Development and evaluation of an "emergency access button" in Danish out-of-hours primary care: a study protocol of a randomized controlled trial

J F Ebert, L Huibers, F K Lippert, B Christensen, M B Christensen, J F Ebert, L Huibers, F K Lippert, B Christensen, M B Christensen

Abstract

Background: Out-of-hours (OOH) health care for acute medical problems is often challenged by long waiting time for callers in need of advice and triage. Allowing patients to bypass the OOH telephone waiting line may increase patient satisfaction and provide them with a feeling of safety. We aimed to develop an "emergency access button" enabling patients to bypass the normal telephone waiting line in out-of-hours primary care (OOH-PC) if they perceive their condition to be critical and to evaluate the effect of introducing the button in terms of patient satisfaction and their feeling of safety.

Methods: All patients calling the OOH-PC in two different Danish health care regions during three months will be included in this randomized controlled trial. Data will be collected through two questionnaires developed for this study: a pop-up questionnaire on the relevance of bypassing the normal waiting line to be completed by triage professionals after patient contact and a paper/electronic questionnaire on perceived safety and satisfaction with the emergency access button to be completed by the callers. These questionnaires were developed and validated using external and internal expert feedback, focus group interviews and a two-week field test. The study will be conducted over three months with an estimated user-rate of the emergency access button of 3%.

Discussion: We have developed an emergency access button and we now want to investigate whether this new option will influence upon the level of satisfaction and the feeling of safety in the calling patients. Additionally, the study will reveal the assessed relevance of the decision to bypass the line by triage professionals.

Trial registration: Registered as NCT02572115 at Clinicaltrials.gov on October 5th 2015.

Keywords: Accessibility; After hours; Denmark; Health services; Primary care; Triage.

Figures

Fig. 1
Fig. 1
Flowchart of intervention
Fig. 2
Fig. 2
Flowchart of power calculation

References

    1. Huibers L, Giesen P, Wensing M, Grol R. Out-of-hours care in western countries: assessment of different organizational models. BMC Health Serv Res. 2009; doi:10.1186/1472-6963-9-105 [doi].
    1. Christensen MB, Olesen F. Out of hours service in Denmark: evaluation five years after reform. BMJ. 1998;316(7143):1502–1505. doi: 10.1136/bmj.316.7143.1502.
    1. Huibers L, Thijssen W, Koetsenruijter J, Giesen P, Grol R, Wensing M. GP cooperative and emergency department: an exploration of patient flows. J Eval Clin Pract. 2013; doi:10.1111/j.1365-2753.2011.01806.x [doi].
    1. Murphy AW. 'Inappropriate' attenders at accident and emergency departments I: definition, incidence and reasons for attendance. Fam Pract. 1998;15(1):23–32. doi: 10.1093/fampra/15.1.23.
    1. Olshaker JS. Managing emergency department overcrowding. Emerg Med Clin North Am. 2009; doi:10.1016/j.emc.2009.07.004 [doi].
    1. Derlet RW, Richards JR. Overcrowding in the nation's emergency departments: complex causes and disturbing effects. Ann Emerg Med. 2000;35(1):63–8. doi: 10.1016/S0196-0644(00)70105-3.
    1. Moth G, Flarup L, Christensen MB, Olesen F, Vedsted P. [Survey on reasons for encounters and disease patterns in OOH primary care LV-KOS 2011] Kontakt- og sygdomsmønsteret i lægevagten LV-KOS 2011. . 2012.
    1. Hugenholtz M, Broer C, van Daalen R. Apprehensive parents: a qualitative study of parents seeking immediate primary care for their children. Br J Gen Pract. 2009; doi:10.3399/bjgp09X394996 [doi].
    1. Kallestrup P, Bro F. Parents' beliefs and expectations when presenting with a febrile child at an out-of-hours general practice clinic. Br J Gen Pract. 2003;53(486):43–44.
    1. Keizer E, Smits M, Peters Y, Huibers L, Giesen P, Wensing M. Contacts with out-of-hours primary care for nonurgent problems: patients' beliefs or deficiencies in healthcare? BMC Fam Pract. 2015; doi:10.1186/s12875-015-0376-9 [doi].
    1. Poole R, Gamper A, Porter A, Egbunike J, Edwards A. Exploring patients' self-reported experiences of out-of-hours primary care and their suggestions for improvement: a qualitative study. Fam Pract. 2011; doi:10.1093/fampra/cmq090 [doi].
    1. Kelly M, Egbunike JN, Kinnersley P, Hood K, Owen-Jones E, Button LA, Shaw C, Porter A, Snooks H, Bowden S, Edwards A. Delays in response and triage times reduce patient satisfaction and enablement after using out-of-hours services. Fam Pract. 2010; doi:10.1093/fampra/cmq057 [doi].
    1. Campbell J, Roland M, Richards S, Dickens A, Greco M, Bower P. Users' reports and evaluations of out-of-hours health care and the UK national quality requirements: a cross sectional study. Br J Gen Pract. 2009; doi:10.3399/bjgp09X394815 [doi].
    1. Chan AW, Tetzlaff JM, Altman DG, Laupacis A, Gotzsche PC, Krleza-Jeric K, Hrobjartsson A, Mann H, Dickersin K, Berlin JA, Dore CJ, Parulekar WR, Summerskill WS, Groves T, Schulz KF, Sox HC, Rockhold FW, Rennie D, Moher D. SPIRIT 2013 statement: defining standard protocol items for clinical trials. Ann Intern Med. 2013; doi:10.7326/0003-4819-158-3-201302050-00583 [doi].
    1. Flarup L, Moth G, Christensen MB, Vestergaard M, Olesen F, Vedsted P. A feasible method to study the Danish out-of-hours primary care service. Dan Med J. 2014;61(5):A4847.
    1. Ware JE, Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992;30(6):473–83. doi: 10.1097/00005650-199206000-00002.
    1. Kroenke K, Spitzer RL, Williams JB, Monahan PO, Lowe B. Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Ann Intern Med. 2007;146(5):317–25. doi: 10.7326/0003-4819-146-5-200703060-00004.
    1. Statistics Denmark. . Accessed April/19 2016.
    1. Hohwu L, Lyshol H, Gissler M, Jonsson SH, Petzold M, Obel C. Web-based versus traditional paper questionnaires: a mixed-mode survey with a Nordic perspective. J Med Internet Res. 2013; doi:10.2196/jmir.2595 [doi].

Source: PubMed

3
订阅