Out-of-Hours Care Collaboration between General Practitioners and Hospital Emergency Departments in the Netherlands

Elisabeth Sybilla Johanna van Gils-van Rooij; Christoffel Joris Yzermans; Sjoerd Michael Broekman; Berthold Rudy Meijboom; Gerben Paul Welling; Dingenus Herman de Bakker

doi:10.3122/jabfm.2015.06.140261

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Box 1.
Emergency care in the Netherlands.
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Figure 1.
Study flow chart. ED, emergency department; GP, general practitioner; UCC, urgent care collaboration.

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Table 1. Characteristics of Patients and Utilization Per Setting

	Total (n = 122,061)	Usual Care^* (n = 63,441)	UCCs^{^†} (n = 58,620)
Sex
Male	54.8 (48.1)	56.8 (48.2)	52.8 (48.0)
Female	59.1 (51.9)	61.1 (51.8)	57.1 (52.0)
Age, years (mean ± SD)^{^‡}	38.51 ± 26.98	38.76 ± 26.93	38.24 ± 27.03
Urgent care provider^{^‡}
GP	85.8 (75.3)	85.4 (72.4)	86.2 (78.4)
ED	28.2 (24.7)	32.5 (27.6)	23.8 (21.6)
Medical service^{^‡}
Medical advice from GP	34.5 (30.3)	36.5 (31.0)	32.4 (29.5)
GP consultation at care centre	44.9 (39.4)	41.7 (35.3)	48.2 (43.8)
GP consultation at home	6.4 (5.6)	7.2 (6.1)	5.7 (5.1)
Treatment at ED	28.2 (24.7)	32.5 (27.6)	23.8 (21.6)

Data are the number of patients per 1000 residents (%) unless otherwise indicated.
↵* Includes 538,115 residents.
↵† Includes 533,000 residents.
↵‡ There is a statistically significant (P < .05) difference between the usual care and urgent care collaboration (UCC) groups.
ED, emergency department; GP, general practitioner; SD, standard deviation.

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Table 2. Comparison of Patients Consulting a GP or ED in the Usual Care and Urgent Care Collaboration Setting

Characteristics	GPs (n = 91,895)		EDs (n = 30,166)		Effect Size^*
Characteristics	Usual Care (n = 45,934)	UCC (n = 45,961)	Usual Care (n = 17,507)	UCC (n = 12,659)	Effect Size^*
Sex
Male^{^†}	20,918 (68.4%)	21,551 (76.5%)	9,660 (31.6%)	6,611 (23.5%)	0.091
Female^{^†}	25,016 (76.1%)	24,410 (80.1%)	7,847 (23.9%)	6,048 (19.9%)	0.049
Age (years)
0–4^{^†}	7,224 (89.9%)	7,012 (88.9%)	816 (10.1%)	879 (11.1%)	0.016
5–14^{^†}	4,854 (70.0%)	5,260 (80.6%)	2,077 (30.0%)	1,267 (19.4%)	0.122
15–24^{^†}	5,306 (63.0%)	5,781 (77.4%)	3,122 (37.0%)	1,687 (22.6%)	0.157
25–44^{^†}	10,156 (73.2%)	10,761 (81.7%)	3,715 (26.8%)	2,405 (18.3%)	0.102
45–64^{^†}	8,228 (69.6)	7,721 (74.5)	3,590 (30.4)	2,645 (25.5)	.054
64–74	4,024 (67.6)	3,806 (68.5)	1,925 (32.4)	1,753 (31.5)	.009
>74	6,142 (73.1)	5,620 (73.5)	2,262 (26.9)	2,023 (26.5)	.005
Moment of contact^{^†}
Evening	21,298 (70.2)	22,005 (77.8)	9,041 (29.8)	6,261 (22.2)	.087
Night	8,030 (70.1)	7,273 (72.9)	3,431 (29.9)	2,710 (27.1)	.031
Daytime	16,606 (76.7)	16,683 (81.9)	5,035 (23.3)	3,688 (18.1)	.064
Urgency
Very urgent	3,628 (64.1)	5,625 (63.6)	2,030 (35.9)	3,216 (36.4)	.005
Medium urgency^{^†}	13,142 (74.8)	16,634 (71.3)	4,544 (25.7)	6,703 (28.7)	.034
Less urgent^{^†}	29,164 (85.1)	23,702 (90.9)	5,126 (14.9)	2,381 (9.1)	.087
Symptom/disease cluster
Acute somatic symptoms^{^†}	18,287 (97.2)	19,634 (97.8)	519 (2.8)	436 (2.2)	.019
Infections	8,610 (93.7)	7,605 (92.9)	581 (6.3)	577 (7.1)	.015
Trauma^{^†}	7,258 (62.0)	8,178 (80.3)	4,449 (38.0)	2,009 (19.7)	.200
Chronic or long-lasting diseases^{^†}	4,100 (75.6)	3,110 (70.1)	1,326 (24.4)	1,326 (29.9)	.061
Other clusters^{^†}	2,687 (92.7%)	2,304 (83.9)	211 (7.3)	441 (16.1)	.137

Data are number (%) of patients per setting.
↵* Effect size: small = 0.1, medium = 0.3, large = 0.5.
↵† There is a statistically significant (P < .05) difference between usual care and urgent care collaboration (UCC) groups.
ED, emergency department; GP, general practitioner.

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Table 3. Most Frequently Presented Symptoms in the “Trauma” Symptom/Disease Cluster

Symptom/Disease	GPs (n = 15,436)		EDs (n = 6,458)
Symptom/Disease	Usual Care (n = 7258)	UCCs (n = 8178)	Usual Care (n = 4449)	UCCs (n = 2009)
Laceration/cut	1606 (65.5)	2401 (94.0)	846 (34.5)	154 (6.0)
Sprain/strain of joint	126 (8.9)	88 (14.6)	1293 (91.1)	515 (85.4)
Sprain/strain of ankle	495 (62.1)	500 (87.9)	302 (37.9)	69 (12.1)
Bruise/contusion	511 (100.0)	769 (100.0)	0 (0.0)	0 (0.0)
Injury musculoskeletal NOS	507 (78.0)	531 (88.8)	143 (22.0)	67 (11.2)
Fracture hand/foot bone	158 (25.4)	123 (24.3)	463 (74.6)	384 (75.7)
Trauma/injury NOS	517 (97.4)	505 (97.9)	14 (2.6)	11 (2.1)
Fracture: other^*	119 (20.1)	103 (25.7)	473 (79.9)	298 (74.3)
Abrasion/scratch/blister	359 (94.5)	456 (99.8)	21 (5.5)	1 (0.2)
Burn/scald	325 (88.3)	296 (96.7)	43 (11.7)	10 (3.3)

Data are number (%) of patients per setting.
↵* Fracture other than radius/ulna, tibia/fibula, hand/foot, femur.
ED, emergency department; GP, general practitioner; NOS, not otherwise specified; UCC, urgent care collaboration.

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Table 4. Setting/Region and the Odds Ratios (95% Confidence Intervals) for Emergency Department as the Urgent Care Provider

	Unadjusted		Controlled for Patient Characteristics^*		Controlled for Patient and Health Problem Characteristics^{^†}
	OR	95% CI	OR	95% CI	OR	95% CI
Setting
UCC	0.655	0.629–0.681	0.655	0.629–0.681	0.691	0.662–0.721
UC	—	—	—	—	—	—
Region
A (UCC)	0.717	0.665–0.772	0.732	0.678–0.789	0.826	0.762–0.895
B (UCC)	0.983	0.895–1.081	0.982	0.893–1.080	1.091	0.985–1.208
C (UCC)	0.883	0.818–0.954	0.891	0.824–0.963	0.948	0.873–1.030
D (UC)	—	—	—	—	—	—
E (UC)	1.049	0.964–1.142	1.050	0.964–1.144	1.039	0.949–1.138
F (UC)	1.356	1.267–1.452	1.386	1.294–1.484	1.514	1.407–1.629

↵* Controlled for sex and age.
↵† Controlled for sex, age, moment of contact, and symptom/disease cluster.
CI, confidence interval; OR, odds ratio; UC, usual care; UCC, urgent care collaboration.