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Patients either contacting a general practice cooperative or accident and emergency department out of hours: a comparison
  1. P Giesen,
  2. E Franssen,
  3. H Mokkink,
  4. W van den Bosch,
  5. A van Vugt,
  6. R Grol
  1. Centre for Quality-of-Care Research, Radboud University Nijmegen, Nijmegen, The Netherlands
  1. Correspondence to:
 Paul Giesen
 Centre for Quality-of-Care Research, Radboud University Nijmegen, WOK 117, PO Box 9101, 6500 HB Nijmegen, The Netherlands; p.giesen{at}voha.umcn.nl

Abstract

Introduction: Lack of collaboration between general practice (GP) cooperatives and accident and emergency (A&E) departments and many self referrals may lead to inefficient out-of-hours care.

Methods: We retrospectively analysed the records of all patients contacting the GP cooperative and all patients self referring to the A&E department out of hours in a region in the Netherlands.

Results: 258 patients contacted the GP cooperative and 43 self referred to the A&E department per 1000 patients per year. A wide range of problems were seen in the GP cooperative, mainly related to infections (26.2%). The A&E department had a smaller range of problems, mainly related to trauma (66.1%). Relatively few urgent problems were seen in the GP cooperative (4.6%) or for self referrals in the A&E department (6.1%). Women, children, the elderly, and rural patients chose the GP cooperative significantly more often, as did men and patients with less urgent complaints, infections, and heart and airway problems.

Discussion: The contact frequency of self referrals to the A&E department is much lower than that at the GP cooperative. Care is complementary: the A&E department focuses on trauma while the GP cooperative deals with a wide range of problems. The self referrals concern mostly minor, non-urgent problems and can generally be treated by the general practitioner, by a nurse, or by advice over the telephone, particularly in the case of optimal collaboration in an integrated care facility of GP cooperatives and A&E departments with one access point to medical care for all patients.

  • A&E, accident and emergency
  • GP, general practice
  • ICPC, International Classification of Primary Care
  • A&E department
  • GP cooperative
  • out-of-hours care
  • self referral

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Footnotes

  • Sponsors: none

  • Conflicts of interest: none declared

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