Out-of-hours primary care in Denmark is designed to help acutely ill people outside the usual opening hours of their designated general practitioners (GPs). Nevertheless, the telephone-based gatekeepers of the service are often overloaded with trivial questions and minor illnesses that reduce access for the people who really need immediate help. For the first time, researchers have identified how many people use this service inappropriately. According to the doctors on duty, one fourth of the callers should have already contacted their GP earlier in the day or should have waited and contacted the GP the next day. Young people and chronically ill people especially take up space from the people who really need the service.
When Danes suddenly get sick, the distance to their GP can seem far. Instead of contacting their GP, they can therefore be tempted to wait until the office has closed and call out-of-hours primary care instead. The largest survey to date on the use of out-of-hours primary care in Denmark found doctors reporting that too many people contact this service without any valid reason.
“About one fourth of the people calling the service should have consulted their GP earlier in the day or waited until the day after. Young people made one third of the unnecessary calls; further, more than one third of the callers had already had symptoms for more than 24 hours and thus could have consulted their GP the day before. However, many of these people are not sure whether they are seriously ill and therefore often do not get the response they expect when they call,” explains Grete Moth, postdoctoral fellow, Research Unit for General Practice, Aarhus University.
Considered justified and reasonable
The researchers asked doctors working in the out-of-hours system in the Central Denmark Region to register their patient contact over 12 months. Although most people fortunately contact these doctors for a good reason, the survey showed that too many people either do not understand or explicitly misuse this unique service in Denmark.
“Being able to call after normal opening hours and speak with a doctor is an incredible luxury that is unique globally. Calls to the out-of-hours service cost more than daytime GP consultations, and this extra and unnecessary burden on the service is worrying. The out-of-hours doctors are even paid per call, so each unnecessary call is an extra strain on a health system that is already under pressure.”
The survey is one of several projects focusing on out-of-hours care and telephone triage. The researchers in this survey therefore also consciously focused on the doctors’ perspectives, and the verdict is relatively clear and simple. Both young people and chronically ill people call out of hours too frequently. According to the doctors, these groups are actually not so acutely ill that they could not wait.
“The reasons for inappropriately calling the out-of-hours care is not known but it is worth wondering if it is, at least partly, because it is more convenient on a busy day. It is easier, quicker and more comfortable than having to consult their GP, and many of those calling presumably consider that they have the right to get immediate help. We can consider whether more people are calling because of trends in society, and we have therefore decided to examine this more closely.”
In future research, Grete Moth and her colleagues will investigate the alignment between the attitudes of patients and doctors towards the seriousness of the illness. The numbers of people calling out of hours without a valid reason according to the doctors are not necessarily increasing only because of social trends.
We have not yet finished our survey in which we examine why people call despite not having a valid medical reason. One important reason, however, is definitely that many are genuinely concerned and actually call because they believe that they need immediate treatment. Some of these people are dissatisfied that they do not get the help they expect.
Since people make these many superfluous calls for varying reasons, Grete Moth says that the key to solving the problem is not simply telling these people to avoid calling. Since every unnecessary call costs money and time, targeted information on how people should and should not use this service is one important aspect of a wider solution – but only one. A more differentiated approach to this is presumably needed.
The perspectives of both doctors and patients are needed to solve this problem. We need to be better informed, for example, on whether young people are more worried today than previously or whether there are other underlying causes. We also need to remember that this study is only a current snapshot that serves as a baseline for determining future trends. Unfortunately, we do not know whether people are making more or fewer unnecessary calls than they were 10 years ago.
“Medical appropriateness of adult calls to Danish out-of-hours primary care: a questionnaire-based survey” has been published in BMD Family Practice. The Central Denmark Region, Trygfonden and the General Practice Research Fund supported the study. In 2015, the Novo Nordisk Foundation awarded a grant to Grete Moth for the project Home Healthcare-KOS – Survey of Contact and Illness Patterns in Home Healthcare.