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After-hours services in capitation-funded primary care practice

Use and satisfaction

Janusz Kaczorowski, PhD
Professor and Research Director in the Department of Family Practice at the University of British Columbia in Vancouver

Michelle Howard, MSc PhD
Research Coordinator in the Department of Family Medicine at McMaster University

Correspondence: Dr Neimanis, 849 Upper Wentworth St, Suite 302, Hamilton, ON L9A 5H4; telephone 905 388-3541; fax 905-388-0477; e-mailineimani{at}mcmaster.ca

OBJECTIVE To examine patients’ use of and satisfaction with the nurse-staffed Telephone Health Advisory Service (THAS) and physician after-hours care in a rostered Family Health Organization, as well as physicians’ satisfaction with both types of services.

DESIGN Cross-sectional telephone survey.

SETTING A Family Health Organization in Hamilton, Ont.

PARTICIPANTS Nineteen family physicians and their patients who used an after-hours service during 9 selected weeks between March and December of 2007.

MAIN OUTCOME MEASURES Distribution of encounters directed to the on-call physician or to the THAS; types of health problems; and patient and physician satisfaction.

RESULTS A total of 817 calls were recorded from 774 patients. Of these patients, 606 were contacted and 94.4% (572/606) completed encounter-specific surveys: 358 completed the on-call physician survey and 214 completed the THAS survey. Mean age of respondents was 40.8 years; most were women, and approximately one-third called on behalf of children. Most calls (66.8%, 546/817) were made directly to the on-call physicians. The most common problems were respiratory (34.3%, 271/789), gastrointestinal (10.1%, 80/789), and genitourinary (9.3%, 73/789). Most patients reported being very satisfied with the after-hours care provided by the THAS (62.5%, 125/200) or the on-call physicians (70.9%, 249/351). Almost all callers who bypassed the THAS knew about it (89.8%, 316/352), but either felt their problems were too serious or wished to talk to a physician. Most physicians agreed or strongly agreed that they were satisfied with their colleagues’ on-call care (81.0%, 17/21); 47.6% (10/21) agreed that the THAS was helpful in managing on-call duty.

CONCLUSION When direct after-hours physician contact is available, a minority of patients uses a nurse-staffed triage. Physicians find the arrangements onerous and would prefer to see after-hours care managed and remunerated differently.