Patient satisfaction with out-of-hours primary care in the Netherlands

Abstract The aims of this study are (1) to evaluate the performance of current triage for chest pain; (2) to describe the case mix of patients undergoing triage for chest pain; and (3) to identify opportunities to improve performance of current Dutch triage system for chest pain. Chest pain is a common symptom, and identifying patients with chest pain that require urgent care can be quite challenging. Making the correct assessment is even harder during telephone triage. Temporal trends show that the referral threshold has lowered over time, resulting in overcrowding of first responders and emergency services. While various stakeholders advocate for a more efficient triage system, careful evaluation of the performance of the current triage in primary care is lacking. TRiage of Acute Chest pain Evaluation in primary care (TRACE) is a large cohort study designed to describe the current Dutch triage system for chest pain and subsequently evaluate triage performance in regard to clinical outcomes. The study consists of consecutive patients who contacted the out-of-hours primary care facility with chest pain in the region of Alkmaar, the Netherlands, in 2017, with follow-up for clinical outcomes out to August 2019. The primary outcome of interest is ‘major event’, which is defined as the occurrence of death from any cause, acute coronary syndrome, urgent coronary revascularization, or other high-risk diagnoses in which delay is inadmissible and hospitalization is necessary. We will evaluate the performance of the triage system by assessing the ability of the triage system to correctly classify patients regarding urgency (accuracy), the proportion of safe actions following triage (safety) as well as rightfully deployed ambulances (efficacy). TRACE is designed to describe the current Dutch triage system for chest pain in primary care and to subsequently evaluate triage performance in regard to clinical outcomes.

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Frequent attendance of primary care out-of-hours services in The Netherlands: characteristics of patients and presented morbidity

Family Practice ◽

10.1093/fampra/cmp103 ◽

2009 ◽

Vol 27 (2) ◽

pp. 129-134 ◽

Cited By ~ 23

Author(s):

D. den Boer-Wolters ◽

M. J Knol ◽

K. Smulders ◽

N. J de Wit

Keyword(s):

Primary Care ◽

The Netherlands ◽

Out Of Hours ◽

Frequent Attendance

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Developing a standard short questionnaire for the assessment of patient satisfaction with out-of-hours primary care

Family Practice ◽

10.1093/fampra/cmi050 ◽

2005 ◽

Vol 22 (5) ◽

pp. 560-569 ◽

Cited By ~ 22

Author(s):

C Salisbury ◽

A Burgess ◽

V Lattimer ◽

D Heaney ◽

J Walker ◽

...

Keyword(s):

Primary Care ◽

Patient Satisfaction ◽

Out Of Hours ◽

Short Questionnaire

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Effects of access to radiology in out-of-hours primary care on patient satisfaction and length of stay

European Journal of General Practice ◽

10.1080/13814788.2021.1959911 ◽

2021 ◽

Vol 27 (1) ◽

pp. 221-227

Author(s):

Martijn H. Rutten ◽

Paul H. J. Giesen ◽

Willem J. J. Assendelft ◽

Gert Westert ◽

Marleen Smits

Keyword(s):

Primary Care ◽

Patient Satisfaction ◽

Length Of Stay ◽

Out Of Hours

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The impact of demand management strategies on parents’ decision-making for out-of-hours primary care: findings from a survey in The Netherlands

BMJ Open ◽

10.1136/bmjopen-2016-014605 ◽

2017 ◽

Vol 7 (5) ◽

pp. e014605 ◽

Cited By ~ 4

Author(s):

Marie-Jeanne Giesen ◽

Ellen Keizer ◽

Julia van de Pol ◽

Joris Knoben ◽

Michel Wensing ◽

...

Keyword(s):

Primary Care ◽

Decision Making ◽

The Netherlands ◽

Demand Management ◽

Management Strategies ◽

Out Of Hours ◽

The Impact

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Examining differences in out-of-hours primary care use in Belgium and the Netherlands: a cross-sectional study

European Journal of Public Health ◽

10.1093/eurpub/ckz083 ◽

2019 ◽

Vol 29 (6) ◽

pp. 1018-1024 ◽

Cited By ~ 5

Author(s):

Marleen Smits ◽

Annelies Colliers ◽

Tessa Jansen ◽

Roy Remmen ◽

Stephaan Bartholomeeusen ◽

...

Keyword(s):

Primary Care ◽

General Practitioner ◽

The Netherlands ◽

Health Problem ◽

Cross Sectional Study ◽

Health Problems ◽

Electronic Health Record Data ◽

Cross Sectional ◽

Out Of Hours ◽

Organizational Differences

AbstractBackgroundThe organizational model of out-of-hours primary care is likely to affect healthcare use. We aimed to examine differences in the use of general practitioner cooperatives for out-of-hours care in the Netherlands and Belgium (Flanders) and explore if these are related to organizational differences.MethodsA cross-sectional observational study using routine electronic health record data of the year 2016 from 77 general practitioner cooperatives in the Netherlands and 5 general practitioner cooperatives in Belgium (Flanders). Patient age, gender and health problem were analyzed using descriptive statistics.ResultsThe number of consultations per 1000 residents was 2.3 times higher in the Netherlands than in Belgium. Excluding telephone consultations, which are not possible in Belgium, the number of consultations was 1.4 times higher. In Belgium, the top 10 of health problems was mainly related to infections, while in the Netherlands there were a larger variety of health problems. In addition, the health problem codes in the Dutch top 10 were more often symptoms, while the codes in the Belgian top 10 were more often diagnoses. In both countries, a relatively large percentage of GPC patients were young children and female patients.ConclusionDifferences in the use of general practitioner cooperatives seem to be related to the gatekeeping role of general practitioners in the Netherlands and to organizational differences such as telephone triage, medical advice by telephone, financial thresholds and number of years of experience with the system. The information can benefit policy decisions about the organization of out-of-hours primary care.

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Use of out-of-hours primary care in affluent and deprived neighbourhoods during reforms in long-term care: an observational study from 2013 to 2016

BMJ Open ◽

10.1136/bmjopen-2018-026426 ◽

2019 ◽

Vol 9 (3) ◽

pp. e026426 ◽

Cited By ~ 1

Author(s):

Tessa Jansen ◽

Robert A Verheij ◽

Francois G Schellevis ◽

Anton E Kunst

Keyword(s):

Primary Care ◽

The Netherlands ◽

Electronic Health Records ◽

Long Term Care ◽

Term Care ◽

Health Records ◽

Out Of Hours ◽

Deprived Neighbourhoods ◽

Neighbourhood Level

ObjectivesMajor long-term care (LTC) reforms in the Netherlands in 2015 may specifically have disadvantaged socioeconomically deprived groups to acquire LTC, possibly impacting the use of acute care. We aimed to demonstrate whether LTC reforms coincided with changes in the use of out-of-hours (OOH) primary care services (PCSs), and to compare changes between deprived versus affluent neighbourhoods.DesignEcological observational retrospective study using routinely recorded electronic health records data from 2013 to 2016 and population registry data.SettingData from 15 OOH PCSs participating in the Nivel Primary Care Database (covering approximately 6.5 million inhabitants) in the Netherlands. PCS utilisation data on neighbourhood level were matched with sociodemographic characteristics, including neighbourhood socioeconomic status (SES).ParticipantsElectronic health records from 6 120 384 OOH PCS contacts in 2013–2016, aggregated to neighbourhood level.Outcome measures and analysesNumber of contacts per 1000 inhabitants/year (total, high/low-urgency, night/evening-weekend-holidays, telephone consultations/consultations/home visits).Multilevel linear regression models included neighbourhood (first level), nested within PCS catchment area (second level), to account for between-PCS variation, adjusted for neighbourhood characteristics (for instance: % men/women). Difference-in-difference in time-trends according to neighbourhood SES was assessed with addition of an interaction term to the analysis (year×neighbourhood SES).ResultsBetween 2013 and 2016, overall OOH PCS use increased by 6%. Significant increases were observed for high-urgency contacts and contacts during the night. The largest change was observed for the most deprived neighbourhoods (10% compared with 4%–6% in the other neighbourhoods; difference not statistically significant). The increasing trend in OOH PCS use developed practically similar for deprived and affluent neighbourhoods. A a stable gradient reflected more OOH PCS use for each lower stratum of SES.ConclusionsLTC reforms coincided with an overall increase in OOH PCS use, with nearly similar trends for deprived and affluent neighbourhoods. The results suggest a generalised spill over to OOH PCS following LTC reforms.

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Management of sepsis in out-of-hours primary care: a retrospective study of patients admitted to the intensive care unit

BMJ Open ◽

10.1136/bmjopen-2018-022832 ◽

2018 ◽

Vol 8 (9) ◽

pp. e022832 ◽

Cited By ~ 4

Author(s):

Feike J Loots ◽

Marleen Smits ◽

Carlijn van Steensel ◽

Paul Giesen ◽

Rogier M Hopstaken ◽

...

Keyword(s):

Primary Care ◽

Intensive Care Unit ◽

Intensive Care ◽

Retrospective Study ◽

The Netherlands ◽

Hospital Mortality ◽

Hospital Arrival ◽

Out Of Hours ◽

Suspected Infection ◽

Prehospital Management

ObjectivesTimely recognition and treatment of sepsis is essential to reduce mortality and morbidity. Acutely ill patients often consult a general practitioner (GP) as the first healthcare provider. During out-of-hours, GP cooperatives deliver this care in the Netherlands. The aim of this study is to explore the role of these GP cooperatives in the care for patients with sepsis.DesignRetrospective study of patient records from both the hospital and the GP cooperative.SettingAn intensive care unit (ICU) of a general hospital in the Netherlands, and the colocated GP cooperative serving 260 000 inhabitants.ParticipantsWe used data from 263 patients who were admitted to the ICU due to community-acquired sepsis between January 2011 and December 2015.Main outcome measuresContact with the GP cooperative within 72 hours prior to hospital admission, type of contact, delay from the contact until hospital arrival, GP diagnosis, initial vital signs and laboratory values, and hospital mortality.ResultsOf 263 patients admitted to the ICU, 127 (48.3%) had prior GP cooperative contacts. These contacts concerned home visits (59.1%), clinic consultations (18.1%), direct ambulance deployment (12.6%) or telephone advice (10.2%). Patients assessed by a GP were referred in 64% after the first contact. The median delay to hospital arrival was 1.7 hours. The GP had not suspected an infection in 43% of the patients. In this group, the in-hospital mortality rate was significantly higher compared with patients with suspected infections (41.9% vs 17.6%). Mortality difference remained significant after correction for confounders.ConclusionGP cooperatives play an important role in prehospital management of sepsis and recognition of sepsis in this setting proved difficult. Efforts to improve management of sepsis in out-of-hours primary care should not be limited to patients with a suspected infection, but also include severely ill patients without clear signs of infection.

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