Differentiated Access to Out-of-hours Primary Care Through Emergency Access

Patients calling the Danish out-of-hours primary care service (OOH-PC; i.e. lægevagt) and Medical Helpline 1813 (i.e. Akuttelefonen) queue up in the telephone waiting line. Ranging from patients calling for acute illness such as chest pain to parents calling to ask if their coughing child is well enough to go to day care the next day, they must all wait for their turn to talk to the triage general practitioner (GP) or triage nurse. This Project is a part of a PhD-project which is a composition of two different randomised controlled studies with overlapping background. This registration with www.clinicaltrials.gov only concerns the following study:

• Intervention to bypass the telephone queue in case of a perceived emergency: The investigators implement an option for patients to bypass the telephone queue by pressing a button if they perceive their illness as acute and severe.

Background:

Acute out-of-hours (OOH) care is an important part of health care and the point of entrance into the health care system for many patients, who contact outside normal working hours (i.e. 4 pm to 8 am on weekdays, all weekends, and bank holidays). Patients with acute health problems have several options to access the health care system, such as OOH-PC, 112-Emergency Medical Communication Centre (112-EMCC), and Medical Helpline 1813. These settings have complementary aims in delivering health care, but at the same time their patient population is partly overlapping.

Primary care is often the first point of contact, also outside office hours. However, in the Capital Region of Denmark patients call the Helpline 1813 which is answered by triage nurses who have the option to forward the call to a doctor, to triage to a consultation at the emergency department (ED) or another hospital department, to order a home visit, to forward the call to 112-EMCC or to give telephone health advice. In the four other regions OOH-PC is run by GPs, who answer and triage all telephone calls. They can triage to a telephone advice, a clinic consultation, a home visit, or directly refer to the ED/hospital. Patients contacting the OOH-PC or Helpline 1813 are put on hold and wait in a telephone queue if no GP or nurse is available to answer their call.