Do callers to out-of-hours care misuse an option to jump the phone queue?

Figures & data

Figure 1. Flow diagram of included subjects (based on CONSORT guidelines). EAB: emergency action button; GPC: general practice cooperative (Central Denmark Region); MH-1813: medical helpline 1813 (Capital Region of Denmark).

Table 1. Distribution of sex, age group, and waiting time in the study population 2017, N = 6554.

Setting	GPC			MH-1813
Subgroups	EAB not offered	EAB offered not used	EAB used	EAB not offered	EAB offered not used	EAB used
Subgrou	(n = 1278)	(n = 1114)	(n = 828)	(n = 1117)	(n = 1095)	(n = 1122)
Characteristics
Sex (%)
Male	45.85	44.88	46.98	42.79	43.84	51.25
Female	54.15	55.12	53.02	57.21	56.16	48.75
Age group, years (%)
0–4	15.41	16.61	9.42	19.07	17.90	15.95
5–13	7.82	8.35	4.95	12.26	12.60	6.60
14–17	3.52	5.30	3.62	5.28	4.66	3.65
18–40	31.77	34.56	27.29	30.08	35.8	26.02
41–60	18.31	18.49	19.69	17.99	15.71	19.88
61–75	12.83	8.98	19.08	9.04	8.49	14.53
≥76	10.33	7.72	15.94	6.27	4.84	13.37
Waiting time, seconds
Actual, median	75	73	25	137	173	46
IQI: p25-p75	12;223	11;217	11;59	10;390	12;442	34;66
Estimated, median	–	–	–	120	120	360
IQI: p25-p75	–	–	–	0;300	0;360	180;660

No significant differences were seen in the distribution of sex in the GPC for the three groups. In MH-1813, the distribution of sex in the “EAB used” subgroup was significantly different from the other two groups (p < 0.001) when using the chi-squared test.

The distribution of age groups was significantly different between all groups and settings when comparing individually using the chi-squared test, except between the “EAB not offered” and “EAB offered not used” groups in the MH-1813 (p = 0.094).

EAB: emergency action button; GPC: general practice cooperative (Central Denmark Region); MH-1813: medical helpline 1813 (Capital Region of Denmark); IQI: interquartile range.

Table 2. Severity of contacts for adults and children aged <18 years as assessed by triage professionals 2017, N = 6554 (%).

		EAB not offered		EAB offered not used		EAB used		EAB offered (corrected)
Setting	Group	Adult	Child	Adult	Child	Adult	Child	Adult	Child
GPC		n = 936	n = 342	n = 777	n = 337	n = 679	n = 149
	Severe, potentially life threatening	3.7	n < 5	3.3	n < 5	17.7	9.4	3.7	0.7
	Severe, not life threatening	17.3	12.0	13.9	11.3	26.1	30.9	14.2	11.5
	Not severe but illness	56.6	68.4	59.2	65.3	44.0	50.3	58.8	65.2
	Not severe	19.1	15.8	22.0	20.8	9.1	8.1	21.7	20.5
	Don't know	3.2	3.5	1.5	2.1	3.1	n < 5	1.6	2.1
MH-1813		n = 708	n = 409	n = 710	n = 385	n = 828	n = 294
	Severe, potentially life threatening	7.1	3.4	6.5	2.6	19.3	6.1	6.9	2.7
	Severe, not life threatening	17.8	12.2	14.5	10.9	24.5	18.0	14.8	11.1
	Not severe but illness	28.1	37.7	35.1	36.9	25.0	34.0	34.8	36.8
	Not severe	42.4	44.3	39.9	47.0	27.3	38.8	39.5	46.8
	Don't know	4.7	2.4	4.1	2.6	3.9	3.1	4.1	2.6
Combined		n = 1644	n = 751	n = 1487	n = 722	n = 1507	n = 443
	Severe, potentially life threatening	5.2	n < 19	4.8	n < 15	18.5	7.2	5.2	1.8
	Severe, not life threatening	17.5	12.1	14.2	11.1	25.1	22.3	14.5	11.3
	Not severe but illness	44.3	51.7	47.7	50.1	33.5	39.5	47.3	50.0
	Not severe	29.1	31.3	30.5	34.8	19.4	28.4	30.2	34.6
	Don't know	3.8	2.9	2.8	2.4	3.5	n < 14	2.8	2.4

Results with less than five cases are not reported due to data protection regulations by the Danish Data Protection Agency. These cases are instead labelled “n < 5”. In the “combined” section, this is also the case as a percentage would give away results labelled n < 5.

EAB not offered vs. EAB offered not used: Adults: GPC p = 0.036; MH-1813: p = 0.066; Combined: p = 0.030. Children: GPC p = 0.377; MH-1813: p = 0.890; Combined: p = 0.637. Analysed using the Pearson chi squared test for differences in distribution of answers.

EAB not offered vs. EAB offered (corrected): Adults: GPC p = 0.036; MH-1813: p = 0.099; Combined: p = 0.0501. Children: GPC p = 0.348; MH-1813: p = 0.910; Combined: p = 0.699. Analysed using the using the Pearson chi squared test with a Rao Scott second order correction. To account for the fact that we only had information on a random sample (approximately 3%) from the” EAB offered not used”-group we applied a sampling weight of approximately 33 in that group when we calculated the test-statistic.

All distributions in the “EAB used” group are significantly different from the “EAB offered not used” and “EAB not offered” groups (p < 0.001), except from the “EAB not offered” group for children in MH-1813 (p = 0.067).

EAB: emergency action button; GPC: general practice cooperative (Central Denmark Region); MH-1813: medical helpline 1813 (Capital Region of Denmark).

Table 3. Relevance of choice to use the EAB for adults and children aged <18 years as assessed by triage professionals 2017, N = 1950 (%).

		GPC		MH-1813		Combined
	Setting	Adults	Children	Adults	Children	Adults	Children	P-value
		n = 679	n = 149	n = 828	n = 294	n = 1507	n = 443	Adults	Children
Strictly medical (%)								0.01	0.05
	Very relevant	19.4	12.8	20.3	9.2	19.9	10.4
	Relevant	17.4	18.1	20.3	15.0	19.0	16.1
	Less relevant	27.2	32.9	20.8	24.2	23.7	27.1
	Not relevant	34.5	35.6	35.3	50.2	34.9	45.2
	Don't know	1.5	<5 (.)	3.3	<5 (.)	2.5	<10 (.)
Overall perspective (%)								0.00	0.02
	Very relevant	23.9	18.8	26.7	14.4	25.4	15.9
	Relevant	34.3	36.9	27.1	26.1	30.3	29.8
	Less relevant	21.8	20.8	16.9	22.7	19.1	22.0
	Not relevant	17.7	22.8	24.8	33.0	21.6	29.5
	Don't know	2.4	<5 (.)	4.6	3.8	3.6	<16 (.)

Results with less than five cases are not reported due to data protection regulations by the Danish Data Protection Agency. These cases are instead labelled “n < 5”. P-values in the table refer to the chi-square test for the same age group (adults GPC vs. adults MH-1813, children GPC vs. children MH-1813) in each setting.

Adults are compared to children within settings with chi-square test for medical relevance: adults vs children at GPC: p = 0.283, adults vs children at MH-1813: p < 0.001. Adults are compared to children in both settings with chi-square test for relevance seen from an overall perspective: adults vs children at GPC p = 0.278, adults vs children at MH18-13 p < 0.001.

EAB: emergency action button; GPC: general practice cooperative (Central Denmark Region); MH-1813: medical helpline 1813 (Capital Region of Denmark).

Table 4. Number of suspected AMI in patients aged >40 years and total ambulance dispatches in the GPC and MH-1813 based on questionnaire responses from triage professionals 2017, N = 6554.

	No option	EAB option but not use	EAB use	EAB offered (corrected)^b	Total	p Value^a	Missings / N (Pct)
OOH-PC
AMI >40 years, n (%)	530 (38.5)	392 (28.5)	453 (32.9)		1375 (100.0)
No, n (%)	521 (98.3)	379 (96.7)	406 (89.6)	(96.4)	1306 (95.0)
Yes, n (%)	9 (1.7)	13 (3.3)	47 (10.4)	(3.6)	69 (5.0)	0.00	0 / 1375 (0.00)
Ambulance, n	1278 (39.7)	1114 (34.6)	828 (25.7)		3220 (100)
No, n (%)	1243 (97.3)	1091 (97.9)	726 (87.7)	(97.7)	3060 (95.0)
Yes, n (%)	35 (2.7)	23 (2.1)	102 (12.3)	(2.3)	160 (5.0)	0.00	0 / 3220 (0.00)
MH-1813
AMI >40 years, n (%)	372 (30.3)	318 (25.9)	536 (43.7)		1226 (100.0)
No, n (%)	345 (95.3)	290 (93.9)	472 (93.3)	(93.8)	1107 (94.1)
Yes, n (%)	17 (4.7)	19 (6.1)	34 (6.7)	(6.2)	70 (5.9)	0.46	49 / 1226 (4.00)
Ambulance, n (%))	1117 (33.5)	1095 (32.8)	1122 (33.7)		3334 (100.0)
No, n (%)	1070 (95.8)	1045 (95.4)	961 (85.7)	(95.2)	3076 (92.3)
Yes, n (%)	47 (4.2)	50 (4.6)	161 (14.3)	(4.8)	258 (7.7)	0.00	0 / 3334 (0.00)

Table lists total number of suspected AMIs in patients over 40 years where an ambulance was dispatched and total number of ambulances dispatched in each group. Number of suspected AMIs is based upon questionnaire information from triage professionals.

^aThe Chi Squared test test was used.

^bThe test for homogeneity between the intervention groups “EAB offered (corrected)” and “EAB not offered”, were calculated using the Pearson Chi Squared test with a Rao Scott second order correction. To account for the fact that we only had information on a random sample (approximately 3%) from the” EAB offered not used” group we applied a sampling weight of approximately 33 in that group when we calculated the test-statistic.

AMI: acute myorcardial infarction; EAB: emergency action button; GPC: general practice cooperative (Central Denmark Region); MH-1813: medical helpline 1813 (Capital Region of Denmark).

Data sharing

The EU regulations on the protection of personal data implies that the authors are not authorised to share non-aggregated data with a third party. However, data are available from Jonas F Ebert on reasonable request.