Comparison of out of hours care provided by patients' own general practitioners and commercial deputising services: a randomised controlled trial. II: the outcome of care

Abstract

Objective: To evaluate an out of hours cooperative of general practitioners compared with a deputising service. Design: Observational study of two services in overlapping geographical areas. Setting: A general practice cooperative in Kensington, Chelsea, and Westminster and a deputising service operating in that area and the neighbouring area of Brent and Harrow. Subjects: All patients contacting a doctor at either service in an eight week period beginning 1 September 1995. Main outcome measures: Patients' age and sex; rates of home visiting, telephone advice, and attendance at a primary centre; hospital admission rates; prescribing rates; times of patient calls; and response times. Results: Data were collected on 5812 patient contacts. Doctors from the cooperative visited 32.0% (1253/ 3920) of patients, offered telephone advice to 57.8% (2267), and saw 7.1% (278) of patients at the primary care centre. By contrast, the deputising service visited 76.3% (1444/1892) of patients and gave telephone advice to 19.3% (365). Doctors from the cooperative prescribed drugs to fewer patients (37.6%; 1473/3915) than did the deputising service (51.7%; 941/1821) (odds ratio 0.56 (95% confidence interval 0.50 to 0.63) adjusted for age and sex) and admitted 8.7% (339/ 3888) of patients to hospital compared with 6.8% (128/1889) from the deputising service (odds ratio 1.30 (1.05 to 1.61) adjusted for age and sex). Response times for the deputising service were faster (median time to visit 65 minutes) than for the cooperative (median time to visit 75 minutes) but the time to first contact with a doctor was shorter for the cooperative because most people initially received telephone advice. Conclusions: The cooperative in this study dealt with patient contacts very differently from the way the deputising service dealt with contacts, fewer patients being visited and fewer receiving prescriptions. The data presented enable other out of hours services to compare their own performance using a standard data collection and analysis program.

The effectiveness of out-of-hours dental services: II. patient satisfaction

“…2 However, both poor response rates and low base numbers mean that dental hospital service data must be treated with some caution. In contrast with previous analyses using the same questionnaire (and larger samples), 15,16 our subscale scores have not adjusted for the age, sex, registration status or other patient characteristics. Registered (ie more regular) dental attenders are generally more satisfied with dental care, 19 and this may be an important confounder of our results.…”

“…It was adapted from the questionnaire developed by McKinley and colleagues for evaluating out-of-hours primary medical care, 14 and which has subsequently been used to compare the effectiveness of various models of out-of-hours care, such as GP co-operatives and deputising services. [15][16][17] The questionnaire was adapted simply by replacing any references to 'the doctor' with 'the dentist', and any references to 'medical centre' with 'dental clinic/surgery' . Also, since so little is known about the value of telephone advice, compared with face-to-face care, the following statement item was added: 'I would have been happy with advice plus a reliable appointment when surgeries re-opened' (Q4).…”

GP stress and patient dissatisfaction with nights on call: an exploratory study - GP stress and patient satisfaction

“…These data suggest that patients perceived their GP as showing less interest before and after a night on call than usual, possibly because of fatigue. Patients are more satis ed with out-of-hours care provided by their own doctors (13), but this may be at the expense of reduced satisfaction for patients seen during the day.…”

“…For example, it is related to adherence with treatment (12), system of care provision (13), length of consultation (14) and patient health status (15). More importantly, satisfaction is predictive of subsequent improvements in health (16).…”

The effectiveness of out-of-hours dental services: I. pain relief and oral health outcome

“…'Universal access' services -intended for both registered and unregistered patients -exist in some areas, and these may use either telephone-based or 'walk-in' access arrangements, and see patients in either hospital, NHS community dental service (CDS) or general dental surgery settings. 1 Despite this diversity in the types of out-of-hours dental care available, and a wealth of studies of different models of GP-provided out-of-hours medical care, [3][4][5][6][7][8][9][10][11][12][13][14][15][16] there are no comparative studies that assess the effectiveness of emergency dental care provided in different ways. This study was originally designed to compare the cost-effectiveness of 'universal-access' out-of-hours dental care arrangements with 'conventional' out-of-hours care (that is, arrangements where there are separate service arrangements for registered and unregistered patients).…”