7th EurOOHnet conference Abstract book and participants ... · Abstract book and participants' and...

7th EurOOHnet conference

Abstract book and participants' and organisations' description

Bled, Slovenia,

26th and 27th of May 2016

Editor: Zalika Klemenc-Ketiš

Bled, May, 2016

7th EurOOHnet Conference

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7th EurOOHnet conference Abstract book and participants' and organisations' description Urednica: Zalika Klemenc-Ketiš Izdalo: Združenje zdravnikov družinske medicine SZD Založil: Zavod za razvoj družinske medicine Bled, maj 2016 Copyright © Združenje zdravnikov družinske medicine – 2016 Vse pravice pridržane.

CIP - Kataložni zapis o publikaciji

Narodna in univerzitetna knjižnica, Ljubljana

614.2(082)(0.034.2)

EUROOHNET Conference (7 ; 2016 ; Ljubljana)

Abstract book and participants' and organisations' description [Elektronski

vir] / 7th EurOOHnet Conference, Bled, Slovenia, 26th and 27th of May 2016 ;

editor Zalika Klemenc-Ketiš. - El. knjiga. - Ljubljana : Zavod za razvoj družinske

medicine, 2012

Način dostopa (URL): http://www.drmed.org/zborniki-2/

ISBN 978-961-6810-40-1 (pdf)

1. Klemenc-Ketiš, Zalika

284820992


3

Table of content:

ABSTRACTS .............................................................................................................................................. 5

Alessandra Buja: Determinants of OOH service users’ potential inappropriate referral and non-

referral to the ED ................................................................................................................................. 7

Simone Cernesi: Palliative Care as a "trojan horse" to qualify OOH service ....................................... 8

Annelies Colliers: Implementation of a general practitioner cooperative adjacent to the emergency

department of a hospital increases the caseload for the GPC but not for the emergency

department ......................................................................................................................................... 9

Jacopo Demurtas: q-SCAN: online survey to assess perceived quality of OOH setting among OOH

operators ........................................................................................................................................... 10

Jonas F. Ebert: Differentiated access to out-of-hours primary care through emergency access ..... 11

Rebecca Fisher: How to patients at the end of life use out of hours primary care? A UK based

descriptive study ............................................................................................................................... 12

Gardini Marco: Out of hours phone consultations: a literature review using MeSH........................ 13

Linda Huibers: Citizen decision making in case of an acute health problem out of office hours –

Danish versus Dutch .......................................................................................................................... 14

Ellen Keizer: Development of the “Kernset”: a Dutch national instrument to measure the quality of

telephone triage at out-of-hours GP cooperatives ........................................................................... 15

Zalika Klemenc-Ketis: The Safety Attitudes Questionnaire – Ambulatory Version: psychometric

properties of the Slovenian version for the out-of-hours primary care setting ............................... 16

Jamie Murdoch: The role of e-learning in improving the use of computer decision support software

to deliver telephone triage ................................................................................................................ 17

John O'Malley: The Provision of End of Life Care in an OOH setting; misconceptions and barriers 18

Oliver Senn: Impact of alternative type of health care plans on out-of-hours care use in Switzerland

........................................................................................................................................................... 19

Dennis Schou Graversen: Out-of-hours telephone triage by nurses and doctors in Danish acute care

settings. A study of quality focusing on communication, safety and efficiency ............................... 20

Marleen Smits: Medical necessity of face-to-face contacts at Dutch OOH GP cooperative............. 21

Hilde Philips: iCAREdata .................................................................................................................... 22

Hilde Philips: Implementing Telephone triage in Belgium ................................................................ 23

Alberto Vaona: Training interventions for improving telephone consultation skills in clinicians: a

Cochrane Systematic Review ............................................................................................................ 24

Alberto Vaona: Does a CDSS software increase the obligatory questions doctors ask during

telephone consultations? .................................................................................................................. 25

PARTICIPANTS’ CVs ................................................................................................................................ 26

EurOOHnet conference 2016 – CV Gunnar Tschudi Bondevik .......................................................... 27


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EurOOHnet conference – CV Cernesi Simone .................................................................................. 28

EurOOHnet conference – CV Annelies Colliers ................................................................................. 29

EurOOHnet conference – CV Jacopo Demurtas ............................................................................... 30

EurOOHnet conference – CV Jonas Fynboe Ebert ............................................................................. 31

EurOOHnet conference – CV Dennis Schou Graversen ..................................................................... 32

EurOOHnet conference – CV Linda Huibers ...................................................................................... 33

EurOOHnet conference – CV Ellen Keizer ......................................................................................... 34

EurOOHnet conference – CV Zalika Klemenc-Ketis ........................................................................... 35

EurOOHnet conference – CV Dr John O’Malley ................................................................................ 36

EurOOHnet conference – CV Hilde Philips ........................................................................................ 37

EurOOHnet conference – CV Roy Remmen ...................................................................................... 38

EurOOHnet conference – CV Oliver Senn.......................................................................................... 39

EurOOHnet conference – CV Marleen Smits ..................................................................................... 40

EurOOHnet conference – CV Alberto Vaona ..................................................................................... 42

MEMBER ORGANISATIONS’ BACKGROUND .......................................................................................... 43

Belgium (Flanders) ............................................................................................................................. 44

Denmark ............................................................................................................................................ 45

The Netherlands ................................................................................................................................ 46

Norway .............................................................................................................................................. 48

SLOVENIA ........................................................................................................................................... 49

Switzerland ........................................................................................................................................ 50

United kingdom ................................................................................................................................. 51


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ABSTRACTS


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Alessandra Buja: Determinants of OOH service users’ potential

inappropriate referral and non-referral to the ED Title Determinants of OOH service users’ potential inappropriate referral and non-

referral to the ED Author(s) Alessandra Buja, Roberto Toffanin, S Rigon, P Sandonà, T Carrara, G Damiani,

V Baldo. Affiliation Alessandra Buja: Department of Molecular Medicine, University of Padua, Public

Health Section, Laboratory of Public Health and Population Studies, Via Loredan 18, 35128 Padua, Italy. Assistant professor. Roberto Toffanin: Health Director, ULSS 4, Region Veneto, Via Boldrini 1, 36016 Thiene (VI), Italy. Local Health Director. [email protected] Stefano Rigon: Epidemiological Unit, ULSS 4, Region Veneto, Via Boldrini 1, 36016 Thiene (VI), Italy. M.D. [email protected] Paolo Sandonà: Out of Hour Service, ULSS 4, Region Veneto, Via Boldrini 1, 36016 Thiene (VI), Italy. M.D. [email protected] Tommaso Carrara: University of Padua, Faculty of Medicine, Via Giustiniani 2, 35128 Padua, Italy. M.D. [email protected] Gianfranco Damiani: Department of Public Health, Catholic University of the Sacred Heart, Largo Francesco Vito, 1, 00168 Rome, Italy. Associate professor. [email protected] Vincenzo Baldo: Department of Molecular Medicine, University of Padua, Public Health Section, Laboratory of Public Health and Population Studies, Via Loredan 18, 35128 Padua, Italy. Full professor.

Background A growing presence of inappropriate patients has been recognized as one of the main factors influencing emergency department (ED) overcrowding. Out-of-hours (OOH) physicians, on the other hand, must avoid delaying the diagnostic and therapeutic course of patients with urgent medical conditions. A safe, good-quality, consistent and effective in-hours and OOH services are crucial for providing care as close to the patient’s home as possible.

Aim The aim of this study was to investigate how often OOH physicians’ referral or non-referral of patients to the ED are potentially inappropriate.

Methods This is an observational retrospective cohort study based on data collected in 2011 in the LHA No. 4, Region Veneto, Italy. After distinguishing patients contacting the OOH service who were referred to the ED from those who were not, and checking for patients actually presenting to the ED within 24 hours thereafter, these patients’ medical management was judged as appropriate (if it met at least one of the following conditions: red or yellow outgoing triage code; patient hospitalized or refused hospitalization; patients assessed for any category of trauma; short-stay unit admission; arrived dead or died at ED) or inappropriate for the remaining cases.

Results The analysis considered 22,662 OOH service contacts. 20,596 patients (90.9%) were not referred to the ED. The patients potentially managed inappropriately by the OOH service, in terms of referrals and non-referrals to the ED, amounted to 1,599 (7%): 1207 (5.3%) were potentially inappropriate referral, 392 (1,7%) were potentially inappropriate non-referral. Age, nationality, disease, and type of intervention the main variables associated with the appropriateness of patient management.

Conclusions These findings may be useful for pinpointing the factors associated with a potentially inappropriate patient management and so contribute to improving the deployment of health care and the quality of care delivered by OOH services.

Preferred format Poster presentation


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Simone Cernesi: Palliative Care as a "trojan horse" to qualify OOH service

Title Palliative Care as a "trojan horse" to qualify OOH service

Author(s) Simone Cernesi

Affiliation Movimento Giotto, OOH doctor ASL Modena (Sassuolo)

Background In Italy the out of hours (OOH) service has many critical issues; it is poorly

integrated not only with the hospital but also to the entire network of primary care.

In the future it is expected that there will be more patients, especially non

oncological, that will require a palliative approach.

Palliative care along with an improvement of skills in the management of chronic

diseases could qualify OOH service, even though datas about the importance of

palliative care in OOH service in Italy are still missing.

Aim To investigate OOH GPs’ competences, equipment and educational needs in

palliative care.

EG.

1) Opioids availability and use in OOH (eg. availability of morphine or other

drugs for treatment of pain and palliative care at OOH workplace)

2) Integration between OOH and the Palliative Care network

3 ) Educational and training needs (perceived and not perceived).

Methods In a preliminary analysis of a "chat group", created using social media, specific for

OOH doctors, positive stimuli have emerged with the aim to improve the service

and make it more useful for patients and caregiver.

Extrapolating some of the issues and focusing on palliative care, we developed a

questionnaire concerning Palliative Care in OOH, the core competences required to

an OOH doctor to perform palliative care and the equipment available at the OOH

service.

The questionnaire will be administered among the OOH doctors, through an online

survey, involving colleagues across the different regions of Italy.

Results Attended results will permit a first evaluation of the equipment and skills of the

OOH doctor

Conclusions Once analyzed the Italian situation, we could benchmark it with other countries

participating to EurOOHnet

Preferred

format

o Oral presentation – 15 minutes x


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Annelies Colliers: Implementation of a general practitioner cooperative

adjacent to the emergency department of a hospital increases the caseload

for the GPC but not for the emergency department Title Implementation of a general practitioner cooperative adjacent to the emergency

department of a hospital increases the caseload for the GPC but not for the

emergency department

Author(s) Annelies Colliers1, Roy Remmen1, Marie-Luise Streffer1, Barbara Michiels1,

Stefaan Bartholomeeusen1, Koenraad G. Monsieurs1,2, Jef Goris3, Samuel

Coenen1, Veronique Verhoeven1, Hilde Philips1

Affiliation 1 University of Antwerp, Faculty of Medicine and Health Sciences, Department of General Practice – Primary and Interdisciplinary Care 2 Antwerp University Hospital, Emergency Department

3 General Practice Cooperative Antwerp North

Background The implementation of General Practitioner Cooperatives (GPC) for Out-Of-Hours (OOH) primary care, raises the question if the location of a GPC adjacent to a hospital reduces the OOH caseload of the emergency department (ED).

Aim

Methods Two natural experiments were used in this before-after study, the effect of the implementation of two GPCs in two different regions on the out-of-hours caseload of the local EDs was compared. One GPC was located adjacent to the ED of a general hospital, the other was not. GPCs (or rota systems) and EDs in comparable regions were selected as control groups during the same study period. The study was performed in Flanders (Belgium) with no gate keeping function for general practitioners.

Results After implementation of the GPC there was a significantly increase in caseload at the GPC in the two regions, mainly due to an increase of consultations with small children. There were no significant changes in caseload at the ED services. Self-referrals’ to the ED did not change significantly. For the general practitioners (GPs) the number of home visits decreased during out-of-hours in one region.

Conclusions In a country with no gatekeeping role for GPs, implementing a GPC increased the

out-of-hours caseload of the GPCs. The caseload of the EDs stabilized during the

study period.

Preferred format o 1-slide-5-minutes presentation


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Jacopo Demurtas: q-SCAN: online survey to assess perceived quality of OOH

setting among OOH operators Title q-SCAN: online survey to assess perceived quality of OOH setting among OOH

operators Author(s) J. Demurtas Affiliation EurOOHnet, Movimento Giotto, Wonca VdGM, SIMG, OOH doctor Capalbio, ASL

SudEst TOSCANA Background The unique role, a new model for Italian Family Medicine is approaching,

nevertheless differences among OOH settings persist and this regarding a kaleidoscope of aspects, reaching safety and educational issues. Currently the In Hour doctor works from 8:00 to 20:00h, from Monday to Friday and the Saturday from 8:00 to 10:00; the OOH doctor works the nights (from 20:00 to 8:00), covering the 24 hours, the Saturday (10h) and the Sunday (24h). In the unique role, which will be included in the upcoming National Collective Agreement (ACN), the OOH operator, especially if he’ll be involved, together with the Family Doctor, in a new 16 hours per day activity versus the standard 24 hours service, will face a new model and with that, new challenges. Primary care assistance will be given through a complex system of GPs (capitation and hour payment) that will require the definition and development of new competences, a targeted medical education and new tools to act in the primary care service.

To assess the baseline situation and define the required interventions, we need to know about the context, the characteristics and peculiarities of OOH operators’ workplace before the introduction of the unique role.

Aim To evaluate the standard equipment, organisation and tools of OOH settings among OOH operators, before and after the introduction of the new primary care system in Italy.

Methods Cross sectional survey. Creation of an online survey, in Italian, focused on: OOH operator education and appraisal OOH service organization, setting, workspace Tools Safety The survey will be administered to a broad population of OOH operators, including OOH GPs (also locums) and Family Medicine Trainees (involved in OOH turnation).

Results Attended results are an average low standard of equipment, workspace, tools to guarantee the OOH Primary Care.

Conclusions Gathered data will be useful to reassess the situation and OOH workplace condition after the introduction of the unique role and check for improvements or variations in the system

Preferred format o Oral presentation – 15 minutes


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Jonas F. Ebert: Differentiated access to out-of-hours primary care through

emergency access Title Differentiated access to out-of-hours primary care through emergency access

Author(s) J.F. Ebert1, 2, M.B. Christensen1, 2, F. Lippert3, L. Huibers1, 2 B. Christensen1, 4

Affiliation 1Department of public health, Aarhus University, 2Research unit for general practice, Aarhus, 3Prehospital unit, Capital Region of Denmark 4Section for general practice, Aarhus University

Background Patients calling the Danish out-of-hours primary care service (OOH-PC) queue up

in the telephone waiting line. Ranging from patients calling for an 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

professional. Currently, if a patient calls OOH-PC, he has to wait in line, even if

the health problem is experienced highly urgent or life-threatening. The

alternative to waiting in line is calling 112 instead, as there is no possibility to

bypass the telephone waiting line.

Aim To implement and test an “emergency access” opportunity that allows callers with the OOH service to bypass the telephone waiting queue if they experience their health problem as highly urgent

Methods DESIGN: Randomized controlled trial

SETTING: OOH-PC in the Central Denmark Region and Medical Helpline 1813

(MH-1813) in the Capital Region of Denmark

SUBJECTS: All patients calling OOH-PC and MH-1813 in the last quarter of

2016

MAIN OUTCOME MEASURES: Patient satisfaction, feeling of safety,

frequencies of patients who bypassed the telephone queue.

Results As the study is planned to take place in the last quarter of 2016 only preliminary

results from a field test can be presented.

Conclusions PERSPECTIVE: This study will provide knowledge on the feasibility and effects of implementing an option to bypass the telephone waiting queue at OOH-PC and MH-1813, and it will be clarified whether patients will use such an option appropriately. This information will be used to decide whether this intervention should be implemented nationwide. We hope to see an increase in feeling of safety and satisfaction with the OOH-PC and MH-1813.



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Rebecca Fisher: How to patients at the end of life use out of hours primary

care? A UK based descriptive study Title How to patients at the end of life use out of hours primary care? A UK based

descriptive study Authors Dr Rebecca Fisher (presenting), Dr Gail Hayward Affiliation Department of Primary Care Health Sciences, University of Oxford, UK. Background Out of hours (OOH) primary care services provide clinical cover for over two thirds

of the calendar year, and are integral to the care of patients at end of life. Little is known about the OOH service usage of ‘palliative’ patients in the community, despite this information being a key first step in designing services better suited to their needs.

Aim To describe patterns of usage of patients presenting to the OOH service at the end of life.

Methods A database was created of all patient contacts with the Oxfordshire OOH service over a four year period (June 2010 – August 2014). Coding validity was established by analysis of a sub-set of data. Data was extracted for all patient contacts coded as ‘palliative’ and was analysed using SPSS.

Results 1.15% of contacts with the OOH service were coded as ‘palliative’. Patients contacting the OOH service with palliative care needs do so predominantly during weekend daytime periods, and over a third had multiple contacts with the service coded as ‘palliative’. Contacts coded as ‘palliative’ were relatively less deprived than contacts to the OOH service for all causes, even after adjusting for age and sex.

Conclusions Patients at the end of life often have different needs and time-frames of need to non-palliative patients, and it is possible that the current ‘one-size-fits-most’ model of out of hours primary care provision in the UK does not allow for this. Detailed analysis of patient flow through services is urgently needed as a basis for improvement.

Preferred format Oral presentation – 15 minutes


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Gardini Marco: Out of hours phone consultations: a literature review using

MeSH Title Out of hours phone consultations: a literature review using MeSH

Author(s) Gardini Marco MD

Affiliation Italy

Background Phone consultation is the most common way to access out of hours (OOH)

primary care service in Italy and in several other European Countries. MeSH is

the controlled vocabulary thesaurus used for indexing articles for PubMed.

Aim The aim of this review is to highlight documented complications within the system and find possible solutions.

Methods A systematic review was performed of published researches on after-hours phone

consultations, searching in Pubmed up to March 2016. Studies were included if

they concerned OOH phone medical care and focused on the General Practitioner

role.

Results During the specific MeSH research 103 manuscripts were identified, 23 of which

were reviewed. OOH telephone interventions are prone to errors and situations

that threaten patient's safety occur often. Especially, the lack of information

regarding the patient’s clinical and personal conditions could endanger patient

continuity of care and might pose legal consequences for the General Practitioner.

Little is known about interventions patterns of OOH phone consultations.

Conclusions More studies are needed on to assess the efficacy of OOH phone interventions.

There is room for improve regarding the OOH phone consultations by creating

shared and validated protocols. Implementation of protocols/procedures based

exclusively on the best available scientific evidences are necessary. A sample of

structured phone consultation is presented.

Preferred format o Other: Oral presentation/Poster – 5 minutes


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Linda Huibers: Citizen decision making in case of an acute health problem

out of office hours – Danish versus Dutch Title Citizen decision making in case of an acute health problem out of office hours –

Danish versus Dutch

Author(s) Linda Huibers

Affiliation Research Unit for General Practice

Note: The Swiss team participated as well, and their part will be presented by Oliver

Senn.

Background Demands in out-of-hours (OOH) primary care are high, resulting in high

workload and costs. It is being debated whether all contacts are relevant. A

previous study showed that Danes have a higher contact rate with OOH primary

care than Dutch citizens.

Aim To study citizens’ decision making contacting OOH care in case of an acute

health problem and compare the differences between Danes and Dutch in

threshold for contacting OOH care.

Methods We performed a cross-sectional study, including a random selection of citizens

from three age groups (0-4, 30-39, and 50-59 years) in Denmark and the

Netherlands. A questionnaire was developed, consisting of background

characteristics, six written case scenarios of acute health problems out-of-office

hours, and factors related to help seeking. Health problems presented varied in

level of urgency.

Results In total, 1,846 Dutch and 1,614 Danish citizens responded. The following

analyses are currently done: description of respondents, description of decision

making per case scenario, threshold for contacting OOH care, corrected for

important help seeking related factors.

Conclusions Identification of specific groups with different thresholds for contacting OOH

care gives input for interventions to redirect patient flows and future research. An

answer to the question whether a difference in threshold between Danes and

Dutch could be an explanation of the difference in contact rate with OOH primary

care.

Preferred format X Oral presentation – 15 minutes


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Ellen Keizer: Development of the “Kernset”: a Dutch national instrument to

measure the quality of telephone triage at out-of-hours GP cooperatives Title Development of the “Kernset”: a Dutch national instrument to measure the quality

of telephone triage at out-of-hours GP cooperatives Author(s) Ellen Keizer1, Marleen Smits1, Paul Giesen1

Affiliation 1Scientific Centre for Quality of Healthcare, Radboudumc, Nijmegen, Netherlands

Background In the Netherlands, there used to be different instruments for measuring the quality of telephone triage at GP cooperatives. The instruments focussed mainly on communicational aspects, and less on the medical quality of the triage decisions. Moreover, GP cooperatives used different procedures for sampling and rating. There was a need for more uniformity and more items on medical aspects.

Aim To develop a minimal set of items to measure the quality of telephone triage at GP cooperatives.

Methods A national inventory with a questionnaire for all GP cooperatives in the Netherlands was performed to determine the most important aspects of telephone triage. Next, items from existing instrument were searched belonging to these topics. Subsequently, an expert panel, consisting of six GPs and six triage nurses, judged these items on importance and formulation. The concept Kernset was tested in a pilot study on measurement characteristics, reliability, validity, discriminative power, feasibility and usability. In this pilot study 114 anonymous calls from four GP cooperatives spread across the Netherlands were judged by eight raters, both internal and external.

Results The Kernset consists of 25 items about the telephone conversation: 14 medical and 11 communicational aspects. Cronbach’s alpha was high (medical items 0.94; communication item 0.75). There was 52% complete agreement between the raters and 74% reasonable agreement. There were differences in strictness between the raters. The content validity was ensured by constructing the Kernset based on existing instruments, the Dutch national triage-system and judgements from an expert panel about the content of the items. 20% of the differences in items can be explained by differences between the triage nurses, which means that the Kernset is able to demonstrate differences between triage nurses.

Conclusions Most items were suitable to measure the quality of telephone triage. Differences between calls and triage nurses can be measured using the Kernset. A more intensive training for the raters could improve the reliability.



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Zalika Klemenc-Ketis: The Safety Attitudes Questionnaire – Ambulatory

Version: psychometric properties of the Slovenian version for the out-of-

hours primary care setting Title The Safety Attitudes Questionnaire – Ambulatory Version: psychometric

properties of the Slovenian version for the out-of-hours primary care setting

Author(s) Zalika Klemenc-Ketis (1,2), Matjaz Maletic (3), Vesna Stropnik (4), Ellen Tveter

Deilkås (5), Dag Hofoss (6), Gunnar Tschudi Bondevik (7,8)

Affiliation 1) Department of Family Medicine, Medical Faculty, University of Maribor, Taborska 8, 2000 Maribor, Slovenia 2) Department of Family Medicine, Medical Faculty, University of Ljubljana, Poljanski nasip 58 1000 Ljubljana, Slovenia 3) Faculty of Organisational Sciences, University of Maribor, Kidriceva cesta 55a, 4000 Kranj, Slovenia 4) Health Centre Ravne na Koroskem, Ob Suhi 11, 2390 Ravne na Koroskem, Slovenia 5) Health Services Research Unit, Akershus University Hospital, Norway 6) Institute of Health and Society, University of Oslo, Norway 7) Department of Global Public Health and Primary Care, University of Bergen, Norway 8) Uni Research Health, Bergen, Norway

Background Several tools have been developed to measure safety attitudes of health care

providers, out of which the Safety Attitudes Questionnaire (SAQ) is most widely used. In 2007, it was adapted to outpatient (primary health care) settings and in 2014 it was tested in out-of-hours health care settings in Norway.

Aim The aim of this study was to validate its Slovenian version in out-of-hours health care settings.

Methods This was a cross-sectional study that took place in Slovenian out-of-hours primary care clinics as a part of an international study entitled Patient Safety Culture in European Out-of-hours services. The questionnaire consisted of the Slovenian version of the Safety Attitudes Questionnaire Ambulatory Version (SAQ-AV). The link to the questionnaire was emailed to the participants (health care workers in out-of-hours clinics). A total of 438 participants were invited.

Results Out of 438 invited participants, 250 answered the questionnaire (response rate 57.1%). Exploratory factor analysis put forward five factors: 1) Perceptions of management, 2) Job satisfaction, 3) Safety climate, 4) Teamwork climate, and 5) Communication. Cronbach’s alpha of the whole SAQ was 0.922. Cronbach’s alpha of the five factors ranged from 0.587 to 0.791. Mean total score of the SAQ was 56.6 ± 16.0 points. The factor with the highest average score was Teamwork Climate and the factor with the lowest average was Job Satisfaction.

Conclusions This study proved that the Slovenian version of the SAQ-AV was a reliable tool to use in the Slovenian out-of-hours health care OOHC settings.

Preferred format 1-slide-5-minutes presentation


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Jamie Murdoch: The role of e-learning in improving the use of computer

decision support software to deliver telephone triage Title The role of e-learning in improving the use of computer decision support software to

deliver telephone triage. Author(s) Dr Jamie Murdoch Affiliation School of Health Sciences, University of East Anglia Background Telephone triage, mediated by computer-decision support software (CDSS), is

increasingly used internationally to manage demand for care. However, the qualitative study we conducted revealed how CDSS, used by nurses, could adversely affect the patient-nurse interaction, impacting on nurse questioning and information obtained from patients. This evidence indicates the need for interventions to improve how clinicians use CDSS to deliver telephone triage.

Aim To investigate how an e-learning module can be used to deliver change in the delivery of telephone triage.

Method We applied conversation analytic methods to systematically analyse nurse and patient communication in 22 consented audio recordings of telephone triage consultations and 10 linked video-recordings of nurses’ use of CDSS used during triage. Using these data, we developed and delivered an e-learning module to a cohort of 26 participants in the UK, including nurse call handlers and call centre managers. A questionnaire was then sent to all participants to obtain qualitative feedback on how the course led to changes in practice.

Results Feedback from e-learning participants revealed how the online module led to service changes in the supervision and auditing of call handlers delivering telephone triage.

Conclusion This research has an impact on if and how CDSS should be used to triage patients over the phone, skills required to use CDSS, and the optimal questioning style clinicians should adopt when triaging patients. Our findings to date indicate that e-learning, using video screenshots of CDSS in use, might be an effective tool for improving the delivery of telephone triage. Further research is required to develop and test the effectiveness of e-learning for improving the delivery of telephone triage.

Preferred Format Oral Presentation – 15 minutes


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John O'Malley: The Provision of End of Life Care in an OOH setting;

misconceptions and barriers Title The Provision of End of Life Care in an OOH setting; misconceptions and

barriers

Author Dr John O’Malley Affiliation Mastercall Healthcare, Stockport, UK.

Background Patients dying from Liver disease in the UK are treated differently from other groups despite Liver disease now being the third commonest cause for death in the UK. It is known that patients with EOL organ failure die much later after diagnosis and access formal and specialist palliative care far closer to death than similar patients dying from cancer. Patients with EOL liver disease also are more likely not to die in the place of their choosing and the vast majority die in hospital.

Aim In preparation for a larger programme of developing EOL Liver care services in OOHs, we wanted to see what set Liver disease apart and what barriers existed preventing similar levels care provided in OOHs for other disease groups.

Methods 150 doctors who work in an OOH setting were surveyed electronically with 46 replies. Eight questions were asked and the responses collated with free text comments collected also.

Results Ascites management and the ‘characteristics’ of the patients involved were cited as the main challenges along with the possibility of variceal haemorrhage. Hospice advice was not found very useful and there were indications that many were not able to differentiate between reversible and irreversible deterioration.

Conclusions There is a misconception of the needs of such patients with, for example, pain relief, being low in the perceived OOH tasks. Other needs such as nutrition, fatigue and sleep disturbance were not recognised and there was an overemphasis on ascites and haematemesis from varices. There were concerns over education regarding use of medications in hepatic encephalopathy, drug interactions, and treatment of ascites. Further work with hospices and secondary care is needed to redress the imbalance of care suffered by EOL liver disease patients. A North West England Group has now been set up involving all relevant stakeholders to progress this work.

Preferred format x Oral presentation – 15 minutes


19

Oliver Senn: Impact of alternative type of health care plans on out-of-hours

care use in Switzerland Title Impact of alternative type of health care plans on out-of-hours care use in

Switzerland Author(s) Oliver Senn

Affiliation

Members of the study

group: Linda Huibers, Ellen Keizer, Anders Helles Carlsen, Grete Moth, Morten Bondo

Christensen

Background In Switzerland the mandatory health insurance offers free access to specialist and

emergency care. In addition to the choice of deductible (ranging from 300 to 2500

Swiss Francs a year) to reduce monthly premium, there is a growing interest of

alternative health care plans (HCP) offering restricted choice of doctors acting on

the principles of gatekeeping in return for lower premiums. The EuroOOHnet

study “citizen decision making in OOH care” aims to compare patient

characteristics and thresholds for contacting OOH care across Danish, Dutch and

Swiss citizens.

Aim The current project focused on the Swiss population and assessed the impact of

alternative HCPs on OOH use as an independent explanation of the difference in

OOH consumption compared to the basic (mandatory) HCP.

Methods Cross-sectional survey, consisting of six case vignettes of acute health problems

during out-of hours with a varying level of urgency have been presented. Socio-

demographics, factors of current health status, health care utilisation and variables

of alternative HCPs have been assessed. Two alternative HCPs have been

evaluated. A HCP that offers an emergency telephone helpline (phone-HCP) and

a managed care HCP (HMO-HCP) with a GP (network) acting as a gatekeeper.

OOH use for the six case vignettes was defined as follows: 1) contacting an OOH

care resulting in a physician encounter (e.g. ED, walk-in centre, GP-OOH

practice, ambulance) and 2) contacting an OOH care resulting in a physician

encounter or an telephone helpline. Multiple logistic regression analysis was

applied to investigate the independent association between OOH use and the

different types of HCPs.

Results Out of the 1141 participants the distribution across the basic-HCP, phone-HCP

and HMO-HCP was as follows: 387 (33.9%), 169 (14.8%) and 585 (51.3%).

Participants in the alternative HCPs were significantly younger, reported better

general health and higher deductibles compared to basic-HCP insured

participants. Controlled for potential confounders, alternative HCPs were

independently associated with a lower OOH use when defined as physician

encounter. In contrast the phone-HCP was independently associated with a higher

OOH contact rate when OOH use additionally included OOH telephone triage.

Conclusions Alternative HCPs seem to affect OOH use, indicating the role of the health care

insurer as a regulator of health care utilisation in a non-gatekeeping health care

system. Differences in patient characteristics with regard to age and health status

across the different HCPs have to be considered when evaluating the impact of

alternative HCPs.

Preferred format


20

Dennis Schou Graversen: Out-of-hours telephone triage by nurses and

doctors in Danish acute care settings. A study of quality focusing on

communication, safety and efficiency Title Out-of-hours telephone triage by nurses and doctors in Danish acute care

settings. A study of quality focusing on communication, safety and efficiency Author(s) Graversen, Dennis Schou, MD PhD student, Huibers Linda, MD PhD PostDoc,

Pedersen, Anette Fischer, Associate Professor PhD PostDoc, Christensen, Morten

Bondo, GP senior researcher PhD

Affiliation Research unit for General Practice, Department of Public Health, Aarhus

University

Background Considerable changes in the organisation of Danish acute out-of-hours (OOH)

healthcare services have been implemented. Hence, regional differences exist

when calling OOH-service in terms of the education of the healthcare

professionals performing the telephone triage. Comparative studies on quality of

telephone triage performed by GPs and nurses are sparse.

Aim We aim to: 1. Generate a valid and feasible measurement tool used to asses quality of

telephone triage in various Danish OOH settings 2. Explore and compare the quality of OOH telephone triage by focusing

on communication, safety and efficiency performed by GPs, nurses and doctors with different specialities.

3. Explore if the quality of the triage is associated with contacts to the patients’ own GPs the following days

Methods A quasi-experimental study will be conducted using audio recordings of real

patient contacts to GPs, nurses and doctors with different specialities in two

Danish regions. A total of 1,900 patient contacts will be randomly selected in two

groups; one representing contacts with increased risk of being under-triaged and

another selected from all contacts. A reviewer panel will assess the quality of the

patient contacts using a measurement tool. This measurement tool will be

formally translated from a Dutch currently used and validated tool. The

measurement tool will be adjusted and validated in Danish settings through a

Delphi process and reliability tested in a pilot study. The final measurement tool

will include items measuring communication, medical content and whether

outcome of telephone triage can be considered as appropriate. Further, register

data for contacts to primary care will be collected and analysed.

Results

Conclusions This study will as the first study provide comparative insight into the quality of

OOH-telephone triage measured by communication, safety and efficiency

performed by GP’s, nurses and other doctors in Danish acute care services.


o 1-slide-5-minutes presentation


21

Marleen Smits: Medical necessity of face-to-face contacts at Dutch OOH GP

cooperative Title Medical necessity of face-to-face contacts at Dutch OOH GP cooperative Author(s) Smits M, In de Maur A, Mout P, Giesen P Affiliation Background General practitioners (GP) experience a high workload when working in the GP

cooperative. They have the feeling that triage nurses often overtriage the calls (higher urgency than necessary) and that they arrange many unnecessary clinic consultations and home visits.

Aim To examine differences in urgency assessments between triage nurses (during telephone triage) and GPs (after the face-to-face contact) and gain insight into the necessity of face-to-face contacts, according to the GPs.

Methods Cross-sectional study in one Dutch GP cooperative of 485 face-to-face contacts: 394 consultations and 91 home visits. After each contact a GP assessed, in retrospect, the urgency and medical necessity of the contact and if a telephone doctor could have prevented the face-to-face contact. In addition, patient and contact characteristics (e.g. age, sex, urgency, diagnosis) and background characteristics of the GPs and triagists were registered (e.g. age, sex, working experience).

Results In 48%, the urgency of the contact was assessed differently by the GP in retrospect: 10% higher; 39% lower. Discrepancy in urgency assessment was more frequent for musculoskeletal and psychological problems. GPs assessed 79% of the face-to-face contacts as medically necessary and 16% as medically unnecessary, but conceivable based on contextual factors such as anxiety and pain. In 5%, the GP assessed the contact neither as medically necessary nor as conceivable. 66% of the medically unnecessary contacts could have been prevented by a telephone doctor.

Conclusions The feeling of GPs that triage nurses easily arrange a clinic consultation or home visit for patients with low urgent complaints, is based on only 5% needless face-to-face contacts. We recommend to repeat the study in other regions and further explore the effects of the telephone doctor.



22

Hilde Philips: iCAREdata Title iCAREdata

Author(s) Hilde Philips, Paul Van Royen, Roy Remmen, Samuel Coenen, Annelies Colliers,

Hanne Claessens, Stephaan Bartholomeeusen, Philip Holmgren, Veronique

Verhoeven, Cil Leytens, …

Affiliation University of Antwerp, ELIZA

Background Since 2014, we develop a large researchdatabase for OOH care data from GPCs,

EDs and pharmacies.

Aim To create a research database for OOH care which enables research on health care

systems, epidemiology, surveillance, benchmarking

Methods Poster presentation to present progress of this project

Results Targets already reached

Conclusions Further achievements

Preferred format o Poster presentation


23

Hilde Philips: Implementing Telephone triage in Belgium Title Implementing Telephone triage in Belgium

Author(s) Annelies Colliers, Hilde Philips, Hanne Claessens, Veronique Verhoeven, Roy

Remmen, Samuel Coenen

Affiliation University of Antwerp, ELIZA

Background Belgian government has decided to implement telephone triage for non-urgent

care. This study is a pilot for what the effects of telephone triage might be on

patient flows during OOH in Belgium.

Aim Assessing safety and efficiency of telephone triage in Belgium

To measure the effects on patient flows during OOH

To estimate the extra costs for the call centres 112

Methods This study includes 4 workpackages

- Evaluation of the performance of the protocols and dispatchers

- Patient questionnaires: how do they choose for which problem?

- Epidemiology using routine data (iCAREdata)

- Cost calculation on workload of the dispatchers

Results Starting research

Conclusions Not yet available


o 1-slide-5-minutes presentation


24

Alberto Vaona: Training interventions for improving telephone

consultation skills in clinicians: a Cochrane Systematic Review Title Training interventions for improving telephone consultation skills in clinicians: a

Cochrane Systematic Review

Author(s) Vaona A, Pappas Y, Grewal RS, Ajaz M, Majeed A, Car J

Affiliation Azienda ULSS 20 Verona

Background The ability to consult by telephone has become an integral part of any modern

patient-centred healthcare system. Nowadays, up to more than a quarter of all care

consultations are conducted by telephone but doctors are not trained in telephone

communication and consultation. Several studies assessed the short term effect of

interventions aimed at improving clinicians' telephone consultation skills but there

is no systematic review reporting patient-oriented outcomes or outcomes of

interest to clinicians.

Aim To assess the effectiveness of training interventions on clinicians' telephone

consultation skills.

Methods We searched 8 electronic databases, two trial registers together with reference

checking, citation searching and contact with study authors to identify additional

studies.

We considered randomised controlled trials, non-randomised controlled trials,

controlled before-after studies and interrupted time series studies evaluating

training interventions compared with any control intervention and/or no

intervention for improving patient outcomes and clinicians' telephone consultation

skills with patients.

We used standard methodological procedures expected by The Cochrane

Collaboration for data analysis.

Results We found no study assessing the effect of training intervention for improving

clinicians telephone communication skills on patient primary outcomes (health

outcomes measured by validated tools or biomedical markers or patient

behaviours; patient morbidity or mortality; patient satisfaction; diagnostic

accuracy; adverse events). We identified one controlled before-after study

evaluating the effect of a training intervention on clinicians' telephone consulting

skills by a validated tool reporting there was no difference between the

intervention and the control (no formal instruction in telephone management) on

history taking and case management skills but no quantitative data were provided.

Conclusions Telephone consultation skills are part of a wider set of remote consulting skills

which grow in their importance as more and more medical care is delivered from

a distance with the support of information technology. Nevertheless, no evidence

is available to guide the training of clinicians and telephone consultation skills

seem to be a forgotten educational and research ground. There is an urgent need

for more research assessing the effect of different training interventions on

clinicians' telephone consultation skills.

Preferred format 1-slide-5-minutes presentation


25

Alberto Vaona: Does a CDSS software increase the obligatory questions

doctors ask during telephone consultations? Title Does a CDSS software increase the obligatory questions doctors ask during

telephone consultations?

Author(s) A.Vaona

Affiliation Azienda ULSS 20 Verona

Background Obligatory questions are the questions a health professional should ask in order to

assess a clinical case urgency during a phone call. Since a long time it is known

health professionals ask a limited proportion of obligatory questions during

telephone consultations. This represents a major concern about telephone triage

safety.

Several CDSS (computerised decision support softwares) have been developed to

help call handlers during telephone consultations collecting all the necessary

information they need to decide about the case they are managing. Nothing is

known about how the proportion of obligatory questions asked by health

professionals changes when a CDSS is available compared with when it is not.

Aim Measure the change in the proportion of obligatory questions asked by OOH

primary care doctors when supported by a CDSS (Odyssey Teleassess®) in

comparison with no support on the same clinical case.

Methods Five incognito standardised patients made 360 phone calls to Azienda ULSS20

Verona OOH primary care service centres presenting 7 clinical cases (previously

used in other studies). OOH doctors, blind to the incognito patients identity, could

be supported or not by the CDSS at random. For each clinical case we compared

the proportions of obligatory questions asked by doctors when they were

supported or not.

Results Available at EurOOH Net 2016 Meeting

Conclusions Available at EurOOH Net 2016 Meeting

References 1) Brown SB1, Eberle BJ. Use of the telephone by pediatric house staff: a

technique for pediatric care not taught.

J Pediatr. 1974 Jan;84(1):117-9.

2) Derkx HP1, Rethans JJ, Muijtjens AM et al. Quality of clinical aspects of call

handling at Dutch out of hours centres: cross sectional national study. BMJ. 2008

Sep 12;337:a1264.

Preferred format Oral presentation – 15 minutes


26

PARTICIPANTS’ CVs


27

EurOOHnet conference 2016 – CV Gunnar Tschudi Bondevik

Surname Bondevik First name Gunnar Tschudi Job(s) and titles Professor, MD, PhD, General Practitioner, Specialist in Family Medicine Institute(s) Department of Global Public Health and Primary Care, University of Bergen, Norway &

National Centre for Emergency Primary Health Care, Uni Research Health, Bergen, Norway

Address institute 1 Kalfarveien 31, N-5018 Bergen, Norway Address institute 2 (same) Phone number institute ++ 47 55 58 61 00 Email [email protected] Other activities Clinical work in general practice Relation with out-of-hours primary care

Researcher at the National Centre for Emergency Primary Health Care, Uni Research Health, Bergen, Norway

Selection of international publications

1. Nieber, Tobias; Holm-Hansen, Elisabeth; Bondevik, Gunnar Tschudi; Blinkenberg, Jesper; Thesen, Janecke; Zakariassen, Erik; Hunskaar, Steinar. Organization of Norwegian out-of-hours primary health care services. Journal of the Norwegian Medical Association 2007;127(10):1335-1338.

2. Zakariassen, Erik; Blinkenberg, Jesper; Holm-Hansen, Elisabeth; Nieber, Tobias; Thesen, Janecke; Bondevik, Gunnar Tschudi; Hunskaar, Steinar. Locations, facilities and routines in Norwegian out-of-hours services. Journal of the Norwegian Medical Association 2007;127(10):1339-1342.

3. Huibers, Linda AMJ; Moth, Grete; Bondevik, Gunnar Tschudi; Kersnik, Janko; Huber, Carola A; Christensen, Morten B; Leutgeb, Rüdiger; Casado, Armando M; Remmen, Roy & Wensing, Michel. Diagnostic scope in out-of-hours primary care services in eight European countries: an observational study. BMC Family Practice 2011 May 13;12(1):30.

4. Huibers, Linda; Philips, Hilde; Giesen, Paul; Remmen, Roy; Christensen, Morten B; Bondevik, Gunnar Tschudi.

EurOOHnet - the European research network for out-of-hours primary health care. European Journal of General Practice 2013. Eur J Gen Pract 2013, http://informahealthcare.com/doi/abs/10.3109/13814788.2013.846320.

5. Bondevik, GT; Hofoss D; Holm Hansen E; Deilkås ECT. The Safety Attitudes Questionnaire – Ambulatory Version: psychometric properties of the Norwegian translated version for the primary care setting. BMC Health Serv Res. 2014 Mar 29;14(1):139. doi: 10.1186/1472-6963-14-139.

6. Bondevik, GT; Hofoss D; Holm Hansen E; Deilkås ECT. Patient Safety Culture in Norwegian primary care – a study in out-of-hours casualty clinics and GP practices. Scandinavian Journal of Primary Health Care, 2014; 32: 132-13.

7. Abrahamsen HB; Sollid SJM; Öhlund LS; Røislien J; Bondevik GT. Simulation-based training and assessment of non-technical skills in the Norwegian Helicopter Emergency Medical Services: a cross-sectional survey. Emergency Medicine Journal, 2015; 32: 647-653.

8. Bondevik, GT; Holst L; Haugland M; Bærheim A; Raaheim A. Interprofessional workplace learning in primary care: Students from different health professions work in teams in real-life settings. International Journal of Teaching and Learning in Higher Education, 2015; 27(2): 175-182.


28

EurOOHnet conference – CV Cernesi Simone

Surname Cernesi First name Simone Job(s) and titles GP with special interest in Palliative Care Institute(s) Ausl Modena, Sassuolo Address institute 1 Via Cairoli 19, 41049 Sassuolo, Modena, Italy Address institute 2 Phone number institute 0039 0536 863642 Email [email protected] Other activities EUROPEAN PALLIATIVE CARE ACADEMY LEADERSHIP COURSE

2015-2017

WONCA VdGM EUROPE HIPPOKRATES PROGRAMME VICE

NATIONAL EXCANGE

COORDINATOR

Relation with out-of-hours primary care

OOH MD since 2008 Sassuolo OOH rapresentative


No international publications


29

EurOOHnet conference – CV Annelies Colliers

Surname Colliers

First name Annelies

Job(s) and titles MD, GP, Phd student

Institute(s) Department of Primary and Interdisciplinary Care (ELIZA) – Centre for General Practice (CHA), Faculty of Medicine and Health Sciences University of Antwerp

Address institute 1 Campus Drie Eiken Universiteitsplein 1 2610 Antwerp, Wilrijk Belgium

Address institute 2

Phone number institute 0032 (0)3 265 18 32

Email [email protected]

Other activities Network facilitator Alic4e trial (PREPARE)

Medical teacher: undergraduate and graduate medical students

Relation with out-of-hours

primary care

Junior-researcher on OOH care


OOH-care: • Improving Care And Research Electronic Data Trust Antwerp (iCAREdata): a research database of

linked data on out-of-hours primary care. Colliers A, Bartholomeeusen S, Remmen R, Coenen S, Michiels B, Bastiaens H, Van Royen P, Verhoeven V, Holmgren P, De Ruyck B, Philips H. BMC Research Notes - accepted

• Agreement on urgency assessment between secretaries and general practitioners : an observational study in out-of-hours general practice service in Belgium. Philips H, van Bergen J, Huibers L., Colliers A, Bartholomeeusen S, Coenen S, Remmen R. Acta Clin Belg 2015;70:309-14.

Other topics:

• Screening Belgian university students for Chlamydia trachomatis infection : a feasibility study Colliers A, Verster A, Van Puyenbroeck K, Stalpaert Michel, Van Royen P, Verhoeven V. International journal of adolescent medicine and health (2009),p. 343-346

• Collecting data for sexually transmitted infections (STI) surveillance : what do patients prefer in Flanders? Verhoeven V, Colliers A, Verster A, Avonts D, Peremans L, Van Royen P. BMC health services research - 20:7(2007), p. 149

• The male factor in cervical carcinogenesis : a questionnaire study of men's awareness in primary care Verhoeven V, Baay M, Colliers A, Verster A, Van Royen Pl, Avonts D, Vermorken J B. Preventive medicine - 43:5(2006), p. 389-393


30

EurOOHnet conference – CV Jacopo Demurtas

Surname Demurtas

First name Jacopo

Job(s) and titles OOH Doctor. MD, Family Medicine Specialist, M. Ed. Student

Institute(s) AUSL Toscana Sud Est – Grosseto

Address institute 1 Via Cimabue, 109 58100 Grosseto

Address institute 2

Phone number institute 0564/485931


Other activities SIMG Secretary Grosseto, Wonca VdGM Italian Delegate, Youth Committee

Member College of Physicians Pisa, Teacher Tuscany School of GP


primary care

OOH Doctor, involved in research in primary care and union activity


Just Italian publications.


31

EurOOHnet conference – CV Jonas Fynboe Ebert

Surname Ebert

First name Jonas Fynboe

Job(s) and titles PhD student, MD

Institute(s) Research unit for general practice, Aarhus University, Denmark

Address institute 1 Bartholins allé 2, 8000 Aarhus C

Address institute 2 Denmark

Phone number institute + 45 86 16 79 59


Other activities


primary care

PhD project regarding OOH-PC in Denmark. Part of the OOH-PC research

group at Aarhus University


None


32

EurOOHnet conference – CV Dennis Schou Graversen

Surname Graversen

First name Dennis Schou

Job(s) and titles MD, PhD student

Institute(s) Research Unit for General Practice, Department of Public Health, University of

Aarhus, Denmark

Address institute 1 Bartholins Allé 2

Address institute 2 DK – 8000 Aarhus C

Phone number institute +45 87 16 79 01


Other activities


primary care • Developing a valid measurement tool in assessing quality of OOH

telephone triage in Denmark.

• Comparing communication, safety and efficiency of telephone triage

performed by nurses, doctors and general practitioners in Danish OOH-PC



33

EurOOHnet conference – CV Linda Huibers

Surname Huibers

First name Linda

Job(s) and titles Post doc researcher (PhD, MD)

Institute(s) 1) Research Unit for General Practice, Department of Public Health, Aarhus

University, Denmark

2) Scientific Institute for Quality of Healthcare, Radboud university medical

center, The Netherlands

Address institute 1 Bartholins allé 2, 8000 Aarhus C, Denmark

Address institute 2 P.O. Box 9101, 114 IQ healthcare

6500 HB Nijmegen, The Netherlands

Phone number institute 1 0045 871 67959


Other activities


primary care

Research area


1. Ellen Keizer, Marleen Smits, Yvonne Peters, Linda Huibers, Paul Giesen, Michel Wensing. Contacts with

out-of-hours primary care for nonurgent problems: patients' beliefs or deficiencies in healthcare? BMC

Fam Pract 2015; 16:1.

2. Huibers L, Moth G, Christensen MB, Vedsted P. Antibiotic prescribing patterns in out-of-hours primary

care: A population-based descriptive study. Scand J Prim Health Care 2014;32:200-7. doi:

10.3109/02813432.2014.972067.

3. Huibers L, Moth G, Andersen M, Van Grunsven P, Giesen P, Christensen MB, Olesen F. Consumption in

out-of-hours health care: Danes double Dutch? Scan J Prim Health Care 2014;32:44-50. doi:

10.3109/02813432.2014.898974.

4. Moth G, Huibers L, Vedsted P. From GP to nurse triage in the Danish out-of-hours primary care service -

simulated effects on costs. Int J Fam Med 2013;2013:987834. doi: 10.1155/2013/987834

5. Smits M, Keizer E, Huibers L, Giesen P. GPs’ experiences with out-of-hours GP cooperatives: a survey

study. Eur J Gen Pract 2014;20:196-201. doi:10.3109/13814788.2013.839652.

6. Huibers L, Koetsenruijter J, Grol R, Giesen P, Wensing M. Follow-up after telephone consultations at

out-of-hours primary care: a cross-sectional study. J Am Board Fam Med. 2013;26(4):373-9. doi:

10.3122/jabfm.2013.04.120185.

7. Huibers L, Keizer E, Giesen P, Grol R, Wensing M. Nurse telephone triage: good quality associated with

appropriated decisions. Fam Pract. 2012;29:547-52

8. Giesen P, Smits M, Huibers L, Grol R, Wensing M. Quality of after-hours primary care in the

Netherlands: a narrative review. Ann Intern Med 2011;155:108-13

9. Huibers L, Giesen P, Smits M, Mokkink H, Grol R, Wensing M. Nurse telephone triage in Dutch out-of-

hours primary care: the relation between history taking and urgency estimation. Eur J Emerg Med.

2012;19:309-15. doi: 10.1097/MEJ.0b013e32834d3e67.

10. Huibers L, Smits M, Renaud V, Giesen P, Wensing M. Safety of telephone triage in out-of-hours care: a

systematic review. Scand J Prim Health Care 2011;29:198-209

11. Huibers LAMJ, Moth G, Bondevik G, Kersnik J, Huber CA, Christensen MB, Leutgeb R, Remmen R,

Wensing M. Diagnostic scope in out-of-hours primary care services in 8 European countries: an

observational study. BMC Fam Pract 2011;12:30

12. Smits M, Huibers L, Kerssemeijer B, De Feijter E, Wensing M, Giesen P. Patient safety in out-of-hours

primary care: a review of patient records. BMC Health Serv Res 2010;10:335

13. Huibers L, Giesen P, Wensing M, Grol R. Out-of-hours care in western countries: assessment of

different organizational models BMC Health Serv Res 2009;9:105


34

EurOOHnet conference – CV Ellen Keizer

Surname Keizer

First name Ellen

Job(s) and titles Junior researcher, PhD student

Institute(s) IQ healthcare, Radboud University Medical Center



Address institute 2

Phone number institute +31 (0) 24 36 19641


Other activities


primary care

Research into OOH GP cooperatives: Help seeking behaviour, Healthcare

consumption, Patient experiences, GP experiences, Telephone Triage


Keizer E, Maassen I, Smits M, Wensing, Giesen P. Reducing the use of primary out-of-hours services Eur J Gen Pract 2016 Keizer E, Smits M, Peters Y, Huibers L, Giesen P, Wensing M. Contacts with out-of-hours primary care for nonurgent problems: patients’ beliefs or deficiencies in healthcare? BMC Fam Pract 2015; 16:1. Smits M, Peters Y, Broers S, Keizer E, Wensing M, Giesen P. Association between primary care practice characteristics and use of out-of-hours GP cooperatives. BMC Fam Pract 2015; 16: 52. Smits M, Keizer E, Huibers L, Giesen P. GPs’ experiences with out-of-hours GP cooperatives: a survey study from the Netherlands. Eur J Gen Pract 2014; 20: 196-201.

Jansink R, Braspenning J, Keizer E, van der Weijden T, Elwyn G, Grol R.No identifiable Hb1Ac or

lifestyle change after a comprehensive diabetes programme including motivation interviewing: a

cluster randomised trial. Scan J Prim Health Care 2013; 31(2):119-27

Jansink R, Braspenning J, Laurant M, Keizer E, van der Weijden T, Elwyn G, Grol R. Minimal

improvement of nurses’ motivation interviewing skills in routine diabetes care one year after training:

a cluster randomized trial BMC Fam Pract 2013; 14:44

Jansink R, Braspenning J, Keizer E, van der Weijden T, Elwyn G, Grol R. Misperception of patients with

type 2 diabetes about diet and physical activity, and its effect on readiness to change. J Diabetes 2012;

4(4):417-23

Huibers L, Keizer E, Giesen P, Grol R, Wensing M. Nurse telephone triage: good quality associated with appropriated decisions. Fam Pract 2012; 29(5):547-52


35

EurOOHnet conference – CV Zalika Klemenc-Ketis

Surname Klemenc-Ketis

First name Zalika

Job(s) and titles Assist. prof., MD, PhD

Institute(s) Department of family medicine, Faculty of Medicine Maribor, Slovenia

Address institute 1 Taborska 8, 2000 Maribor

Address institute 2

Phone number institute


Other activities


primary care

Research


1. Philips H, Huibers L, Holm Hansen E, Bondo Christensen M, Leutgeb R, Klemenc-Ketis Z, Chmiel C, Muñoz

MA, Kosiek K, Remmen R. Guidelines adherence to lower urinary tract infection treatment in out-of-hours

primary care in European countries. Qual Prim Care. 2014;22(4):221-31.

2. Klemenc-Ketis Z, Tomazin I, Kersnik J. HEMS in Slovenia: one country, four models, different quality

outcomes. Air Med J. 2012 Nov-Dec;31(6):298-30

3. Klemenc-Ketis Z, Bacovnik-Jansa U, Ogorevc M, Kersnik J. Outcome predictors of Glasgow Outcome Scale

score in patients with severe traumatic brain injury. Ulus Travma Acil Cerrahi Derg. 2011 Nov;17(6):509-15.

4. Klemenc-Ketis Z Life changes in patients after out-of-hospital cardiac arrest : the effect of near-death

experiences. Int J Behav Med. 2013 Mar;20(1):7-12

5. Poplas-Susić T, Klemenc-Ketis Z, Komericki-Grzinić M, Kersnik J. Glasgow Coma Scale in acute poisonings

before and after use of antidote in patients with history of use of psychotropic agents. Srp Arh Celok Lek.

2010 Mar-Apr;138(3-4):210-3.

6. Klemenc-Ketis Z, Kersnik J, Grmec S The effect of carbon dioxide on near-death experiences in out-of-

hospital cardiac arrest survivors: a prospective observational study. Crit Care. 2010;14(2):R56.

7. Poplas-Susic T, Komericki-Grzinic M, Klemenc-Ketis Z, Tusek-Bunc K, Zelko E, Kersnik J. Aetiological and

demographical characteristics of acute poisoning in the Celje region, Slovenia. Eur J Emerg Med. 2009

8. Stropnik V, Klemenc-Ketis Z. AEDskills among lay people in the region of Koroska: a pilot study. Signa

Vitae 2014; 9(1):1-3.

9. Taskovska M, Klemenc-Ketis Z, Kersnik J. Adherence to guidelines for the treatment of uncomplicated lower

urinary tract infections in the primary care emergency department. Zdrav Var 2013;52:1.


36

EurOOHnet conference – CV Dr John O’Malley

Surname O’Malley

First name John

Job(s) and titles Organisational Medical Director

Institute(s) Mastercall Healthcare

Address institute 1 International House

Address institute 2 Pepper Road, Hazel Grove, Stockport SK7 5BW

Phone number institute 0044 161 477 9190


Other activities Health care law and ethics


primary care

Social Enterprise provider of out of hospital services including OOHs to 650, 000

patients in the Greater Manchester area


None in the OOH field.

My main role is as the Organisational Medical Director of Mastercall, a NHS Social Enterprise, which provides

Out of Hospital Care to the Trafford and Stockport areas. I am passionate about raising quality and safety in

OOHs through education and transparency. I also have a strong interest in palliative care and the immense

importance of OOH care in its provision.

I worked as a Hospital Practitioner in Gastroenterology, involved in clinics and endoscopy. I have been active in

national and international gastroenterology issues and have sat on several guideline committees .I was the

secretary, journal and web editor for the Primary Care Society for Gastroenterology until 2013.

I have an MA in Health Care Ethics/Health Law with a dissertation on ‘The Moral Responsibility for Health’.

My abandoned, temporarily, PhD centres on the meaning of Professsionhood as applied to medicine.

My hobbies include shouting at ‘University Challenge’, deluding myself I know the answers and waiting for the

call to be George Clooney’s double.


37

EurOOHnet conference – CV Hilde Philips

Surname Philips

First name Hilde

Job(s) and titles MD, GP, PhD

Institute(s) Department of Primary and Interdisciplinary Care (ELIZA) – Centre for General Practice (CHA), Faculty of Medicine and Health Sciences University of Antwerp

Address institute 1 Campus Drie Eiken Universiteitsplein 1 2610 Antwerp, Wilrijk Belgium

Address institute 2

Phone number institute 0032 (0)3 265 18 31


Other activities Senior researcher in out-of-hours care research

Project leader of the research project 1733, telephone triage

General Practitioner


primary care

Senior researcher


OOH-care (most recent, other than EurOOHnet publications): • Improving Care And Research Electronic Data Trust Antwerp (iCAREdata): a research database of

linked data on out-of-hours primary care. Colliers A, Bartholomeeusen S, Remmen R, Coenen S, Michiels B, Bastiaens H, Van Royen P, Verhoeven V, Holmgren P, De Ruyck B, Philips H. BMC Research Notes - accepted

• Agreement on urgency assessment between secretaries and general practitioners : an observational study in out-of-hours general practice service in Belgium. Philips H, van Bergen J, Huibers L., Colliers A, Bartholomeeusen S, Coenen S, Remmen R. Acta Clin Belg 2015;70:309-14.

• Accessibility and use of primary health care : how conclusive is the social-economical situation in Antwerp? Philips Hilde, Rotthier P., Meyvis L., Remmen R. Acta clinica Belgica - ISSN 1784-3286 - 70:2(2015), p. 100-104

• Reducing inappropriate A&E attendances. Philips Hilde, Michiels Barbara, Coenen Samuel, Remmen Roy. The British journal of general practice - ISSN 0960-1643 - 64:619(2014), p. 71


38

EurOOHnet conference – CV Roy Remmen

Surname Remmen

First name Roy

Job(s) and titles Head of Department, professor

Institute(s) Dpt Primary and Interdisciplinary care, faculty of Medicine and Health Sciences

Address institute 1 Faculteit Geneeskunde en Gezondheidswetenschappen Campus Drie Eiken – R3.11 Universiteitsplein 1 – 2610 Wilrijk (Antwerpen) – Belgium

Address institute 2

Phone number institute + 32 3 265 25 29


Other activities General practitioner


primary care

One of my research focus


Can we improve adherence to guidelines for the treatment of lower urinary tract infection? A simple,

multifaceted intervention in out-of-hours services Willems Leentje, Denckens Pieter, Philips Hilde, Henriquez Rodrigo, Remmen Roy. The journal of antimicrobial chemotherapy-issn 0305-7453-67(2012),p. 2997-3000 A systematic review of the evidence on the effectiveness and risks of inactivated influenza vaccines in

different target groups Michiels Barbara, Govaerts Frans, Remmen Roy, Vermeire Etienne, Coenen Samuel. Vaccine-issn 0264-410X-29(2011),p. 9159-9170 Out of hours care : a profile analysis of patients attending the emergency department and the general

practitioner on call Philips Hilde, Remmen Roy, de Paepe Peter, Buylaert Walter, Van Royen Paul. BMC family practice-issn 1471-2296-11(2010),p. 88,1-88,8 Systematic review: effects, design choices, and context of pay-for-performance in health care van Herck Pieter, de Smedt Delphine, Annemans Lieven, Remmen Roy, Rosenthal Meredith B., Sermeus Walter. BMC health services research-issn 1472-6963-10(2010),p. 247,1-247,13


39

EurOOHnet conference – CV Oliver Senn

Surname Senn

First name Oliver

Job(s) and titles MD (General Internist), MPH, Assistant Professor

Institute(s) Institute of Primary Care, University of Zurich

Address institute 1 Pestalozzistrasse 24, 8091 Zurich, Switzerland

Address institute 2 Medical Practice, Rämistrasse 34, 8001 Zurich, Switzerland

Phone number institute 0041-(0)44-255 92 48


Other activities Research activities focusing on primary care: chronic disease, integrated care,

multimorbidity, polypharmacy, communication


primary care

Involved as a GP in a rota system for OOH care, research activities in OOH care


1. CHMIEL C., WANG M., SIDLER P., EICHLER K., ROSEMANN T., SENN O. Implementation of a hospital-integrated general practice--a successful way to reduce the burden of inappropriate emergency-department use, Swiss Med Wkly 2016: 146: w14284. 2. HESS S., SIDLER P., CHMIEL C., BOGLI K., SENN O., EICHLER K. Satisfaction of health professionals after implementation of a primary care hospital emergency centre in Switzerland: A prospective before-after study, International emergency nursing 2015: 23: 286-293. 3. EICHLER K., HESS S., CHMIEL C., BOGLI K., SIDLER P., SENN O., ROSEMANN T., BRUGGER U. Sustained health-economic effects after reorganisation of a Swiss hospital emergency centre: a cost comparison study, Emerg Med J 2014: 31: 818-823. 4. WANG M., WILD S., HILFIKER G., CHMIEL C., SIDLER P., EICHLER K., ROSEMANN T., SENN O. Hospital-integrated general practice: a promising way to manage walk-in patients in emergency departments, J Eval Clin Pract 2014: 20: 20-26. 5. CHMIEL C., HUBER C. A., ROSEMANN T., ZOLLER M., EICHLER K., SIDLER P., SENN O. Walk-ins seeking treatment at an emergency department or general practitioner out-of-hours service: a cross-sectional comparison, BMC health services research 2011: 11: 94. 6. EICHLER K., IMHOF D., CHMIEL C., ZOLLER M., SENN O., ROSEMANN T., HUBER C. A. The provision of out-of-hours care and associated costs in an urban area of Switzerland: a cost description study, BMC Fam Pract 2010: 11: 99.


40

EurOOHnet conference – CV Marleen Smits

Surname Smits

First name Marleen

Job(s) and titles Post doctoral researcher, PhD

Institute(s) IQ healthcare, Radboud University Medical Center



Address institute 2

Phone number institute +31 (0) 24 36 66874


Other activities


primary care

Research into OOH GP cooperatives: Patient safety, Triage, Healthcare

consumption, Patient experiences, GP experiences, Palliative care, Collaboration

GP cooperative & ED, Collaboration GP cooperative & ambulance.


Smits M, Borne B van den, Dijker A, Ryckman R. Increasing Dutch adolescents’ willingness to register their organ donation preference: the effectiveness of an education programme delivered by kidney

transplantation patients. European Journal of Public Health 2006; 16:106-110. Smits M, Christiaans-Dingelhoff I, Wagner C, Wal G van der, Groenewegen PP. The psychometric properties of the ‘Hospital Survey on Patient Safety Culture’ in Dutch hospitals. BMC Health Services Research 2008; 8: 230. Smits M, Janssen JCJA, Vet HCW de, Zwaan L, Timmermans DRM, Groenewegen PP, Wagner C. Analysis of unintended events in hospitals: inter-rater reliability of constructing causal trees and classifying root

causes. International Journal for Quality in Health Care 2009; 21: 292-300. Smits M, Groenewegen PP, Timmermans DRM, Wal G van der, Wagner C. The nature and causes of unintended events reported at ten emergency departments. BMC Emerg Med 2009; 9:16. Smits M, Wagner C, Spreeuwenberg P, Wal G van der, Groenewegen PP. Measuring patient safety culture: an assessment of the clustering of responses at unit and hospital level. Quality and Safety in Health Care 2009; 18: 292-296. Wagtendonk I van, Smits M, Merten H, Heetveld MJ, Wagner C. Nature, causes and consequences of unintended events in surgical units.British Journal of Surgery 2010, 97: 1730-1740. Smits M, Huibers L, Kerssemeijer B, de Feijter E, Wensing M, Giesen P. Patient safety in out-of-hours primary care: a review of patient records. BMC Health Services Research 2010;10:335. Giesen P, Smits M, Huibers L, Grol R, Wensing M. Quality of after-hours primary care: a narrative review of the Dutch solution. Annals of Internal Medicine 2011;155:108-113. Huibers L, Smits M, Renaud V, Giesen P, Wensing M. Safety of telephone triage in out-of-hours care: a systematic review. Scandinavian Journal of Primary Health Care 2011; 29: 198-209 Christiaans-Dingelhoff I, Smits M, Zwaan L, Lubberding S, Wal G van der, Wagner C. To what extent are adverse events found in patient records reported by patients and healthcare professioals via complaints,

claims and incident reports? BMC Health Services Research 2011; 11:49 Smits M, Wagner C, Spreeuwenberg P, Timmermans DRM, Wal G van der, Groenewegen PP. The role of patient safety culture in the causation of unintended events. Journal of Clinical Nursing 2012; 21, 3392–3401


41

Smits M, Huibers L, Oude Bos A, Giesen P. Patient satisfaction with out-of-hours GP cooperatives: a longitudinal study. Scand J Prim Health Care 2012; 30: 206-2013. Wagner C, Smits M, Sorra J, Huang CC. Assessing patient safety culture in hospitals across countries. Int J Qual Health Care 2013, 25: 213-221 Smits M, Keizer E, Huibers L, Giesen P. GPs’ experiences with out-of-hours GP cooperatives: a survey study from the Netherlands. Eur J Gen Pract 2014; 20: 196-201. Smits M, Peters Y, Broers S, Keizer E, Wensing M, Giesen P. Association between primary care practice characteristics and use of out-of-hours GP cooperatives. BMC Fam Pract 2015; 16: 52. Smits M, Hanssen S, Huibers L, Giesen P. Telephone triage general practices: a written case scenario study. Scan J Prim Health Care 2016;34:28-36. Wagner C, Merten H, Lubberding S, Zwaan L, Timmermans D, Smits M. Unit based incident reporting and root cause analysis: variation at three hospital unit types. BMJ Open 2016.


42

EurOOHnet conference – CV Alberto Vaona

Surname: Vaona

First name: Alberto

Job(s) and titles: OOH doctors in Verona, PhD student (University of Modena)

Institute(s): Azienda ULSS 20 Verona

Address institute Piazzale Lambranzi 1, 37142 Verona

Phone number institute: 0457614565+3

Email: [email protected]

Research, topics, and plans

Research areas of interest: telephone triage, CDSS, diabetes primary care management, systematic reviews

Current project(s)/ ongoing research (title and key words): Efficiency and safety of a clinical decision support

software (CDSS) for medical telephone triage in a primary care out of hours service: a randomized controlled

trial

Ideas for future research:

-a randomized control trial comparing two different (CDSS) in the OOH service

-a randomized control trial assessing the effects of RICE telephone consultation model training


A cross-sectional study of the quality of telephone triage in a primary care out-of-hours service.

Pasini A, Rigon G, Vaona A.

J Telemed Telecare. 2015 Mar;21(2):68-72. doi: 10.1177/1357633X14566573. Epub 2015 Jan 13.

Effectiveness of computerized decision support systems linked to electronic health records: a systematic review

and meta-analysis.

Moja L, Kwag KH, Lytras T, Bertizzolo L, Brandt L, Pecoraro V, Rigon G, Vaona A, Ruggiero F, Mangia M,

Iorio A, Kunnamo I, Bonovas S.

Am J Public Health. 2014 Dec;104(12):e12-22. doi: 10.2105/AJPH.2014.302164. Epub 2014 Oct 16. Review.

Barriers and facilitators to the uptake of computerized clinical decision support systems in specialty hospitals:

protocol for a qualitative cross-sectional study.

Moja L, Liberati EG, Galuppo L, Gorli M, Maraldi M, Nanni O, Rigon G, Ruggieri P, Ruggiero F, Scaratti

G, Vaona A, Kwag KH.

Implement Sci. 2014 Aug 28;9:105. doi: 10.1186/s13012-014-0105-0.

Interferons-beta versus glatiramer acetate for relapsing-remitting multiple sclerosis.

La Mantia L, Di Pietrantonj C, Rovaris M, Rigon G, Frau S, Berardo F, Gandini A, Longobardi A, Weinstock-

Guttman B, Vaona A.

Cochrane Database Syst Rev. 2014 Jul 26;7:CD009333. doi: 10.1002/14651858.CD009333.pub2. Review.


43

MEMBER ORGANISATIONS’

BACKGROUND


44

Belgium (Flanders) Out-of-hours primary care

Organisational model(s)

o Individual GP

• Small rotation groups

• Large-scale organisations

o Other, describe:

Main model • Most widespread model: fifty-fifty

• Model studied by member institute : mostly GPCs

Main model:

• Description of model Belgian health care is characterized by free access to primary, secondary and

tertiary care facilities.

Two models in OOH primary care:

- Small rotation groups

- GPCs: 26 GPCs in Flanders, about 50% of residents are covered, 80-

160 GPs/GPC

• Type of health care professionals available

GPs, supported by administrative and logistical (e.g. chauffeur) personnel

• Access • Free

o After referral by a health care professional

o Other, describe:

• Telephone triage o Yes, who:

• No

• Payment professionals o Salary per hour

• Fee-for-service

• Other, describe: capitation based

• Payment patients o Free, explain:

• Payment, explain: direct payment, with partly reimbursement by medical insurance (obligatory in Belgium) or third party payment

Opening hours out-of-hours services

From Friday 19 p.m. until Monday 7 a.m.

Other services out-of-hours care available

(short description of model, professionals, access, payment)

Emergency care Free access, no direct payment, secondary and tertiary care facilities,

emergency doctors and nurses

Ambulance care Free access with central phone number 112, triage by trained non-medical

staff, no direct payment, paramedics, MD and ED nurse when necessary

Other


45

Denmark Out-of-hours primary care

Organisational model(s) o Large-scale organisations (in four regions GP based, in one region nurse-

/doctor based)

Main model • Most widespread model

Main model:

• Description of model In Denmark the region is responsible for organising OOH primary care. In

four out of five regions the GPs do organise out-of-hours primary care in

large-scale settings. GPs do the telephone triage and decide between a

telephone consultation, a clinic consultation, a home visit, or a direct referral

to the hospitals.


GPs

• Access • Free: patients have to call

• Telephone triage o Yes, who: by GPs, without a computerised decision support system

• Payment professionals o Fee-for-service: fee varies per type of shift (telephone, consultation, or visits)

• Payment patients o Free, explain: primary care is tax-financed, so all citizens have free access to primary care


Monday to Friday from 16:00 to 08:00, Weekends: from Friday 16:00 to Monday 08:00 Holidays: all day



Emergency care In principle patients have to call, but some self-referring patients exist.

Different models for emergency care exist, with varying professionals and

level of care available.

Ambulance care Patients call 112 and get in contact with a dispatcher, who uses a

computerised decision support system to triage the call. Varying types of

ambulances are available, with and without acute care doctors.

Other In one region OOH care is organised by the region. Patients have to call 1813,

where they either talk to nurses (who use a computerised decision support

tool) or doctors (with varying specialities). After triage, patients get a

telephone advice (with self-care or referral to the own doctor), a consultation

at the emergency department, or a home visit. Professionals are paid a fee for

service, whereas the service is free for patients.


46

The Netherlands Out-of-hours primary care


Large-scale organisations

Main model Most widespread model

Main model:

• Description of model

• Out-of-hours primary care is provided by large-scale general practitioner (GP) cooperatives. 1. There are about 120 GP cooperatives in the Netherlands with a

population of 100,000 to 500,000 inhabitants. 2. Participation of 50-250 GPs per cooperative. 3. GPs are on average 4 hours a week on call and do 85% of the shifts

themselves. 4. Distance of patients to GP cooperative maximally 30 km. 5. GP cooperative in 65% situated in front of A&E department of the

hospital. 6. Telephone triage by triagists supervised by GPs: contacts are divided

into telephone advice, centre consult, or GP home visit. All GP cooperatives use the same triage system (NTS).

7. Drivers in identifiable GP cars that are fully equipped (e.g. oxygen, intra venous drip equipment, automated external defibrillator, medication).

8. Information and communication technology (ICT) support including electronic patient files, online connection to the GP car, and sometimes connection with the electronic medical record in the GP daily practice.


• GPs, triagists (assistants), sometimes nurse practitioners or physician assistants who do some types of consultations

• Access • Access via a single regional telephone numbe (only 5-10% walk in without a call in advance)

• Telephone triage • Telephone triage by triagist (physician assistant), supervised by GP

• Payment professionals • Salary per hour (GP about 65 euro bruto)

• Payment patients • Free: the basic insurance package includes primary care and the financial deductible is not applicable to primary care.


Daily from 5 p.m. to 8 a.m. and the entire weekend and on public holidays.



Emergency care Nearly all hospitals have an emergency department (ED). The GP is the point of access to secondary care, but patients in need for highly urgent care can go to the hospital emergency department without prior contact with the GP or GP cooperative (self-referrals). Also access via ambulance (112). There is a trend of co-location and collaboration between the ED and GP cooperative during OOH (GP cooperative treats the self-referrals of the ED). The yearly financial deductible (385 euro in 2016) for patients is applicable to ED care. Professionals: ED physicians, resident physicians (under supervision of specialist) and nurses

Ambulance care Patients can call an ambulance via 112. Ambulance dispatching performed by nurses using a triage system (in 40% this is the same NTS triage system as used by GP cooperatives). Two persons on ambulances: a nurse and a driver who can assist. Nurse on ambulance decides to treat the patient or send him to the hospital. The yearly financial deductible (385 euro in 2016) for patients is applicable to ambulance care.


47

Trend: les call centres: from 26 > 10 in coming years Other


48

Norway Out-of-hours primary care Organisational model(s)

Individual GP X Small rotation groups – in rural areas X Large-scale organisations – in urban areas Other, describe:

Main model X Most widespread model Model studied by member institute

Main model: The organization of out-of-hours (OOH) primary health care services in Norway has changed from municipal-based to larger inter-municipal co-operations with regular employees and improved competence. The establishment of larger OOH clinics include all municipalities, and serve the entire population. Professionals: Medical doctors and registered nurses

Description of model Type of health care professionals available

Access X Free After referral by a health care professional Other, describe:

Telephone triage X Yes, who: registered nurses No

Payment professionals X Salary per hour – most OOH-clinics (larger) X Fee-for-service – some OOH clinics (smaller) Other, describe:

Payment patients Free, explain: X Payment, explain: The patient has to pay €25,- per consultation


4pm – 8am + weekends

Other services out-of-hours care available (short description of model, professionals, access, payment) Emergency care Outside hospitals: Primary care/GPs responsible Ambulance care Run by hospitals: Secondary care responsible Other


49

SLOVENIA Out-of-hours primary care

Organisational model(s) o Other, describe: primary health care centres

Main model • Most widespread model

Main model: There is a fixed number of institutions that provide OOHC defined in the

sixties on a population basis, i.e. There should live at least 15,000 inhabitants

in the catchment area of an OOHC centre. OOHC is organised by Primary

health care centres, which had the same population criteria to be organised.

Mainly these are founded as non-for-profit institutions in community centres

throughout the country. GPs working in this area are obliged to participate in

providing these services. The services during the night, on weekends and

holidays are paid separately from the budget for provision of regular GP

services.

There is a free access to OOHC in Slovenia.

• Description of model


Various, mainly specialist in family medicine and specialists in emergency

medicine

• Access • Free

• Telephone triage o No

• Payment professionals o Fee-for-service

• Payment patients o Free, explain: urgent cases o Payment, explain: non-urgent cases


24/7



Emergency care Available 24/7, free

Ambulance care Available 24/7, free

Other


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Switzerland Out-of-hours primary care


o Individual GP

xSmall rotation groups

o Large-scale organisations

xOther, describe: walk-in centres, large primary care group practices, general

practice embedded in the ED

Main model • Most widespread model : rota system, group practices, walk-in centres

and general practices integrated in the ED are increasing

X Model studied by member institute: primary care service integrated in the

ED

Main model:

• Description of model Rota system


GPs often combined with an Emergency Medical Service Telephone Triage

(run by specially trained nurses)

• Access X Free (covered by the mandatory health insurance plan)

• After referral by a health care professional

X Other, describe: alternative health insurance plans that offer lower

premiums and access demands a telephone triage

• Telephone triage o Yes, who: depends on the locally emergency service area

o No

• Payment professionals X Salary per hour X Fee-for-service o Other, describe:

• Payment patients X Free, explain: covered by the mandatory health insurance plan X Payment, explain: out-of pocket amount includes a 10% co-insurance (max. 700 CHF a year for adults and max. 350 CHF a year for children) and depends on the deductible (ranging from 300 CHF to 2500 CHF a year)


Rota system provides access 24/7 ooh access (at least by telephone triage) Walk-in centres and large group practices offering ooh care are opened 7 days

a week, opening hours vary on Sundays and working days (7.00-22.00) Other services out-of-hours care available


Emergency care All publicly owned or subsidized general hospitals run an ED with free access

(24 hours)

Ambulance care A national number (144): qualified personnel in the emergency call centre

will direct the patient to an adequate point of care

Other


51

United kingdom Out-of-hours primary care


o Individual GP

o Small rotation groups

X Large-scale organisations

o Other, describe:

Main model X Most widespread model

• Model studied by member institute

Main model:

• Description of model Out of hours care pre 2004 was, in the UK, covered mainly by practices either

individually providing cover or amalgamating into co-operatives with a

smaller provision by private agencies. Since then, the number of practices

providing their own cover has reduced markedly and now is mainly seen in

rural areas, because of lack of other providers. The majority of the co-

operatives have now become Social Enterprises which provide services to the

NHS but do not have shareholders that receive dividends. In other words, all

profits are put back into patient care. In the intervening years, many private

companies have been involved but recently, due to the fact they see very little

profit in OOHs, they have withdrawn to a great extent and Social Enterprises

such as Mastercall now cover 60% of England and Wales. Scotland has a

system where NHS directly provides OOH care.

Until 2015, the model was based on the patient either phoning the OOHs

directly or being transferred automatically if they phoned their own GP

practice. The call would then be triaged and put through for either telephone

advice which may lead to a treatment centre visit but might be closed as

advice only or a home visit.

Since 2015, such triage has been passed over to a system called NHS 111

which is dependent on an algorithm based system called NHS Pathways

which is used by non clinical call handlers. This then directs the call in a

variety of ‘dispositions’, such as the emergency department, OOHs, GP

practices, pharmacy etc. In some areas they can book directly into computer

systems and make appointments but in view of the wide variation in

effectiveness in many areas, most OOHs have resisted this and , in many

respects, re- triage the call. The effect of NHS 111 varies but since its

inception in late 2015 we have noticed a drop in calls (but now starting to

rise) with a surge of patients being sent to the hospital emergency department,

many inappropriately.

All OOHs are commissioned by Clinical Commissioning Groups which are

GP led NHS organisations funded by the NHS. Most OOHs are on a block

contract and not case by case one which means the costs of increases in

workload and thus increases in sessional staff have to be covered by the OOH

organisations. Because of this, most have diversified into Out of Hospital care

such as practices, walk in centres, home IV antibiotic therapy services and

work with local ambulance services. This income is then used to offset the

OOH costs.

Increasingly, Hospitals are now starting to provide OOHs which are usually

co-located with their Emergency Departments.


We do have a small number of employed GPs but the vast majority are

sessional with roles in the daytime. We also extensively use Advanced Nurse

Practitioners, Emergency Nurse Practitioners and Paramedics. We are also


52

looking into using pharmacist with minor illness training to supplement the

service.

• Access X Free

• After referral by a health care professional

• Other, describe:

• Telephone triage o Yes, who:

X No, officially but in reality, yes!

• Payment professionals X Salary per hour o Fee-for-service o Other, describe:

• Payment patients X Free, explain: All patients, including foreign nationals, are entitled to ‘immediate necessary treatment’ free of charge. This is funded by taxation and a special tax called National Insurance. However, prescriptions are not free but due to exemptions for the elderly, children and welfare recipients, only 12% of patients pay for prescriptions. The devolved Scottish, Northern Irish and Welsh Governments provide free prescriptions to all citizens. o Payment, explain:


We cover 1830-0800 hours in the week and from 1830 hours on a Friday Evening to 0800 hours on a Monday morning. We also cover in hours training days for groups of practices.



Emergency care The NHS provides a full emergency ambulance service linking into

Emergency Departments in local hospitals.

Ambulance care As above.

Other We also have OOH district and palliative care nursing support with also

provision from mental and social work teams.

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