Access to diagnostic tests during GP out-of-hours care: A cross-sectional study of all GP out-of-hours services in the Netherlands

Abstract

KEY MESSAGESOur study shows that in 2014, GPs in the Netherlands had limited and varying access to diagnostic tests (imaging, function tests, laboratory tests and point-of-care tests) during GP out-of-hours care. Diagnostic tests are not more widely available to GPs working at GP out-of-hours services adjacent to hospitals with an accident and emergency department. ABSTRACTBackground: In general practice, excluding serious conditions is one of the cornerstones of the consultation. Diagnostic tests are widely used to assist the decision-making process in these cases. Little is known about general practitioners' (GPs) access to diagnostic tests at GP out-ofhours services. Objectives: To determine GPs' access to diagnostic tests-imaging, function tests, laboratory tests, and point-of-care tests (POCT)-during GP out-of-hours care and to assess whether access to diagnostic facilities differs between services located adjacent to or separate from an accident and emergency (A&E) department. Methods: Cross-sectional survey of all 117 GP out-of-hours services in the Netherlands in 2014. Results: One-hundred-seventeen GP out-of-hours services participated in the survey; response rate 100%. Access to diagnostic tests during GP out-of-hours care varied across services, although generally there was limited access. Electrocardiography was available in 26% (30/117) of all services, conventional radiography in 19% (22/117), laboratory tests between 37% (43/117) and 65% (76/117). All services had glucose POCT and urine dipstick tests available while none utilized troponin POCT. We observed no relevant differences in access to diagnostic tests between services adjacent to or separate from an A&E department. Conclusion: GPs in the Netherlands had limited and varying access to diagnostic tests during GP out-of-hours care in 2014. Out-of-hours services adjacent to A&E departments do not offer wider access to diagnostic tests. Further research on the accessibility of diagnostic tests in other European countries with similar and different GP out-of-hours care systems could shed further light on the effects of accessibility to diagnostic tests.

Patient and care characteristics of self-referrals treated by the general practitioner cooperative at emergency-care-access-points in the Netherlands

“…Currently, the diagnostics available for the GPC are limited and varied, only 19% has (restricted) access to conventional radiology [23]. Literature shows that GPs tend to use less resources compared to ED clinicians [9, 24].…”

Does X‐ray imaging by GPC at emergency care access points in the Netherlands change patient flow and reduce ED crowding? A cohort study

“…With only 24% of the EDs working as an ECAP and less than 20% of these ECAPs having access to X-ray diagnostics, the majority of patients that require X-ray imaging are still being referred to the ED. 1,10,11,14 Not only will the change of patient flow reduce the numbers of ED patients but it will also reduce the overall length of stay of ED patients and possibly reduce health care costs. 15 For self-referring patients in the Netherlands, a consult at the ED is 3 times more expensive than a consult at the GPC.…”

“…11 With increasing numbers of GPCs in Europe and multiple countries facing the problem of ED crowding and nonurgent selfreferring patients, our results could be of importance internationally. 1,2,10,14 There is one study in Norway that examined X-ray facilities for GPCs and showed that only 13% of the GPCs had the possibly to request X-rays in out-of-hours care, compared to 19% in the Netherlands. 10,21 This study had some limitations.…”

“…At the moment, the possibility of GPs to request an X‐ray varies per ECAP. Less than 20% of the GPCs in the Netherlands are offered the possibility to request X‐rays for their patients without having to refer them to the ED . Expanding imaging possibilities to GPCs might be more efficient, since not every patient that receives an X‐ray needs to be treated in the ED.…”

“…Less than 20% of the GPCs in the Netherlands are offered the possibility to request X-rays for their patients without having to refer them to the ED. 10 Expanding imaging possibilities to GPCs might be more efficient, since not every patient that receives an X-ray needs to be treated in the ED. Besides, with increasing ED numbers of older patients with more comorbidity and an increase in ED crowding, reducing nonurgent patients at EDs is crucial.…”