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Article ; Online: Point-of-care testing and antibiotics prescribing in out-of-hours general practice: a register-based study in Denmark.

Christensen, Line Due / Vestergaard, Claus Høstrup / Keizer, Ellen / Bech, Bodil Hammer / Bro, Flemming / Christensen, Morten Bondo / Huibers, Linda

BMC primary care

2024 Volume 25, Issue 1, Page(s) 31

Abstract: Background: Point-of-care testing may reduce diagnostic uncertainty in case of suspicion of bacterial infection, thereby contributing to prudent antibiotic prescribing. We aimed to study variations in the use of point-of-care tests (C-reactive protein ... ...

Abstract	Background: Point-of-care testing may reduce diagnostic uncertainty in case of suspicion of bacterial infection, thereby contributing to prudent antibiotic prescribing. We aimed to study variations in the use of point-of-care tests (C-reactive protein test, rapid streptococcal antigen detection test, and urine dipstick) among general practitioners (GPs) and the potential association between point-of-care testing and antibiotic prescribing in out-of-hours general practice. Methods: We conducted a population-based observational register-based study, based on patient contacts with out-of-hours general practice in the Central Denmark Region in 2014-2017. The tendency of GPs to use point-of-care testing was calculated, and the association between the use of point-of-care testing and antibiotic prescribing was evaluated with the use of binomial regression. Results: Out-of-hours general practice conducted 794,220 clinic consultations from 2014 to 2017, of which 16.1% resulted in an antibiotic prescription. The GP variation in the use of point-of-care testing was largest for C-reactive protein tests, with an observed variation (p90/p10 ratio) of 3.0; this means that the GPs in the 90th percentile used C-reactive protein tests three times as often as the GPs in the 10th percentile. The observed variation was 2.1 for rapid streptococcal antigen detection tests and 1.9 for urine dipsticks. The GPs who tended to use more point-of-care tests prescribed significantly more antibiotics than the GPs who tended to use fewer point-of-care tests. The GPs in the upper quintile of the tendency to use C-reactive protein test prescribed 22% more antibiotics than the GPs in the lowest quintile (21% for rapid streptococcal antigen detection tests and 8% for urine dipsticks). Up through the quintiles, this effect exhibited a positive linear dose-response correlation. Conclusion: The GPs varied in use of point-of-care testing. The GPs who tended to perform more point-of-care testing prescribed more antibiotics compared with the GPs who tended to perform fewer of these tests.
MeSH term(s)	Humans ; C-Reactive Protein ; General Practice ; Anti-Bacterial Agents ; Point-of-Care Testing ; After-Hours Care ; Denmark
Chemical Substances	C-Reactive Protein (9007-41-4) ; Anti-Bacterial Agents
Language	English
Publishing date	2024-01-23
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	2731-4553
ISSN (online)	2731-4553
DOI	10.1186/s12875-024-02264-0
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Use of acute care services by adults with a migrant background: a secondary analysis of a EurOOHnet survey.

Keizer, Ellen / Senn, Oliver / Christensen, Morten Bondo / Huibers, Linda

BMC family practice

2021 Volume 22, Issue 1, Page(s) 119

Abstract: Background: High demands create pressure on acute care services, such as emergency medical services (EMS), emergency departments (ED) and out-of-hours primary care (OOH-PC) services. A variety of patient- and organisational factors have been discussed ... ...

Abstract	Background: High demands create pressure on acute care services, such as emergency medical services (EMS), emergency departments (ED) and out-of-hours primary care (OOH-PC) services. A variety of patient- and organisational factors have been discussed as reasons why especially non-western migrants more frequently contact an ED or OOH-PC service than native born. We aim to investigate whether persons with a non-western and western migrant background more often contact an acute care service than native born and how this relates to the number of contacts with their general practitioners (GPs). In addition, we aim to explore how possible differences in acute care use by migrants can be explained. Methods: We performed secondary analysis of data collected for the EurOOHnet survey on OOH help-seeking behaviour in Denmark, the Netherlands and Switzerland. Differences in self-reported acute care use (sum of number of contacts with OOH-PC, the ED and 1-1-2/1-4-4) between non-western and western migrants and native born were tested with a quasi Poisson regression analysis. Mediation analyses were performed to examine the impact of factors related to help-seeking on the relation between self-reported acute care use and migrant background. Results: Non-western migrants had more acute care contacts than native born (adjusted IRR 1.74, 95% CI 1.33-2.25), whereas no differences were found between western migrants and native born. Migrants who regularly contacted OOH-PC or the ED also regularly contacted their GP. Mediation analyses showed that the factors employment, anxiety, attitude towards use of OOH-PC and problems in accessing the own GP could partly explain the higher acute care use of non-western migrants. Conclusion: The higher use of acute care services by non-western migrants compared with native born could partly be explained by feeling fewer barriers to contact these services, feeling more anxiety, more unemployment and problems making an appointment with the GP. Increasing awareness and improving GP access could help migrants in navigating the healthcare system.
MeSH term(s)	Adult ; After-Hours Care ; Europe ; General Practitioners ; Humans ; Primary Health Care ; Surveys and Questionnaires ; Transients and Migrants
Language	English
Publishing date	2021-06-21
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2041495-X
ISSN	1471-2296 ; 1471-2296
ISSN (online)	1471-2296
ISSN	1471-2296
DOI	10.1186/s12875-021-01460-6
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Article ; Online: Variation of GP antibiotic prescribing tendency for contacts with out-of-hours primary care in Denmark - a cross-sectional register-based study.

Huibers, Linda / Vestergaard, Claus Høstrup / Keizer, Ellen / Bech, Bodil Hammer / Bro, Flemming / Christensen, Morten Bondo

Scandinavian journal of primary health care

2022 Volume 40, Issue 2, Page(s) 227–236

Abstract: Objective: To study variation in antibiotic prescribing rates among general practitioners (GP) in out-of-hours (OOH) primary care and to explore GP characteristics associated with these rates.: Design: Population-based observational registry study ... ...

Abstract	Objective: To study variation in antibiotic prescribing rates among general practitioners (GP) in out-of-hours (OOH) primary care and to explore GP characteristics associated with these rates. Design: Population-based observational registry study using routine data from the OOH primary care registration system on patient contacts and antibiotic prescriptions combined with national register data. Setting: OOH primary care of the Central Denmark Region. Subjects: All patient contacts in 2014-2017. Main outcome measures: GPs' tendency to prescribe antibiotics. Excess variation (not attributable to chance). Results: We included 794,220 clinic consultations (16.1% with antibiotics prescription), 281,141 home visits (11.6% antibiotics), and 1,583,919 telephone consultations (5.8% antibiotics). The excess variation in the tendency to prescribe antibiotics was 1.56 for clinic consultations, 1.64 for telephone consultations, and 1.58 for home visits. Some GP characteristics were significantly correlated with a higher tendency to prescribe antibiotics, including 'activity level' (i.e. number of patients seen in the past hour) for clinic and telephone consultations, 'familiarity with OOH care' (i.e. number of OOH shifts in the past 180 days), male sex, and younger age for home visits. Overall, GP characteristics explained little of the antibiotic prescribing variation seen among GPs (Pseudo Conclusion: Some variation in the GPs' tendency to prescribe antibiotics was found for OOH primary care contacts. Available GP characteristics, such as GPs' activity level and familiarity with OOH care, explained only small parts of this variation. Future research should focus on identifying factors that can explain this variation, as this knowledge could be used for designing interventions.KEY POINTSCurrent awareness:Antibiotic prescribing rates seem to be higher in out-of-hours than in daytime primary care.Most important results:Antibiotic prescribing rates varied significantly among general practitioners after adjustment for contact- and patient-characteristics.This variation remained even after accounting for variation attributable to chance.General practitioners' activity level and familiarity with out-of-hours care were positively associated with their tendency to prescribe antibiotics.
MeSH term(s)	After-Hours Care ; Anti-Bacterial Agents/therapeutic use ; Cross-Sectional Studies ; Denmark ; General Practitioners ; Humans ; Male ; Practice Patterns, Physicians' ; Primary Health Care
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2022-06-15
Publishing country	United States
Document type	Journal Article
ZDB-ID	605763-9
ISSN	1502-7724 ; 0281-3432 ; 0284-6020
ISSN (online)	1502-7724
ISSN	0281-3432 ; 0284-6020
DOI	10.1080/02813432.2022.2073981
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Article ; Online: Indications and associated factors for prescribing intravenous iron supplementation in Swiss general practice: a retrospective observational study.

Meier, Rahel / Keizer, Ellen / Rosemann, Thomas / Markun, Stefan

Swiss medical weekly

2019 Volume 149, Page(s) w20127

Abstract: Background: Intravenous iron supplementation (IVIS) is increasing in Swiss general practice. This is controversial because of higher costs and risks compared with oral iron supplementation (OIS). In this study, we aimed to investigate indications for ... ...

Abstract	Background: Intravenous iron supplementation (IVIS) is increasing in Swiss general practice. This is controversial because of higher costs and risks compared with oral iron supplementation (OIS). In this study, we aimed to investigate indications for OIS and IVIS in Swiss general practice and test which factors are associated with prescribing IVIS instead of OIS. Methods: This was a retrospective observational study using data from electronic medical records of 279 Swiss general practitioners (GPs), including all their patients at their first OIS and IVIS administration who were at least 14 years old and with available pretreatment serum ferritin and haemoglobin measurements. We also collected data about the following comorbidities: chronic kidney disease (CKD) stage 3b or higher, inflammatory bowel disease (IBD), chronic heart failure and restless legs syndrome. Outcomes were proportions of cases treated with IVIS or OIS by assumed indication (anaemic or non-anaemic iron deficiency [NAID]) or the abovementioned comorbidities. We evaluated associations with IVIS prescription using regression models adjusting for patient and GP variables. Results: We assessed 1282 IVIS and 3003 OIS cases (median age 44 and 40 years, female in 86.7 and 88.6%, respectively). The most important indication for both IVIS and OIS was NAID (59.4 and 74.7%, respectively). Significant associations with prescribing IVIS instead of OIS were the severity of iron deficiency (reflected by serum ferritin levels and the presence of anaemia), the presence of advanced CKD, IBD and male sex of the GP. There was a time trend towards increasing serum ferritin levels associated with initiation of IVIS in NAID. Conclusion: When preferring IVIS to OIS, Swiss GPs seem to consider severity of iron deficiency and comorbid conditions. However, pretreatment serum ferritin levels in IVIS for NAID are increasing, suggesting an ongoing indication extension and potential overuse.
MeSH term(s)	Administration, Intravenous ; Administration, Oral ; Adult ; Aged ; Anemia, Iron-Deficiency/drug therapy ; Female ; Ferritins/blood ; General Practitioners ; Humans ; Iron/administration & dosage ; Irritable Bowel Syndrome/epidemiology ; Male ; Middle Aged ; Practice Patterns, Physicians'/statistics & numerical data ; Renal Insufficiency, Chronic/epidemiology ; Retrospective Studies ; Switzerland/epidemiology
Chemical Substances	Ferritins (9007-73-2) ; Iron (E1UOL152H7)
Language	English
Publishing date	2019-09-30
Publishing country	Switzerland
Document type	Journal Article ; Observational Study
ZDB-ID	2036179-8
ISSN	1424-3997 ; 1424-7860
ISSN (online)	1424-3997
ISSN	1424-7860
DOI	10.4414/smw.2019.20127
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Article ; Online: Development and testing of the KERNset: an instrument to assess the quality of telephone triage in out-of-hours primary care services.

Smits, Marleen / Keizer, Ellen / Ram, Paul / Giesen, Paul

BMC health services research

2017 Volume 17, Issue 1, Page(s) 798

Abstract: Background: Telephone triage is a core but vulnerable part of the care process at out-of-hours general practitioner (GP) cooperatives. In the Netherlands, different instruments have been used for assessing the quality of telephone triage. These ... ...

Abstract	Background: Telephone triage is a core but vulnerable part of the care process at out-of-hours general practitioner (GP) cooperatives. In the Netherlands, different instruments have been used for assessing the quality of telephone triage. These instruments focussed mainly on communicational aspects, and less on the medical quality of triage decisions. Our aim was to develop and test a minimum set of items to assess the quality of telephone triage. Methods: A national survey among all GP cooperatives in the Netherlands was performed to examine the most important aspects of telephone triage. Next, corresponding items from existing instruments were searched on these topics. Subsequently, an expert panel judged these items on importance, completeness and formulation. The concept KERNset consisted of 24 items about the telephone conversation: 13 medical, ten communicational and one regarding both types. It was pilot tested on measurement characteristics, reliability, validity and variation between triagists. In this pilot study, 114 anonymous calls from four GP cooperatives spread across the Netherlands were judged by three out of eight raters, both internal and external raters. Results: Cronbach's alpha was .94 for the medical items and .75 for the communicational items. Inter-rater reliability: complete agreement between the external raters was 45% and reasonable agreement 73% (difference of maximally one point on the five-point scale). Intra-rater reliability: complete agreement within raters was 55% and reasonable agreement 84%. There were hardly any differences between internal and external raters, but there were differences in strictness between individual raters. The construct validity was confirmed by the high correlation between the general impression of the call and the items of the KERNset. Of the differences within items 19% could be explained by differences between triage nurses, which means the KERNset is able to demonstrate differences between triage nurses. Conclusions: The KERNset can be used to assess the quality of telephone triage. The validity is good and differences between calls and between triage nurses can be measured. A more intensive training for raters could improve the reliability.
MeSH term(s)	After-Hours Care/standards ; Communication ; Humans ; Netherlands ; Observer Variation ; Pilot Projects ; Primary Health Care/methods ; Primary Health Care/standards ; Quality Assurance, Health Care/methods ; Surveys and Questionnaires ; Telephone ; Triage/standards
Language	English
Publishing date	2017-12-02
Publishing country	England
Document type	Journal Article
ISSN	1472-6963
ISSN (online)	1472-6963
DOI	10.1186/s12913-017-2686-1
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Article ; Online: Impact of alternative healthcare plans on out-of-hours help-seeking intentions in Switzerland.

Keizer, Ellen / Huibers, Linda / Bondo Christensen, Morten / Senn, Oliver

Swiss medical weekly

2018 Volume 148, Page(s) w14686

Abstract: Introduction: In Switzerland, mandatory health insurance plans (standard) offer free access to secondary and emergency care. However, in return for a lower premium, individuals can choose alternative healthcare plans (HCPs), with either a general ... ...

Abstract	Introduction: In Switzerland, mandatory health insurance plans (standard) offer free access to secondary and emergency care. However, in return for a lower premium, individuals can choose alternative healthcare plans (HCPs), with either a general practitioner (GP) or a medical call centre (Telmed) acting as gatekeeper. Aim: To examine the impact of alternative HCPs on patients' intended help-seeking behaviour out-of-hours (OOH) in Switzerland. Methods: A secondary analysis of the Swiss data collected for the EurOOHnet survey on help-seeking behaviour in Denmark, the Netherlands and Switzerland was made. The survey used hypothetical scenarios for measuring two outcome measures: intended help-seeking for (1) OOH care and (2) OOH face-to-face care. Binomial regression analyses were used to test the influence of HCPs on intended OOH help-seeking, adjusted for other (population) characteristics. Results: Telmed-insured persons were more inclined to OOH help-seeking than persons with a standard HCP (odds ratio [OR] 2.28, 95% confidence interval [CI] 1.91-2.72; controlled for other population factors), mainly driven by contact with the medical call centre (31 vs 5%), and were less inclined to have an OOH face-to-face contact (OR 0.69, 95% CI 0.55-0.87). Persons with a GP HCP had a lower intended use of face-to-face OOH care contacts than persons with a standard plan (OR 0.74, 95% CI 0.63-0.86). Conclusion: Alternative HCPs on a voluntary basis seem to influence the use of OOH care. These results could be relevant for policy makers, especially from non-gatekeeping countries, to reduce irrelevant use and subsequent costs of emergency and OOH care services.
MeSH term(s)	Adult ; After-Hours Care ; Emergency Medical Services/economics ; Female ; General Practitioners/economics ; General Practitioners/statistics & numerical data ; Help-Seeking Behavior ; Humans ; Insurance, Health/economics ; Male ; Middle Aged ; Primary Health Care ; Surveys and Questionnaires ; Switzerland ; Telemedicine/economics ; Telemedicine/standards
Language	English
Publishing date	2018-10-30
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2036179-8
ISSN	1424-3997 ; 1424-7860
ISSN (online)	1424-3997
ISSN	1424-7860
DOI	10.4414/smw.2018.14686
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Article ; Online: Time trends in general practitioners' home visits for older patients: a retrospective cross-sectional study from Switzerland.

Neuner-Jehle, Stefan / Graber, Sereina Maria / Keizer, Ellen / Huber, Carola / Blozik, Eva / Rosemann, Thomas / Senn, Oliver

Swiss medical weekly

2021 Volume 151, Page(s) w20539

Abstract: What is known on the subject, and what the study adds: The number of home visits by general practitioners (GPs) has decreased in recent years, in contrast to the increasing number of frail and older patients in western countries. Current data on GP home ...

Abstract	What is known on the subject, and what the study adds: The number of home visits by general practitioners (GPs) has decreased in recent years, in contrast to the increasing number of frail and older patients in western countries. Current data on GP home visit numbers and rates are lacking for Switzerland. Our study provides new data on GP home visit numbers and rates, and their associations with patient characteristics. Aim: Our study aimed at investigating the time trend of GP home visits to older patients from 2014 to 2018 in Switzerland, and associations between GP home visits and patient characteristics including healthcare utilisation and living situation. Methods: Retrospective cross-sectional study of insurance claims data from 2014 to 2018 among patients aged ≥65 years (Nextrapolated = 2,095,102; Nraw = 339,301). We compared patient characteristics between patients with and without GP home visits using descriptive statistics. We performed logistic regression analyses to detect associations between patient characteristics and GP home visits, including subgroups of patients aged ≥80 and patients living in a nursing home. Regression models were adjusted for age and sex. Results: The yearly GP home visit rate declined from 10.7% to 9.3% from 2014 to 2018 (p <0.0001). Among patients aged ≥80, the rate declined from 26.1% to 23.1% (p <0.0001), and among patients living in a nursing home from 68.7% to 65.8% (p <0.0001). Regression analyses revealed increased health care utilisation and a higher burden of morbidity and mortality in patients receiving GP home visits. Conclusion: There is an ongoing decline of GP home visits over the past years, with a potentially negative impact on the quality of care for older and frail patients.
MeSH term(s)	Cross-Sectional Studies ; General Practitioners ; House Calls ; Humans ; Retrospective Studies ; Switzerland
Language	English
Publishing date	2021-07-14
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2036179-8
ISSN	1424-3997 ; 1424-7860
ISSN (online)	1424-3997
ISSN	1424-7860
DOI	10.4414/smw.2021.20539
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Article ; Online: Patient safety culture in out-of-hours primary care services in the Netherlands: a cross-sectional survey.

Smits, Marleen / Keizer, Ellen / Giesen, Paul / Deilkås, Ellen Catharina Tveter / Hofoss, Dag / Bondevik, Gunnar Tschudi

Scandinavian journal of primary health care

2018 Volume 36, Issue 1, Page(s) 28–35

Abstract: Objective: To examine patient safety culture in Dutch out-of-hours primary care using the safety attitudes questionnaire (SAQ) which includes five factors: teamwork climate, safety climate, job satisfaction, perceptions of management and communication ... ...

Abstract	Objective: To examine patient safety culture in Dutch out-of-hours primary care using the safety attitudes questionnaire (SAQ) which includes five factors: teamwork climate, safety climate, job satisfaction, perceptions of management and communication openness. Design: Cross-sectional observational study using an anonymous web-survey. Setting Sixteen out-of-hours general practitioner (GP) cooperatives and two call centers in the Netherlands. Subjects Primary healthcare providers in out-of-hours services. Main outcome measures Mean scores on patient safety culture factors; association between patient safety culture and profession, gender, age, and working experience. Results: Overall response rate was 43%. A total of 784 respondents were included; mainly GPs (N = 470) and triage nurses (N = 189). The healthcare providers were most positive about teamwork climate and job satisfaction, and less about communication openness and safety climate. The largest variation between clinics was found on safety climate; the lowest on teamwork climate. Triage nurses scored significantly higher than GPs on each of the five patient safety factors. Older healthcare providers scored significantly higher than younger on safety climate and perceptions of management. More working experience was positively related to higher teamwork climate and communication openness. Gender was not associated with any of the patient safety factors. Conclusions: Our study showed that healthcare providers perceive patient safety culture in Dutch GP cooperatives positively, but there are differences related to the respondents' profession, age and working experience. Recommendations for future studies are to examine reasons for these differences, to examine the effects of interventions to improve safety culture and to make international comparisons of safety culture. Key Points Creating a positive patient safety culture is assumed to be a prerequisite for quality and safety. We found that: • healthcare providers in Dutch GP cooperatives perceive patient safety culture positively; • triage nurses scored higher than GPs, and older and more experienced healthcare professionals scored higher than younger and less experienced professionals - on several patient safety culture factors; and • within the GP cooperatives, safety climate and openness of communication had the largest potential for improvement.
MeSH term(s)	Adult ; After-Hours Care ; Attitude of Health Personnel ; Communication ; Cross-Sectional Studies ; Female ; General Practice ; General Practitioners ; Health Personnel ; Health Services ; Humans ; Male ; Middle Aged ; Netherlands ; Organizational Culture ; Patient Safety ; Primary Health Care ; Safety Management ; Surveys and Questionnaires
Language	English
Publishing date	2018-01-15
Publishing country	United States
Document type	Journal Article
ZDB-ID	605763-9
ISSN	1502-7724 ; 0281-3432 ; 0284-6020
ISSN (online)	1502-7724
ISSN	0281-3432 ; 0284-6020
DOI	10.1080/02813432.2018.1426150
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Article ; Online: Reducing the use of out-of-hours primary care services: A survey among Dutch general practitioners.

Keizer, Ellen / Maassen, Irene / Smits, Marleen / Wensing, Michel / Giesen, Paul

The European journal of general practice

2016 Volume 22, Issue 3, Page(s) 189–195

Abstract: Background: Out-of-hours primary care services have a high general practitioner (GP) workload with increasing costs, while half of all contacts are non-urgent.: Objectives: To identify views of GPs to influence the use of the out-of-hours GP ... ...

Abstract	Background: Out-of-hours primary care services have a high general practitioner (GP) workload with increasing costs, while half of all contacts are non-urgent. Objectives: To identify views of GPs to influence the use of the out-of-hours GP cooperatives. Methods: Cross-sectional survey study among a random sample of 800 GPs in the Netherlands. Results: Of the 428 respondents (53.5% response rate), 86.5% confirmed an increase in their workload and 91.8% felt that the number of patient contacts could be reduced. A total of 75.4% GP respondents reported that the 24-h service society was a 'very important' reason why patients with non-urgent problems attended the GP cooperative; the equivalent for worry or anxiety was 65.8%, and for easy accessibility, 60.1%. Many GPs (83.9%) believed that the way telephone triage is currently performed contributes to the high use of GP cooperatives. Measures that GPs believed were both desirable and effective in reducing the use of GP cooperatives included co-payment for patients, stricter triage, and a larger role for the telephone consultation doctor. GPs considered patient education, improved telephone accessibility of daytime general practices, more possibilities for same-day appointments, as well as feedback concerning the use of GP cooperatives to practices and triage nurses also desirable, but less effective. Conclusion: This study provides several clues for influencing the use of GP cooperatives. Further research is needed to examine the impact and safety of these strategies. [Box: see text].
Language	English
Publishing date	2016-09
Publishing country	England
Document type	Journal Article
ZDB-ID	1281338-2
ISSN	1751-1402 ; 1381-4788
ISSN (online)	1751-1402
ISSN	1381-4788
DOI	10.1080/13814788.2016.1178718
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Article ; Online: GPs' experiences with out-of-hours GP cooperatives: a survey study from the Netherlands.

Smits, Marleen / Keizer, Ellen / Huibers, Linda / Giesen, Paul

The European journal of general practice

2014 Volume 20, Issue 3, Page(s) 196–201

Abstract: Background: Out-of-hours primary care has been provided by general practitioner (GP) cooperatives since the year 2000 in the Netherlands. Early studies in countries with similar organizational structures showed positive GP experiences. However, nowadays ...

Abstract	Background: Out-of-hours primary care has been provided by general practitioner (GP) cooperatives since the year 2000 in the Netherlands. Early studies in countries with similar organizational structures showed positive GP experiences. However, nowadays it is said that GPs experience a high workload at the cooperative and that they outsource a considerable part of their shifts. Objectives: To examine positive and negative experiences of GPs providing out-of-hours primary care, and the frequency and reasons for outsourcing shifts. Methods: A cross-sectional observational survey among 688 GPs connected to six GP cooperatives in the Netherlands, using a web-based questionnaire. Results: The response was 55% (n = 378). The main reasons for working in GP cooperatives were to retain registration as GP (79%) and remain experienced in acute care (74%). GPs considered the peak hours (81%) and the high number of patients (73%) as the most negative aspects. Most GPs chose to provide the out-of-hours shifts themselves: 85% outsourced maximally 25% of their shifts. The percentage of outsourced shifts increased with age. Main reasons for outsourcing were the desire to have more private time (76%); the high workload in daytime practice (71%); and less the workload during out-of-hours (46%). Conclusion: GPs are motivated to work in out-of-hours GP cooperatives, and they outsource few shifts. GPs consider the peak load and the large number of (non-urgent) help requests as the most negative aspects. To motivate and involve GPs for 7 × 24-h primary care, it is important to set limits on their workload.
MeSH term(s)	After-Hours Care/organization & administration ; Age Factors ; Cooperative Behavior ; Cross-Sectional Studies ; Female ; General Practice/organization & administration ; General Practitioners/organization & administration ; General Practitioners/statistics & numerical data ; Humans ; Internet ; Male ; Middle Aged ; Netherlands ; Outsourced Services/organization & administration ; Primary Health Care/organization & administration ; Surveys and Questionnaires ; Workload
Language	English
Publishing date	2014-09
Publishing country	England
Document type	Journal Article ; Observational Study
ZDB-ID	1281338-2
ISSN	1751-1402 ; 1381-4788
ISSN (online)	1751-1402
ISSN	1381-4788
DOI	10.3109/13814788.2013.839652
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ab Jg. 2022: Lesesaal (EG)

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