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Factors associated with variation in urgency of primary out-of-hours contacts.

Zwaanswijk, M., Verheij, R. Factors associated with variation in urgency of primary out-of-hours contacts.: , 2014.
Aim: In the Netherlands, primary out-of-hours care is provided by large scale primary care cooperatives (PCCs). Patients must seek contact with the PCC by telephone before attending. Trained nurses execute the telephone triage by using a standardised six-level triage system, the Netherlands Triage System (NTS). Some PCCs use computer-based decision support systems to assist triage nurses in using the NTS. This is expected to lead to more uniformity in the assignment of urgency levels to patients’ health problems. Still, differences between PCCs exist in the urgency of primary out-of-hours contacts. This study aims to provide insight into factors associated with the variation in assigned urgency. Methods: Data about the urgency of health problems presented to primary out-of-hours services are derived from routine electronic health records of patients who attended 21 PCCs participating in the NIVEL Primary Care Database in 2012. Type of health problem, characteristics of patients (gender, age, urbanisation of patient’s postal code area), degree of cooperation between PCC and the hospital emergency department, and use of computer-based decision support systems are investigated as factors possibly effecting the variation in urgency levels between PCCs. Results: Data of 1.2 million consulting patients with approximately 1.8 million contacts are used. Preliminary results show significant differences between PCCs in the urgency of primary out-of-hours contacts, particularly for urgency levels 4 (non-urgent) and 5 (self-care advice). This variation remains significant for the health problem most frequently presented at the out-of-hours service: cystitis/other urinary infection (ICPC-code U71). Apparently, the assignment of urgency is affected by other factors than the type of health problem alone. For a selection of health problems, additional multilevel linear regression analyses will be conducted to investigate factors associated with the variation in urgency between PCCs. Conclusions: There is significant variation between PCCs in the urgency assigned to patients’ health problems. Such variation may hamper communication and collaboration between health care providers, and may thereby negatively affect the quality and safety of care. Insight into factors associated with this variation may provide suggestions on how to improve the uniformity of urgency assignment. (aut. ref.)