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Income-related differences in out-of-hours primary care telephone triage using national registration data
  1. Tessa Jansen1,
  2. Karin Hek1,
  3. François G Schellevis1,2,
  4. Anton E Kunst3,
  5. Robert A Verheij1,4
  1. 1 Netherlands Institute for Health Services Research, Utrecht, The Netherlands
  2. 2 Department of General Practice, Amsterdam Public Health Research Institute, Amsterdam UMC, locatie VUMC, Amsterdam, The Netherlands
  3. 3 Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, locatie AMC, Amsterdam, The Netherlands
  4. 4 Tranzo, Tilburg University, School of Social and Behavioral Sciences, Tilburg, The Netherlands
  1. Correspondence to Tessa Jansen, Netherlands Institute for Health Services Research, Utrecht 3513 CR, The Netherlands; t.jansen{at}nivel.nl

Abstract

Background Telephone triage is used to facilitate efficient and adequate acute care allocation, for instance in out-of-hours primary care services (OPCSs). Remote assessment of health problems is challenging and could be impeded by a patient’s ambiguous formulation of his or her healthcare need. Socioeconomically vulnerable patients may experience more difficulty in expressing their healthcare need. We aimed to assess whether income differences exist in the patient’s presented symptoms, assessed urgency and allocation of follow-up care in OPCS.

Method Data were derived from Nivel Primary Care Database encompassing electronic health record data of 1.3 million patients from 28 OPCSs in 2017 in the Netherlands. These were linked to sociodemographic population registry data. Multilevel logistic regression analyses (contacts clustered in patients), adjusted for patient characteristics (eg, age, sex), were conducted to study associations of symptoms, urgency assessment and follow-up care with patients’ income (standardised for household size as socioeconomic status (SES) indicator).

Results The most frequently presented symptoms deduced during triage slightly differed across SES groups, with a larger relative share of trauma in the high-income groups. No SES differences were observed in urgency assessment. After triage, low income was associated with a higher probability of receiving telephone advice and home visits, and fewer consultations at the OPCS.

Conclusions SES differences in the patient’s presented symptom and in follow-up in OPCS suggest that the underlying health status and the ability to express care needs affect the telephone triage process . Further research should focus on opportunities to better tailor the telephone triage process to socioeconomically vulnerable patients.

  • access to care
  • prehospital care
  • basic ambulance care
  • triage
  • primary care

Data availability statement

Data are available upon reasonable request. Data may be obtained from a third party and are not publicly available. Results are based on calculations by the researchers of this paper using non-public microdata from Statistics Netherlands. Under certain conditions, these microdata are accessible for statistical and scientific research. For further information: microdata@cbs.nl. The unpublished statistical code and raw data files excluding the microdata of Statistics Netherlands are available upon reasonable request from the authors.

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Data availability statement

Data are available upon reasonable request. Data may be obtained from a third party and are not publicly available. Results are based on calculations by the researchers of this paper using non-public microdata from Statistics Netherlands. Under certain conditions, these microdata are accessible for statistical and scientific research. For further information: microdata@cbs.nl. The unpublished statistical code and raw data files excluding the microdata of Statistics Netherlands are available upon reasonable request from the authors.

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Footnotes

  • Handling editor Mary Dawood

  • Contributors TJ designed the study, performed the statistical analyses and wrote the manuscript. KH, RV, FS and AK supervised the study and statistical analyses, and adapted the manuscript. All authors read and approved the final manuscript.

  • Funding The data of this study were collected within the research infrastructure ‘Nivel Primary Care Database’, which is funded by the Netherlands Ministry of Public Health, Welfare and Sports. The funder had no role in the analyses and interpretation of the data.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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