Out-of-hours primary care services: Demands and patient referral patterns in a Veneto region (Italy) Local Health Authority

- Rates of OOH access change in function of contacts socio-demographic characteristics.
- This population-based study, focusing found that not only clinical characteristics but also socio-demographic and logistic features of the contact change the propensity of OOH physician to refer patients to ED or to specialist visit.
- In addition our study demonstrate that also adjusting for all these variables the OOH physician element involved is associate with the decision to refer a patient to an ED.

PurposeThe aim of this study was to describe the characteristics of patients admitted to an out-of-hours (OOH) service and to analyze the related outputs.SettingA retrospective population-based cohort study was conducted by analyzing an electronic database recording 23,980 OOH service contacts in 2011 at a Local Health Authority in the Veneto Region (North-East Italy).MethodA multinomial logistic regression was used to compare the characteristics of contacts handled by the OOH physicians with cases referred to other services.ResultsOOH service contact rates were higher for the oldest and youngest age groups and for females rather than males. More than half of the contacts concerned patients who were seen by a OOH physician. More than one in three contacts related problems managed over the phone; only ≈10% of the patients were referred to other services. Many factors, including demographic variables, process-logistic variables and clinical characteristics of the contact, were associated with the decision to visit the patient's home (rather than provide telephone advice alone), or to refer patients to an ED or to a specialist. Our study demonstrated, even after adjusting, certain OOH physicians were more likely than their colleagues to refer a patient to an ED.ConclusionOur study shows that OOH services meet composite and variously expressed demands. The determining factors associated with cases referred to other health care services should be considered when designing clinical pathways in order to ensure a continuity of care. The unwarranted variability in OOH physicians' performance needs to be addressed.