting in Iceland and to study the indications for prescriptions. Design A population based retrospective study, using electronic data from the OOH registration system. Setting OOH primary care setting in Reykjavik capital area in Iceland. Subjects All patients that received a prescription for oral antibiotic drug at an OOH service in Reykjavik capital area over a one-year period. Main outcome measures Number of oral antibiotic prescriptions and diagnosis connected to the prescriptions according to age and sex. Results There were 75,582 contacts with the OOH primary care of which 25,059 contacts resulted in prescription of an oral antibiotic (33%). The most common antibiotic prescribed in total, and for the diagnosis studied, was amoxicillin with clavulanic acid. It was most often prescribed for acute otitis media. Of those diagnosed with otitis media 50% were treated with amoxicillin with clavulanic acid and 40% of those diagnosed with pneumonia received that treatment. The second most prescribed antibiotic was amoxicillin. Most often it was prescribed for sinusitis, in 47% of cases with that diagnosis. Conclusion Antibiotics are often prescribed in OOH primary care in Iceland and a substantial number of the patients diagnosed in OOH primary care with acute otitis media or pneumonia are prescribed broad-spectrum antibiotics. Key points Antibiotic prescription rate is high and broad-spectrum drugs often prescribed in OOH primary care service in Iceland. The results should encourage general practitioners in Iceland to review antibiotic prescriptions in OOH service.

Contact characteristics and factors associated with the degree of urgency among older people in emergency primary health care: a cross-sectional study

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.

Contacting out-of-hours primary care or emergency medical services for time-critical conditions\xa0-\xa0impact on patient outcomes

BackgroundOut-of-hours (OOH) healthcare services in Western countries are often differentiated into out-of-hours primary healthcare services (OOH-PC) and emergency medical services (EMS). Call waiting time, triage model and intended aims differ between these services. Consequently, the care pathway and outcome could vary based on the choice of entrance to the healthcare system.We aimed to investigate patient pathways and 1- and 1–30-day mortality, intensive care unit (ICU) stay and length of hospital stay for patients with acute myocardial infarction (AMI), stroke and sepsis in relation to the OOH service that was contacted prior to the hospital contact.MethodsPopulation-based observational cohort study during 2016 including adult patients from two Danish regions with an OOH service contact on the date of hospital contact. Patients <18 years were excluded. Data was retrieved from OOH service databases and national registries, linked by a unique personal identification number. Crude and adjusted logistic regression analyses were performed to assess mortality in relation to contacted OOH service with OOH-PC as the reference and cox regression analysis to assess risk of ICU stay.ResultsWe included 6826 patients. AMI and stroke patients more often contacted EMS (52.1 and 54.1%), whereas sepsis patients predominately called OOH-PC (66.9%). Less than 10% (all diagnoses) of patients contacted both OOH-PC & EMS. Stroke patients with EMS or OOH-PC & EMS contacts had higher likelihood of 1- and 1–30-day mortality, in particular 1-day (EMS: OR = 5.33, 95% CI: 2.82–10.08; OOH-PC & EMS: OR = 3.09, 95% CI: 1.06–9.01). Sepsis patients with EMS or OOH-PC & EMS contacts also had higher likelihood of 1-day mortality (EMS: OR = 2.22, 95% CI: 1.40–3.51; OOH-PC & EMS: OR = 2.86, 95% CI: 1.56–5.23) and 1–30-day mortality. Risk of ICU stay was only significantly higher for stroke patients contacting EMS (EMS: HR = 2.38, 95% CI: 1.51–3.75). Stroke and sepsis patients with EMS contact had longer hospital stays.ConclusionsMore patients contacted OOH-PC than EMS. Sepsis and stroke patients contacting EMS solely or OOH-PC & EMS had higher likelihood of 1- and 1–30-day mortality during the subsequent hospital contact. Our results suggest that patients contacting EMS are more severely ill, however OOH-PC is still often used for time-critical conditions.

Preschool children in Danish out-of-hours primary care: a one-year descriptive study of face-to-face consultations

BackgroundThe demand for out-of-hours (OOH) primary care has increased during the last decades, with a considerable amount of contacts for young children. This study aims to describe the reasons for encounter (RFE), the most common diagnoses, the provided care, and the parental satisfaction with the general practitioner (GP) led OOH service in a Danish population of children (0–5 years).MethodsWe conducted a one-year cross-sectional study based on data for 2363 randomly selected contacts concerning children from a survey on OOH primary care including 21,457 patients in Denmark. For each contact, the GPs completed an electronic pop-up questionnaire in the patient’s medical record. Questionnaire items focussed on RFE, health problem severity, diagnosis, provided care, and satisfaction. The parents subsequently received a postal questionnaire.ResultsThe most common RFE was non-specific complaints (40%), followed by respiratory tract symptoms (23%), skin symptoms (9%), and digestive organ symptoms (8%). The most common diagnosis group was respiratory tract diseases (41%), followed by general complaints (19%) and ear diseases (16%). Prescriptions were dispensed for 27% of contacts, and about ¾ were for antibiotics. A total of 12% contacts concerned acute otitis media; antibiotics were prescribed in 70%. A total of 38% of contacts concerned fever, and ¼ got antibiotics. A total of 7.4% were referred for further evaluation. The parental satisfaction was generally high, but 7.0% were dissatisfied. Dissatisfaction was correlated with low prescription rate.ConclusionRespiratory tract diseases were the most common diagnoses. The GPs at the OOH primary care service referred children to hospital in 7.4% of the face-to-face consultations, and the provided care was evaluated as non-satisfying by only 7.0% of the parents. Clinical implications of the findings mean room for less prescription of antibiotic to children with ear diseases and a need for research in factors related to dissatisfaction.

Assessing the effectiveness of advanced nurse practitioners undertaking home visits in an out of hours urgent primary care service in England.

To measure the effectiveness of advanced nurse practitioners (ANPs) against national quality requirements for out-of-hours (OOH) care, to compare ANP effectiveness with that of doctors working in the same service, and to evaluate the impact of ANPs on the service. There is little documented evidence of ANPs undertaking urgent home visits in the OOH setting. This study advances current knowledge of this aspect of the OOH service and makes recommendations for the management of the ANP urgent home visiting service. Analysis of 1,539 ANP home-visit patient electronic case notes over a 12-month period, a focus group of eight GPs, and interviews with six ANPs. Advanced nurse practitioners are as effective as GPs in undertaking urgent home visits. Their documentation is more consistent and their refer-on rate to secondary care is less than that of GP colleagues. Advanced nurse practitioners can provide equivalent clinical outcomes to GPs when undertaking urgent home visits. This study adds to the body of evidence for the positive impact of ANPs on OOH service delivery and managers can be assured that they are practising at a level that makes them effective and safe to undertake this role.

Evidence-based out-of-hours hospital medicine

Out-of-hours (OOH) hospital ward cover is generally provided by junior doctors and is typified by heavy workloads, reduced staff numbers and various non-urgent nurse-initiated requests. The present inefficiencies and management...

Frequent attenders at primary care out-of-hours services: a\xa0registry-based observational study in Norway

BackgroundOut-of-hours (OOH) services are often consulted for problems that are non-urgent. Some of these patients are frequent attenders (FAs) who may constitute a heavy burden on the OOH service. The aim of the present study was to analyse FAs in a comprehensive material, covering all patients who have visited OOH services in Norway during a 10-year period.MethodsFA was defined as a patient having ≥5 consultations during one year. A cohort of all 15,172 FAs in 2008 was followed until 2017, with a description of demographics, consultations, and diagnoses for each year. FAs in 2017 were also analysed with more extreme definitions (≥10, ≥20, ≥30 consultations). To analyse predictors for FA a logistic regression analysis was performed on the 2017 data.ResultsFAs constituted 2% of all patients (U-shaped age curve and female overrepresentation) and approximately 10% of all consultations each year. 59.8% of the cohort was never FA again, 17.7% had one relapse, 8.6% two, and 4.4% had three relapses. 22.8% was also a FA in 2009. Thereafter the percentage gradually declined to 6.2% in 2017. Only 0.8% of the original cohort were persistent FAs throughout the 10-year period. FAs were three times as likely to be given a psychological diagnosis as the average OOH patient, and this percentage increased in persistent and more extreme FAs. FAs tended to seek help at inconvenient hours (late evening and night), and increasingly so the more extreme they were. Also, they needed more consultation time and more often received home visits. The logistic regression analysis identified the following predictors for becoming FA (odds ratio = OR): Female (OR 1.17), age 0–1 years (OR 3.46), age 70+ (OR 1.57), small municipality (OR 1.61), psychological diagnosis (OR 10.00), social diagnosis (OR 5.97), cancer (OR 6.76), diabetes (OR 4.65), and chronic obstructive pulmonary disease (OR 7.81).ConclusionsFAs were most common among the youngest children and among the elderly, increasing with age. Females were overrepresented, as were patients with psychosocial problems and various chronic somatic conditions. The majority were only temporary FAs.

Who attends out-of-hours general practice appointments? Analysis of a patient cohort accessing new out-of-hours units

ObjectivesThis report describes the patients who used additional out-of-hours (OOH) appointments offered through a UK scheme intended to increase patient access to primary care by extending OOH provision.DesignCohort study and...

Postdischarge Unscheduled Care Burden After Lower Limb Arthroplasty

BackgroundIn contrast to postdischarge arthroplasty readmission rates, the unscheduled reattendance burden to primary care is under-reported. Understanding reasons for reattendance would allow for implementation of strategies to reduce this burden. The present study aims to quantify the out-of-hours (OOH) general practitioner and emergency department (ED) service reattendance burden and readmission rate after primary total hip arthroplasty and total knee arthroplasty, with estimation of the associated costs. MethodsThis is a prospective consecutive cohort study. A prospective audit of all total hip arthroplasty and total knee arthroplasty patients in 2016 in a single high-volume UK arthroplasty unit was performed. Incidence and reasons for reattendance to OOH and ED service, as well as readmission rates, at both 30 and 90 days following discharge are reported. A multivariate analysis was performed to determine patient characteristics, which results in increased reattendance and readmission rates. ResultsA total of 2351 procedures resulted in 374 attendances of OOH service and 665 to ED with a total estimated cost of £190,000 within 90 days. The readmission rate was 6.8%. Risk factors for reattendance and readmission were increasing age and a prolonged length of stay. The use of a 5-day postdischarge phone call and a dedicated Arthroplasty Care Practitioner favors reduced reattendances but not the readmission rate, with the additional benefit of being cost-effective. ConclusionThe postdischarge arthroplasty reattendance burden is associated with significant costs, and strategies to reduce this should be developed. Further research is required to assess the effectiveness and cost-effectiveness of multicomponent strategies to reduce reattendance operating at scale.

Contact to the out-of-hours service among Danish parents of small children – a qualitative interview study

Objective: In Denmark, parents with small children have the highest contact frequency to out-of-hours (OOH) service, but reasons for OOH care use are sparsely investigated. The aim was to explore parental contact pattern to OOH services and to explore parents’ experiences with managing their children’s acute health problems.Design: A qualitative study was undertaken drawing on a phenomenological approach. We used semi-structured interviews, followed by an inductive content analysis. Nine parents with children below four years of age were recruited from a child day care centre in Aarhus, Denmark for interviews.Results: Navigation, information, parental worry and parental development appeared to have an impact on OOH services use. The parents found it easy to navigate in the health care system, but they often used the OOH service instead of their own general practitioner (GP) due to more compatible opening hours and insecurity about the urgency of symptoms. When worried about the severity, the parents sought information from e.g. the internet or the health care professionals. The first child caused more worries and insecurity due to less experience with childhood diseases and the contact frequency seemed to decrease with parental development.Conclusion: Parents’ use of the OOH service is affected by their health literacy levels, e.g. level of information, how easy they find access to their GP, how trustworthy and authorized health information is, as well as how much they worry and their parental experience. These findings must be considered when planning effective health services for young families.Key pointsThe main findings are that the parents in our study found it easy to navigate in the healthcare system, but they used the OOH service instead of their own general practitioner, when this suited their needs. The parents sought information from e.g. the internet or the health care professionals when they were worried about the severity of their children’s diseases. They sometimes navigated strategically in the healthcare system by e.g. using the OOH service for reassurance and when it was most convenient according to opening hours. The first child seemed to cause more worries and insecurity due to limited experience with childhood diseases, and parental development seems to decrease contact frequency.Overall, this study contributes with valuable insights into the understanding of parents’ help seeking behaviour. There seems to be a potential for supporting especially first-time parents in their use of the out of hours services.

What proportion of patients at the end of life contact out-of-hours primary care? A data linkage study in Oxfordshire

ObjectivesOut-of-hours (OOH) primary care services are a key element of community care at the end of life, yet there have been no previous attempts to describe the scope of this...