EurOOHnet—the European research network for out-of-hours primary health care

Abstract

Background and rationale: European countries face similar challenges in the provision of health care. Demographic factors like ageing, population growth, changing patient behaviour, and lack of work force lead to increasing demands, costs, and overcrowding of out-of-hours (OOH) care (i.e. primary care services, emergency departments (EDs), and ambulance services). These developments strain services and imply safety risks. In the last few decades, countries have been re-organizing their OOH primary health care services.

Aim and scope of the network: We established a European research network for out-of-hours primary health care (EurOOHnet), which aims to transfer knowledge, share experiences, and conduct research. Combining research competencies and integrating results can generate a profound information flow to European researchers and decision makers in health policy, contributing towards feasible and high-quality OOH care. It also contributes to a more comparable performance level within European regions.

Conducted research projects: The European research network aims to conduct mutual research projects. At present, three projects have been accomplished, among others concerning the diagnostic scope in OOH primary care services and guideline adherence for diagnosis and treatment of cystitis in OOH primary care.

The future: Future areas of research will be organizational models for OOH care; appropriate use of the OOH services; quality of telephone triage; quality of medical care; patient safety issues; use of auxiliary personnel; collaboration with EDs and ambulance care; and the role of GPs in OOH care.

Keywords::

• emergency and out-of-hours care
• primary care
• quality of health care
• health services
• research network

KEY MESSAGE:

• European countries face similar challenges in the provision of out-of-hours care, which strain services and imply safety risks for patients.

• The European research network for out-of-hours primary health care (EurOOHnet) aims to transfer knowledge, share experiences, and conduct research.

• EurOOHnet accomplished several projects and identified future areas of research.

INTRODUCTION AND RATIONALE

This paper describes a newly established European research network that aims to study out-of-hours (OOH) primary health care. This is an important topic as OOH care organization has changed rapidly in the past two decades and the OOH period covers about three quarters of all hours (1). Reasons for this change include the wish of GPs to reduce the number of hours on call, the increasing patient demand when routine health care is unavailable, more part-time clinicians, and—in some countries—the shortage of GPs, especially in rural areas (2–4). European countries face high demands for medical care due to population growth, ageing, migration, and the changing patient behaviour within a 24/7 culture. The re-organization of OOH services also aims to address concerns about accessibility, quality, and safety of OOH primary care, particularly in urgent situations (4,5).

Consequently, the organization of OOH primary health care is a key topic for health professionals and policy makers in European countries (1,2). Medical outcomes and satisfaction for both patients and health care professionals are relevant issues in the debate about the most appropriate organizational models for OOH care (3–18). Access to primary care differs between and within countries; mostly, free access is possible, but several countries use telephone triage to manage patient flow and ensure the right level of medical service for each patient.

Across Europe, different organizational models for OOH primary health care exist, varying from individual general practitioners (GPs), rotation groups and health care centres, to large-scale organizations (1,2,6–8,11,13). Most models are a mixture of approaches, and some countries have up to nine different organizational models (1). In the last two decades, OOH care has evolved spectacularly, and many countries have faced similar problems. Many European countries have been—or are in the process of—shifting OOH services from local rotation groups towards large-scale primary health care organizations (1,2,6,7,11,13), as is the case in Belgium, Denmark, England, the Netherlands, and Norway (10–12).

Costs are usually much higher when patients go directly to emergency departments (EDs) in hospitals, or phone ambulance emergency numbers instead of contacting a GP (18). It has been suggested that cost containment can best be achieved if patient flows are directed to (OOH) primary health care services (4). Furthermore, appropriate use of primary care services can increase the efficiency of secondary hospital services as these can then concentrate on highly specialized care (16,17).

There are many unsolved questions regarding the organization and provision of OOH primary care, including access, organizational model, triage, quality, and safety of care. There is a need for guidance on these questions for health professionals and policy makers, based on rigorous research and practice-based experiences. Research groups in different countries can learn from each other and stimulate each other to improve their research activity, thus collecting input. A European research network linking key institutions offers a unique opportunity for knowledge transfer.

AIMS AND SCOPE

To address these issues, researchers from several European countries established a new network in 2010: EurOOHnet, the European research network for OOH primary health care (http://www.euroohnet.eu). The network aims to identify the strengths and weaknesses of organizational models across Europe and focuses on future innovations and barriers to change. Thus, the two main aims of the network are:

1. Collaborative research in OOH primary health care: share and conduct international research (using uniform protocols), discuss results, and collaborate on specific research themes.

2. Learn about different organizational models for OOH care across Europe by visiting member countries to exchange information and experiences.

STRUCTURE AND ORGANIZATON

EurOOHnet membership

Membership is at the institutional level of an academic department involved in research on OOH primary health care. At present, the following countries are represented in EurOOHnet: Belgium, Denmark, Germany, Italy, the Netherlands, Norway, Poland, Spain, Slovenia, Switzerland, and the UK.

Potential members can contact EurOOHnet directly, and proposals for membership will be presented to the board. The board members take decisions, based upon the following considerations: candidate members should be leading researchers or leading GPs involved in research on OOH primary care in their countries; and, in principle, one institution per country, will be included.

Organization

Until now, EurOOHnet has been supported by ad hoc contributions from its participants to cover time and travel expenses. At the annual conference in Antwerp in 2012, we formalized the organization and elected a board. The board consists of four members, who will be replaced two-by-two every second year at the annual conference. The board divides the tasks and has the mandate to decide about routine questions, finances, preparation of conferences, and contact with other organizations like Wonca and EGPRN. Furthermore, they are responsible for contacting the entire EurOOHnet network to inform about new developments and request feedback on important decisions.

A two-day conference is organized in one of the member countries every year. In 2010, the first conference was held in Nijmegen, followed by meetings in Bergen, Antwerp, and Heidelberg. The host institution coordinates the logistics of the conference and designs the programme. The board will give feedback on the content of the conference and presentations, to ensure optimal quality of the programme.

RESEARCH PROJECTS

The quality of OOH care is seldom studied (e.g. accessibility, safety, efficiency, and sustainability) and needs further attention in the future. In this way, EurOOHnet aims to collaborate by conducting international studies.

Procedure

Member institutions are welcome to introduce new research projects. The coordinating institution drafts a complete initial research protocol that is first reviewed by the board to ensure quality. Based on this research proposal, the institution then invites members from other countries to participate. Finally, all member countries study the protocol and make a final decision on participation. A member institution that initiates a specific research project has responsibility for coordination of the project and planned output. Projects will have a clear focus on collaboration and academic output.

EurOOHnet projects

Until now, three major projects were accomplished. The first project investigated the diagnostic scope in OOH primary care services using routine clinical data in eight countries (19). We found a highly similar diagnostic scope in OOH primary care services while the incidence of acute life-threatening health problems was low in all countries. A second project studied national guidelines for diagnosis and treatment of cystitis OOH and examined the guideline adherence of GPs. Although the guidelines content was similar in participating countries, adherence varied between regions, suggesting room for improvement, particularly in the correct prescription of the recommended type of antibiotic. Countries with a strong primary care adhere more rigorously to guidelines than other countries do. A third project provided an overview of information flow between routine care providers and OOH services. At the moment, subsequent manuscripts are under review; more information can be found on the website (http://www.euroohnet.eu). Currently, a fourth project is being conducted, focusing on the organization of telephone triage in OOH primary care organizations.

FUTURE

Network

The network continues to apply for financial support at European level for the basic organization and new international research projects. The position of EurOOHnet will be evaluated yearly, and future collaboration with other internationally oriented research groups related to primary health care will be considered.

Future research topics

Future topics for discussion and research include studies on organizational models; appropriate use of the OOH services; quality of telephone triage; quality of medical care; patient safety issues; use of auxiliary personnel; equity of care; collaboration with EDs and ambulance care; and the role of GPs in OOH care.

In addition, evaluation of large-scale OOH primary care services and collaboration with ED is necessary to ensure high-quality care. Instruments to assess quality and safety of collaboration between health care professionals could be used in different OOH care settings to map bottlenecks and give recommendations for improvement.

Debate on policy

Countries face similar challenges concerning the organization of OOH primary health care, but the solutions chosen vary (1). The high number of OOH contacts puts strain on the health care system. This is especially important because budgets for health care are under constraint. Gate keeping by GPs during OOH is one of the strategies to preserve continuity of care for patients and reduce costs. Therefore, focusing interventions on the redirection of patients towards day time primary care is vital. Moreover, the role of triage and use of nurse practitioners in OOH primary care services and collaboration with EDs need evaluation in the European context. Issues to consider are what policies work best in a given context, and what can countries learn from each other. This may speed up the process of defining the problems and to find solutions from the viewpoint of policy makers.

CONCLUSION

A European research network has been established to address issues on the organization and quality of OOH primary health care, by collaborative research and sharing experiences. So far, several projects have been conducted, and areas of interest have been discussed. Potential members, performing research in primary care and acute care, are encouraged to contact EurOOHnet, to enlarge the scope of the network.

ACKNOWLEDGEMENTS

The authors thank all members of EurOOHnet for their input and participation in the network.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.