Effects of access to radiology in out-of-hours primary care on patient satisfaction and length of stay

Figures & data

Table 1. Models of access of GP cooperatives to radiology in The Netherlands, study period and background information.

Access to Radiology		Study period	Background information
None	A	April–July 2014	Located in the eastern part of The Netherlands. No access to conventional radiology by the GP cooperative. Referral to the ED necessary.
	B	October–December 2014	Located in the south-eastern part of The Netherlands. No access to conventional radiology by the GP cooperative. Referral to the ED necessary.
Limited	C	December 2014–April 2015	Located in the south-west of The Netherlands. GP cooperative access to conventional radiology during weekends and public holidays only, possibilities between 11 and 12 a.m. and 5 and 6 p.m. Analysis by hospital radiologist. Outside these hours referral to the ED for conventional radiology is necessary.
	D	May–June 2015	Located in the west of The Netherlands. GP cooperative access to conventional radiology on weekdays between 5 and 8 p.m. and during weekends and public holidays between 10 a.m. and 8 p.m. Analysis by hospital radiologist. Outside these hours referral to the ED for conventional radiology is necessary.
	A′	June–September 2015	Located in the eastern part of The Netherlands. GP cooperative access to conventional radiology on weekdays and during weekends and public holidays, with nightly exclusion. Analysis by a radiologist in an associated hospital elsewhere. Outside these hours referral to the ED for conventional radiology is necessary.
Unlimited	E	July–October 2015	Located in eastern part of The Netherlands. Unlimited access by the GP cooperative during their opening hours. Analysis by the hospital radiologist.

Note: A and A′ are the same organisation.

Figure 1. Patient flow chart per organisational model for general practitioner cooperative access to radiology: no access, limited access (in restricted time frames) and unlimited access (all opening hours). (A) Appointment time of the patient at the GPC (start point). (B) Issue of questionnaire and informed consent form to the patient. (C) Return of questionnaire and informed consent form (endpoint).

Table 2. Patient characteristics per organisational model with respect to access to radiology by the GP cooperative.

Characteristic	No access N = 232	Limited access N = 307	Unlimited access N = 118	Total N = 657
Age mean (SD)	31.3 (22.9)	30.6 (22.2)	33.4 (20.6)	31.3 (22.2)
Gender female N (%)	134 (58.3)	170 (55.4)	59 (50.4)	363 (55.5)
Affected body part N (%)
Wrist*	58 (25.2)	63 (20.7)	16 (13.6)	137 (21.0)
Foot/toes***	23 (10.0)	74 (24.3)	35 (29.7)	132 (20.2)
Hand/fingers	41 (17.8)	60 (19.7)	26 (22.0)	127 (19.4)
Ankle	44 (19.1)	34 (11.1)	17 (14.4)	95 (14.5)
Elbow/lower arm	22 (9.6)	23 (7.5)	8 (6.8)	53 (8.1)
Shoulder/clavicle	15 (6.5)	19 (6.2)	9 (7.6)	43 (6.6)
Knee/lower leg	17 (7.4)	17 (5.6)	2 (1.7)	36 (5.5)
Other	10 (4.3)	15 (4.9)	5 (4.2)	30 (4.6)
Radiological abnormality** N (%)	116 (51.3)	106 (34.5)	41 (34.7)	263 (40.4)
Referral to ED*** N (%)	226 (100)	118 (38.4)	47 (39.8)	391 (60.0)

*P < 0.05; **P < 0.01; ***P < 0.001.

Table 3. Length of stay (in minutes) and patient experiences within the different organisational models with respect to access to radiology by the GP cooperative.

Outcome	No access	Limited access	Unlimited access	Total
Length of stay
All patients*** ^a	N = 191	N = 259	N = 104	N = 651
Mean (95%CI)	121 (114–128)	86 (80–92)	90 (79–102)	99 (95–103)
Range	32–300	15–245	17–270	15–300
Patients without radiological abnormality*** ^a	N = 103	N = 170	N = 66	N = 339
Mean (95%CI)	112 (103–121)	70 (64–75)	63 (54–73)	81 (77–86)
Range	32–270	15–235	17–205	15–270
Patients with radiological abnormality	N = 88	N = 89	N = 38	N = 215
Mean (95%CI)	132 (121–143)	117 (107–127)	137 (118–157)	127 (120–134)
Range	40–300	30–245	37–270	30–300
Length of stay perceived as a problem	N = 232	N = 307	N = 118	N = 657
All patients N (%)	113 (52.6)	121 (43.1)	57 (51.4)	291 (47.9)
Patients without radiological abnormality N (%)	55 (51.9)	69 (38.1)	33 (45.8)	157 (43.7)
Patients with radiological abnormality N (%)	58 (53.2)	52 (52.0)	24 (61.5)	134 (54.0)
Informed about expected length of stay N (%)	75 (34.9)	105 (37.8)	31 (28.2)	211 (35.0)
Experiences with GPC professional
Taken seriously N (%)	230 (100)	285 (96.4)	113 (98.2)	651 (98.0)
Confidence in expertise N (%)	226 (99.2)	298 (97.7)	115 (100)	650 (98.6)
Sufficient time N (%)	226 (99.2)	299 (97.7)	115 (100)	649 (98.6)
Experiences with ED professional
Taken seriously N (%)	209 (89.6)	96 (97.0)	35 (100)	346 (98.3)
Confidence in expertise N (%)	210 (99.1)	96 (97.9)	35 (100)	345 (98.8)
Sufficient time N (%)	202 (95.8)	93 (93.9)	34 (97.1)	345 (95.4)
Grade GPC*^b
Mean (95%CI)	8.36 (8.22–8.50)	8.39 (8.27–8.50)	8.62 (8.43–8.81)	8.42 (8.34–8.50)
Range	5–10	3–10	6–10	3–10
Grade ED
Mean (95%CI)	8.07 (7.91–8.24)	8.22 (7.94–8.49)	8.03 (7.55–8.51)	8.11 (7.97–8.24)
Range	3–10	0–10	2–10	0–10
Grade cooperation GPC–ED
Mean (95%CI)	7.7 (7.37–8.03)	8.02 (7.74–8.30)	8.07 (7.68–8.46)	7.91 (7.72–8.10)
Range	0–10	0–10	5–10	0–10

*P < 0.05; **P < 0.01; ***P < 0.001.

^aSignificant difference between model without access and models with (un)limited access.

^bSignificant difference between model without access and model with unlimited access.

GPC: general practitioner cooperative; Rx: conventional radiology; ED: emergency department; LOS: length of stay.