Table 3.
Practice characteristics and association with out-of-hours primary care use, adjusted for patient characteristics
| Variable | Low use group | High use group | Odds ratio a |
|---|---|---|---|
| N (%) | N (%) | (95% CI) | |
| Telephone accessibility | |||
| Waiting time on telephone (minutes) | |||
| Mean (range) | 1.04 (0–10) | 1.97 (0–10) | 1.26 (1.09-1.46)** |
| Median (range)*** | 0.41 (0–10) | 0.88 (0–10) | |
| Telephone contact with assistantb possible (no answering machine) (hours a week) | |||
| Mean (range) | 36.1 (9–45) | 35.3 (14–45) | 1.06 (0.97-1.15) |
| Telephone lines (per 1000 pts) | |||
| Mean (range) | 1.3 (0.3-4.6) | 1.4 (0.4-6.4) | 1.51 (0.44-5.25) |
| Availability for consultations | |||
| Waiting time for non urgent consultations (days) | |||
| Mean (range) | 0.76 (0–5) | 1.02 (0–5) | 1.54 (0.67-3.53) |
| Consultation after 5 p.m. possible | 14 (28.6) | 8 (15.7) | 0.42 (0.08-2.05) |
| Has telephone consulting hour | 31 (63.3) | 23 (45.1) | 0.26 (0.05-1.34) |
| Open during holidays (with replacement) | 24 (54.5) | 15 (31.3) | 0.42 (0.08-2.33) |
| Personally available for palliative patients (including out-of-hours) | 41 (83.7) | 25 (49.0) | 0.22 (0.06-0.76)* |
| Clinician-hours (per 1000 pts) | |||
| Mean (range) | 11.1 (2.0-30.2) | 12.6 (5.1-24.1) | 0.98 (0.81-1.17) |
| GP characteristics | |||
| Age (years) | |||
| Mean (range) | 51.9 (34–63) | 53.6 (36–65) | 1.00 (0.89-1.12) |
| Gender: female | 6 (12.2) | 9 (17.6) | 2.38 (0.19-30.07) |
| Years of employment as GP | |||
| Mean (range) | 19.8 (5–34) | 21.6 (3–39) | 1.00 (0.92-1.09) |
| Work satisfaction (score 1–10; 1 = low;10 = high) | |||
| Mean (range) | 7.8 (7–9) | 8.0 (4–10) | 2.41 (0.80-7.23) |
| High experienced workload | 26 (53.1) | 38 (74.5) | 2.18 (0.40-11.90) |
| Speak to patients with unnecessary out-of-hours contacts | 9 (18.8) | 13 (25.5) | 1.29 (0.21-7.86) |
| Practice organisation | |||
| Practice type: solo practice | 32 (65.3) | 27 (52.9) | 0.95 (0.19-4.85) |
| Practice size (number of pts) | |||
| Mean (range) | 2459 (464–4103) | 2511 (1295–4556) | 1.00 (1.00-1.00) |
| Training in telephone triage for assistantsb | 8 (16.7) | 18 (35.3) | 1.87 (0.39-8.98) |
| Number of contacts (per pt)c | |||
| Mean (range) | 4.4 (1.7-10.7) | 5.2 (2.3-8.4) | 1.44 (0.85-2.44) |
| Number of diagnostic tests and therapeutic procedures (per 1000 pts)d | |||
| Mean (range) | 74.4 (5.1-304.8) | 119.6 (4.4-935.4) | 1.02 (1.01-1.04)** |
| Presence of professionals (half days a week, per 1000 pts) | |||
| GPs | |||
| Mean (range) | 4.1 (2.1-8.8) | 4.2 (1.9-10.5) | 1.34 (0.66-2.75) |
| Assistantsb | |||
| Mean (range) | 4.9 (2.1-14.4) | 5.5 (2.7-11.0) | 1.71 (1.07-2.73)* |
| Nurse practitioners mental health | |||
| Mean (range) | 0.2 (0.0-5.2) | 0.3 (0.0-4.2) | 4.61 (0.35-61.24) |
| Nurse practitioners somatics | |||
| Mean (range) | 1.1 (0.0-5.2) | 1.6 (0.0-4.7) | 2.07 (0.99-4.32) |
| Physicians in training | |||
| Mean (range) | 0.5 (0.0-3.1) | 0.5 (0.0-3.9) | 0.94 (0.38-2.40) |
*p < 0.05; **p < 0.01; ***p < 0.001.
aOdds ratios adjusted for: 1) geographical distance from the general practice to the GP cooperative, 2) percentage of patients aged 0 to 4 years, and 3) percentage of foreigners.
bAssistants in Dutch general practices have administrative tasks, provide patient information, perform (telephone) triage and perform simple medical procedures (such as suturing, bandaging, giving injections, providing first aid and monitoring diabetic patients).
cSum of telephone contacts, practice consultations, and home visits.
dSum of six medical procedures, i.e. spirometry, electrocardiography, Doppler test, taping, intrauterine spiral, surgery.