Do callers to out-of-hours care misuse an option to jump the phone queue?
Ontology highlight
ABSTRACT:
SUBMITTER: Ebert JF
PROVIDER: S-EPMC6566898 | biostudies-literature | 2019 Jun
REPOSITORIES: biostudies-literature
Publications
Do callers to out-of-hours care misuse an option to jump the phone queue?
Ebert J F JF Huibers L L Christensen B B Lippert F K FK Christensen M B MB
Scandinavian journal of primary health care 20190509 2
<b>Objectives:</b> Out-of-hours (OOH) services provide access to healthcare outside normal office hours, but the waiting time can sometimes be long. All callers must wait in the telephone queue, even if the health problem is urgent or life-threatening. We tested an emergency access button (EAB), which allowed callers with perceived severe health problems to bypass the queue. We aimed to investigate the severity of the health problems and the relevance of EAB use (assessed by triage professionals ...[more]
Similar Datasets
Project description:OBJECTIVE:Acute out-of-hours (OOH) healthcare is challenged by potentially long waiting time for callers in acute need of medical aid. OOH callers must usually wait in line, even when contacting for highly urgent or life-threatening conditions. We tested an emergency access button (EAB), which allowed OOH callers to bypass the waiting line if they perceived their health problem as severe. We aimed to investigate EAB use and patient characteristics associated with this use. DESIGN:Comparative intervention study. SETTING:OOH services in two major Danish healthcare regions. INTERVENTION:Giving callers the option to bypass the telephone waiting line by introducing an EAB. PARTICIPANTS:OOH service callers contacting during end of October to mid-December 2017. MAIN OUTCOME MEASURES:Proportions of EAB use, waiting time and background information on participants in two settings differing on organisation structure, waiting time and triage personnel. RESULTS:In total, 97,791 out of 158,784 callers (61.6%) chose to participate. The EAB was used 2905 times out of 97,791 (2.97%, 95%CI 2.86; 3.08). Patient characteristics associated with increased EAB use were male gender, higher age, low education, being retired, and increasing announced estimated waiting time. In one region, immigrants used the EAB more often than native Danish callers. CONCLUSION:Only about 3% of all callers chose to bypass the waiting line in the OOH service when given the option. This study suggests that the EAB could serve as a new and simple tool to reduce the waiting time for severely ill patients in an OOH service telephone triage setting. Key Points Acute out-of-hours healthcare is challenged by overcrowding and increasing demand for services. This study shows that only approximately 3% of callers chose to bypass the telephone waiting queue when given the opportunity through an emergency access button. An emergency access button may serve as a new tool to help reduce the triage waiting time for severely ill patients in out-of-hours medical facilities.
| S-EPMC6452808 | biostudies-literature
Project description:INTRODUCTION:In the Netherlands, the 'Netherlands Triage Standard' (NTS) is frequently used as digital decision support system for telephone triage at out-of-hours services in primary care (OHS-PC). The aim of the NTS is to guarantee accessible, efficient and safe care. However, there are indications that current triage is inefficient, with overestimation of urgency, notably in suspected acute cardiovascular disease. In addition, in primary care settings the NTS has only been validated against surrogate markers, and diagnostic accuracy with clinical outcomes as the reference is unknown. In the Safety First study, we address this gap in knowledge by describing, understanding and improving the diagnostic process and urgency allocation in callers with symptoms suggestive of acute cardiovascular disease, in order to improve both efficiency and safety of telephone triage in this domain. METHODS AND ANALYSIS:An observational study in which 3000 telephone triage recordings (period 2014-2016) will be analysed. Information is collected from the recordings including caller and symptom characteristics and urgency allocation. The callers' own general practitioners are contacted for the final diagnosis of each contact. We included recordings of callers with symptoms suggestive of acute coronary syndrome (ACS) or transient ischaemic attack (TIA)/stroke. With univariable and multivariable logistic regression analyses the diagnostic accuracy of caller and symptom characteristics will be analysed in terms of predictive values with urgency level, and ACS and TIA/stroke as outcomes, respectively. To further improve our understanding of the triage process at OHS-PC, we will carry out additional studies applying both quantitative and qualitative methods: (i) case-control study on serious adverse events (SAE), (ii) conversation analysis study and (iii) interview study with triage nurses. ETHICS AND DISSEMINATION:The Medical Ethics Committee Utrecht, the Netherlands endorsed this study (National Trial Register identification: NTR7331). Results will be disseminated at scientific conferences, regional educational sessions and publication in peer-reviewed journals.
| S-EPMC6609078 | biostudies-literature
Project description:OBJECTIVE: To study the quantitative consumption in out-of-hours (OOH) primary care in Denmark and the Netherlands, in the context of OOH care services. DESIGN: A retrospective observational study describing contacts with OOH care services, using registration data. SETTING: OOH care services (i.e. OOH primary care, emergency department, and ambulance care) in one Danish and one Dutch region. SUBJECTS: All patients contacting the OOH care services in September and October 2011. MAIN OUTCOME MEASURES: Consumption as number of contacts per 1000 inhabitants in total and per age group per contact type. RESULTS: For the two-month period the Danes had 80/1000 contacts with OOH primary care compared with 50/1000 for the Dutch. The number of contacts per 1000 inhabitants per age group varied between the regions, with the largest difference in the 0-5 years age group and a considerable difference in the young-adult groups (20-35 years). The difference was largest for telephone consultations (47/1000 vs. 20/1000), particularly in the youngest age group (154/1000 vs. 39/1000). The Danes also had more home visits than the Dutch (10/1000 vs. 5/1000), while the Dutch had slightly more clinic consultations per 1000 inhabitants than the Danes (25/1000 vs. 23/1000). CONCLUSION: The Danish population has more contacts with OOH primary care, particularly telephone consultations, especially concerning young patients. Future research should focus on the relevance of contacts and identification of factors related to consumption in OOH primary care.
| S-EPMC4137903 | biostudies-other
Project description:BACKGROUND:In Western countries, patients with acute illness or injury out-of-hours (OOH) can call either emergency medical services (EMS) for emergencies or primary care services (OOH-PC) in less urgent situations. Callers initially choose which service to contact; whether this choice reflect the intended differences in urgency and severity is unknown. Hospital diagnoses and admission rates following an OOH service contact could elucidate this. We aimed to investigate and compare the prevalence of patient contacts, subsequent hospital contacts, and the age-related pattern of hospital diagnoses following an out-of-hours contact to EMS or OOH-PC services in Denmark. METHODS:Population-based observational cohort study including patients from two Danish regions with contact to EMS or OOH-PC in 2016. Hospital contacts were defined as short (<?24?h) or admissions (?24?h) on the date of OOH service contact. Both regions have EMS, whereas the North Denmark Region has a general practitioner cooperative (GPC) as OOH-PC service and the Capital Region of Copenhagen the Medical Helpline 1813 (MH-1813), together representing all Danish OOH service types. Calling an OOH service is mandatory prior to a hospital contact outside office hours. RESULTS:OOH-PC handled 91% (1,107,297) of all contacts (1,219,963). Subsequent hospital contacts were most frequent for EMS contacts (46-54%) followed by MH-1813 (41%) and GPC contacts (9%). EMS had more admissions (52-56%) than OOH-PC. For both EMS and OOH-PC, short hospital contacts often concerned injuries (32-63%) and non-specific diagnoses (20-45%). The proportion of circulatory disease was almost twice as large following EMS (13-17%) compared to OOH-PC (7-9%) in admitted patients, whereas respiratory diseases (11-14%), injuries (15-22%) and non-specific symptoms (22-29%) were more equally distributed. Generally, admitted patients were older. CONCLUSIONS:EMS contacts were fewer, but with a higher percentage of hospital contacts, admissions and prevalence of circulatory diseases compared to OOH-PC, perhaps indicating that patients more often contact EMS in case of severe disease. However, hospital diagnoses only elucidate severity of diseases to some extent, and other measures of severity could be considered in future studies. Moreover, the socio-demographic pattern of patients calling OOH needs exploration as this may play an important role in choice of entrance.
| S-EPMC7045402 | biostudies-literature
Project description:Background:The vertical jump is used to estimate sports performance capabilities and physical fitness in children, elderly, non-athletic and injured individuals. Different jump techniques and measurement tools are available to assess vertical jump height and peak power; however, their use is limited by access to laboratory settings, excessive cost and/or time constraints thus making these tools oftentimes unsuitable for field assessment. A popular field test uses the Vertec and the Sargent vertical jump with countermovement; however, new low cost, easy to use tools are becoming available, including the My Jump iOS mobile application (app). The purpose of this study was to assess the reliability of the My Jump relative to values obtained by the Vertec for the Sargent stand and reach vertical jump (VJ) test. Methods:One hundred and thirty-five healthy participants aged 18-39 years (94 males, 41 females) completed three maximal Sargent VJ with countermovement that were simultaneously measured using the Vertec and the My Jump. Jump heights were quantified for each jump and peak power was calculated using the Sayers equation. Four separate ICC estimates and their 95% confidence intervals were used to assess reliability. Two analyses (with jump height and calculated peak power as the dependent variables, respectively) were based on a single rater, consistency, two-way mixed-effects model, while two others (with jump height and calculated peak power as the dependent variables, respectively) were based on a single rater, absolute agreement, two-way mixed-effects model. Results:Moderate to excellent reliability relative to the degree of consistency between the Vertec and My Jump values was found for jump height (ICC = 0.813; 95% CI [0.747-0.863]) and calculated peak power (ICC = 0.926; 95% CI [0.897-0.947]). However, poor to good reliability relative to absolute agreement for VJ height (ICC = 0.665; 95% CI [0.050-0.859]) and poor to excellent reliability relative to absolute agreement for peak power (ICC = 0.851; 95% CI [0.272-0.946]) between the Vertec and My Jump values were found; Vertec VJ height, and thus, Vertec calculated peak power values, were significantly higher than those calculated from My Jump values (p < 0.0001). Discussion:The My Jump app may provide a reliable measure of vertical jump height and calculated peak power in multiple field and laboratory settings without the need of costly equipment such as force plates or Vertec. The reliability relative to degree of consistency between the Vertec and My Jump app was moderate to excellent. However, the reliability relative to absolute agreement between Vertec and My Jump values contained significant variation (based on CI values), thus, it is recommended that either the My Jump or the Vertec be used to assess VJ height in repeated measures within subjects' designs; these measurement tools should not be considered interchangeable within subjects or in group measurement designs.
| S-EPMC5912202 | biostudies-literature
Project description:BACKGROUND:The rise in antibiotic resistance is a global public health concern, and antibiotic overuse needs to be reduced. Earlier studies of out-of-hours care have indicated that antibiotic prescribing is less appropriate than that of in-hours care. However, no study has compared the out-of-hours treatment of infections to in-hours treatment within the same population. METHODS:This retrospective, descriptive study was based on data retrieved from the Kronoberg Infection Database in Primary Care (KIDPC), which consists of all visits to primary care with an infection diagnosis or prescription of antibiotics during 2006-2014. The purpose was to study the trends in antibiotic prescribing and to compare consultations and prescriptions between in-hours and out-of-hours. RESULTS:The visit rate for all infections was 434 visits per 1000 inhabitants per year. The visit rate was stable during the study period, but the antibiotic prescribing rate decreased from 266 prescriptions per 1000 inhabitants in 2006 to 194 prescriptions in 2014 (mean annual change -?8.5 [95% CI -?11.9 to -?5.2]). For the out-of-hours visits (12% of the total visits), a similar reduction in antibiotic prescribing was seen. The decrease was most apparent among children and in respiratory tract infections. When antibiotic prescribing during out-of-hours was compared to in-hours, the unadjusted relative risk of antibiotic prescribing was 1.37 (95% CI 1.36 to 1.38), but when adjusted for age, sex, and diagnosis, the relative risk of antibiotic prescribing was 1.09 (95% CI 1.08 to 1.10). The reduction after adjustment was largely explained by a higher visit rate during out-of-hours for infections requiring antibiotics (acute otitis media, pharyngotonsillitis, and lower urinary tract infection). The choices of antibiotics used for common diagnoses were similar. CONCLUSIONS:Although the infection visit rate was unchanged over the study period, there was a significant reduction in antibiotic prescribing, especially to children and for respiratory tract infections. The higher antibiotic prescribing rate during out-of-hours was small when adjusted for age, sex, and diagnosis. No excess prescription of broad-spectrum antibiotics was seen. Therefore, interventions selectively aiming at out-of-hours centres seem to be unmotivated in a low-prescribing context.
| S-EPMC7441551 | biostudies-literature
Project description:ObjectiveTelephone triage in patients requesting help may compromise patient safety, particularly if urgency is underestimated and the patient is not seen by a physician. The aim was to assess the research evidence on safety of telephone triage in out-of-hours primary care.MethodsA systematic review was performed of published research on telephone triage in out-of-hours care, searching in PubMed and EMBASE up to March 2010. Studies were included if they concerned out-of-hours medical care and focused on telephone triage in patients with a first request for help. Study inclusion and data extraction were performed by two researchers independently. Post-hoc two types of studies were distinguished: observational studies in contacts with real patients (unselected and highly urgent contacts), and prospective observational studies using high-risk simulated patients (with a highly urgent health problem).ResultsThirteen observational studies showed that on average triage was safe in 97% (95% CI 96.5-97.4%) of all patients contacting out-of-hours care and in 89% (95% CI 86.7-90.2%) of patients with high urgency. Ten studies that used high-risk simulated patients showed that on average 46% (95% CI 42.7-49.8%) were safe. Adverse events described in the studies included mortality (n = 6 studies), hospitalisations (n = 5), attendance at emergency department (n=1), and medical errors (n = 6).ConclusionsThere is room for improvement in safety of telephone triage in patients who present symptoms that are high risk. As these have a low incidence, recognition of these calls poses a challenge to health care providers in daily practice.
| S-EPMC3308461 | biostudies-literature
Project description:BackgroundPatient satisfaction questionnaires are increasingly used for assessing quality of care.AimTo review the evidence for the reliability and validity of patient satisfaction questionnaires for out-of-hours care.DesignSystematic review.SettingPrimary care out-of-hours services.MethodSearches of CINAHL, EMBASE, MEDLINE((R)) and PsycINFO using terms relevant to the measurement of patient satisfaction and out-of-hours services. Abstracts were reviewed and information relating to questionnaire content, data quality, reliability, and validity were extracted from articles by two independent researchers.ResultsFour questionnaires were found, two from the UK - the Patient Satisfaction with Out-of-Hours Care (PSOC) and Short Questionnaire for Out-of-Hours Care (SQOC) - and two from the Netherlands - the van Uden and Moll van Charante questionnaires. Questionnaire content was based on literature reviews and expert opinion; the PSOC and Moll van Charante questionnaires were also developed following interviews or focus groups with patients. Cronbach's alpha values were below 0.7 for some scales within the PSOC and van Uden questionnaires. Test-retest reliability was reported for the PSOC and Moll van Charante questionnaires. Tests of validity were few and did not give explicit consideration to the size of expected associations.ConclusionPotential users wishing to assess patient satisfaction should carefully consider the content of the questionnaires and its relevance to the application and patient group. The four questionnaires have limitations relating to their development and evaluation. The PSOC and van Uden questionnaires have low levels of reliability for some scales, which should be used with caution in future surveys.
| S-EPMC2151790 | biostudies-literature
Project description:BACKGROUND:This study aimed to describe, and identify predictors of, physical activity and screen time in children attending out of school hours care (OSHC). METHOD:Twenty-three randomly selected OSHC centres (n?=?1068 children) participated in this observational, cross-sectional study. Service directors completed interviews regarding policy, training, scheduling and equipment related to physical activity and screen time. Children's activity behaviours (moderate to vigorous physical activity (MVPA), light physical activity, sedentary time and screen time) were measured using standardised direct observation. RESULTS:Directors' interviews revealed a lack of formal policy guiding physical activity and screen time. Time spent in activity behaviours varied widely among OSHC services; for example, average time spent in MVPA ranged from 4 to 49% of the session, time spent sedentary ranged from 31 to 79%, and screen time accounted for 0 to 41%. MVPA was inversely associated with total sedentary time (p?<?0.001). Higher screen time was associated with OSHC services being larger in size (p?=?0.04), offering screen activities on a daily basis (as opposed to less than daily; p?=?0.001), offering screen activities prior to 5?pm (as opposed to offering screen activity 5?pm or later; p?=?0.02), and having a larger number of screen devices available (p?=?0.08). CONCLUSION:Physical activity and screen time practices in OSHC services are currently ad hoc and variable. In future, development of guidelines, policy and intervention programs may help improve physical activity and screen time in the OSHC setting.
| S-EPMC6693127 | biostudies-literature
Project description:BACKGROUND:Various models exist to organize out-of-hours primary care (OOH-PC). We aimed to provide an up-to-date overview of prevailing organizational models in the European Union (EU), implemented changes over the last decade and future plans. This baseline overview may provide information for countries considering remodelling their OOH-PC system. METHODS:A cross-sectional web-based questionnaire among 93 key informants from EU countries, Norway and Switzerland. Key informants with expertise in the field of primary health care were invited to participate. Themes in the questionnaire were the existing organizational models for OOH-PC, model characteristics, major organizational changes implemented in the past decade and future plans. RESULTS:All 26 included countries had different coexisting OOH-PC models, varying from 3 to 10 models per country. 'GP cooperative was the dominant model in most countries followed by primary care centre and rota group'. There was a large variation in characteristics between the models, but also within the models, caused by differences between countries and regions. Almost all countries had implemented changes over the past 10 years, mostly concerning the implementation of telephone triage and a change of organizational model by means of upscaling and centralization of OOH-PC. Planned changes varied from fine-tuning the prevailing OOH-PC system to radical nationwide organizational transitions in OOH-PC. CONCLUSIONS:Different organizational models for OOH-PC exist on international and national level. Compared with a decade ago, more primary care-oriented organizational models are now dominant. There is a trend towards upscaling and centralization; it should be evaluated whether this improves the quality of health care.
| S-EPMC7699311 | biostudies-literature