OOH: demands, referral patterns, frequent attenders characteristics in a Veneto Region (Italy) LHA

Introduction\r\nThe aim of this study was to describe the characteristics of\r\npatients admitted to an Out-of-Hours service (OoHs), the\r\nrelated outputs and to analyse deeply the frequent attenders\r\n(FAs)’s phenomena.\r\nMethods\r\nThis study was a retrospective cohort study on electronic\r\npopulation-based records, linked with the mortality registry\r\nand with patients’ exemption from health care charges. A FA\r\nwas defined as a patient with 3 contacts in 12 months. A\r\nlogistic regression model was constructed to identify independent\r\nvariables associated with this outcome.\r\nResults\r\n23,980 OoHs contacts (CTCs) in 2011 at a Local Health\r\nAuthority in the Veneto Region were registered. Rates were\r\nhigher for the oldest and youngest age groups and for females.\r\nMore than half of CTCs concerned patients who were seen by a\r\nphysician, about 1/3 of CTCs related problems managed by\r\nphone, about 10% of CTCs were referred to other services.\r\nMany factors, including demographic, process-logistic and\r\nclinical variables were associated with the decision to visit the\r\npatient (rather than provide a phone advice), or to refer\r\npatients to ED or to a specialist. Some OOH doctors were\r\nmore likely than their colleagues to refer a patient to ED. FA\r\nstatus was associated with clinical variables (such as psychiatric\r\ndisease), socio-demographic variables (sex, age and income\r\nlevel), and also with the feature of their GPs’ association.\r\nConclusion\r\nOur study shows that OoHs meet composite and variously\r\nexpressed demands. The determining factors associated with\r\ncases referred to other health care services should be\r\nconsidered when designing clinical pathways in order to\r\nensure a continuity of care. The unwarranted variability in\r\nOOH physicians’ performance needs to be addressed. The\r\ndeterminants of OoHs FA include patients’ clinical conditions,\r\nseveral socio-economic characteristics (including income level)\r\nand their GPs’ organizational format.\r\nKey message\r\n This is the first study found that also socio-demographic\r\nand logistic features of the contact change the propensity\r\nof OOH physician to refer patients to ED or to specialist\r\nvisit.