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Open Access Research article

Chronic-disease patients and their use of out-of-hours primary health care: a cross-sectional study

Lone Flarup1*, Grete Moth1, Morten Bondo Christensen1, Mogens Vestergaard13, Frede Olesen1 and Peter Vedsted12

Author Affiliations

1 Research Unit for General Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, Aarhus DK-8000, C, Denmark

2 Danish Research Centre for Cancer Diagnosis in Primary Care (CaP), Department of Public Health, Aarhus University, Aarhus, Denmark

3 Section for General Medical Practice, Department of Public Health, Aarhus University, Aarhus, Denmark

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BMC Family Practice 2014, 15:114  doi:10.1186/1471-2296-15-114

Published: 9 June 2014

Abstract

Background

The general practitioner (GP) plays an important role for chronic disease care. Continuous and close contact with daytime general practice is intended to prevent medical problems arising outside office hours due to already diagnosed chronic disease. However, previous studies indicate that patients with chronic diseases are frequent users of out-of-hours primary care services (OOH), but knowledge is limited on reasons for encounter (RFE), severity of symptoms, and OOH patient handling. We aimed to describe contacts to the OOH services from patients with chronic heart disease, lung disease, severe psychiatric disorders, diabetes, and cancer in terms of RFE, OOH GP diagnosis, assessed severity of symptoms, and actions taken by the GP.

Methods

Eligible patients (aged 18 years and older) were randomly sampled from a one-year cross-sectional study comprising 15,229 contacts to the OOH services in the Central Denmark Region. A cohort of patients with one or more of the five selected chronic diseases were identified by linking data on the Danish civil registration number (CPR) through specific nationwide Danish health registers.

Results

Out of 13,930 identified unique patients, 4,912 had at least one of the five chronic diseases. In total, 25.9% of all calls to the OOH services came from this chronic disease patient group due to an acute exacerbation; 32.6% of these calls came from patients with psychiatric diagnoses. Patients with chronic disease were more likely to receive a face-to-face contact than the remaining group of patients, except for calls from patients with a psychiatric disorder who were more often completed through a telephone consultation. Patients with heart disease calling due to a new health problem formed the largest proportion of all OOH referrals to hospital (13.3%) compared to calls from the other groups with chronic disease (3.4-6.7%).

Conclusions

A third of the patients randomly sampled by their OOH call had one or more of the five selected chronic diseases (i.e. chronic lung disease, heart disease, diabetes, psychiatric disease, or cancer). Patients with chronic disease were more often managed by OOH GPs than other patients.

Keywords:
Out-of-hours services; OOH; Chronic disease; General practice; Primary health care; Reasons for encounter