The 30-day prognosis of chronic-disease patients after contact with the out-of-hours service in primary healthcare

Abstract

Objective. Little is known about the prognosis of patients with chronic disease who contact the out-of-hours (OOH) service in primary care. The characteristics of contacts with the Danish out-of-hours service and daytime general practice, hospitalization, and death were studied during a 30-day follow-up period in patients with chronic heart diseases. Design. Cohort study. Setting and subjects. The study was based on data from 11 897 adults aged 18 + years from a Danish survey of OOH contacts, including information on consultation type. Reason for encounter (RFE) was categorized by OOH GPs at triage as either “exacerbation” or “new health problem”. Registry data were used to identify eligible patients, and the cohort was followed for 30 days after OOH contact through nationwide registries on healthcare use and mortality. Main outcome measures. The 30-day prognosis of chronic-disease patients after OOH contact. Results. Included patients with chronic disease had a higher risk of new OOH contact, daytime GP contact, and hospitalization than other patients during the 30-day follow-up period. OOH use was particularly high among patients with severe mental illness. A strong association was seen between chronic disease and risk of dying during follow-up. Conclusion. Patients with chronic disease used both daytime general practice and the out-of-hours service more often than others during the 30-day follow-up period; they were more often hospitalized and had higher risk of dying. The findings call for a proactive approach to future preventive day care and closer follow-up of this group, especially patients with psychiatric disease.

Key Words::

• Chronic disease
• Denmark
• general practice
• OOH
• out-of-hours service
• primary healthcare
• reasons for encounter

Ethical approval

The project was approved by the Danish Data Protection Agency (J.no. 2011-41-6365). No ethical concerns with the study were identified. According to Danish national regulations, the study did not require approval from the Committee on Health Research Ethics of the Central Denmark Region as data included only non-identifiable personal information and no biomedical intervention was performed.

Acknowledgements

The authors would like to thank the OOH GPs from the Central Denmark Region for their participation.

Source of funding

The project was funded by the Danish National Research Foundation for Primary Care and the Health Foundation. Mogens Vestergaard is supported by an unrestricted grant from the Lundbeck Foundation.

Declaration of interest

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