Activity in out-of-hours services in Norway, 2007

16th Nordic Congress of General Practice

May 2009, Copenhagen

Elisabeth Holm Hansen, Erik Zakariassen, Steinar Hunskår

Norway has a two-level public health care system LEVEL 1

Municipalities • Primary Health care• Emergency medical services

24 hours a day• Casualty clinics with or without

nurses• LEMC

LEVEL 2Regional Health Authorities • Hospital• EMCC /113 • Ambulance services• National Air ambulance

Background

• In Norway, no valid activity statistics from the primary health care out-of-hours services

• The National Centre for Emergency Primary Health Care has initiated a project called The Watchtowers

• Aim: Provide information to enable monitoring, evaluation and comparison of activities in primary health care emergency services

Material and methods

• Day and night recording during one year of all requests to seven casualty clinics covering a total of 18 municipalities

• Variables: Time, gender, age, mode of contact, priority grade and first response initiated

Results

• During 2007 a total of 85 288 requests were registered, 399 contacts per 1000 inhabitants

• Estimated mean number of requests to Norwegian Casualty Clinics per inhabitant per year: 0,4

• 55 % women• Mean age 35 years

Contacts according to population (%)

0

5

10

15

20

25

30

35

40

45

0-4 year 5-14year 15-29 30-59 60-79 80 +

Population

Contacts

Mode of contact (%)

Telephone from patient or patients family 65 %

Direct attendance 26 %

Health personnel 6 %

National emergency medical communication centres (EMCC)

2 %

Police etc 1%

Priority degree (%)

0

10

20

30

40

50

60

70

80

90

Non- urgent Urgent Acute

Per

cen

t

Responses for all contacts Per cent Rate per 1000 inhabitants

Appointment with a doctor 63 251

Advice by telephone, doctor 10 38

Handled by nurse 24 96

Call-out of doctor and ambulance 1,7 7

Home visits by doctor 1,6 6

Total 100

Validation of contact registrations

• Reimbursement claims for 2006:

1.3 mill consultations by doctor in out-of-hours work

392 contacts per 1000 inhabitants

• Estimated national figures in our project 2007;

1,2 mill consultations by doctor in out-of-hours work

399 contacts per 1000 inhabitants

Interpretations

• Norway has a high rate of contacts to the out-of-hours services compared to other countries

• Norway has a large share of non-urgent cases

• Mode of contact influences action taken

• Valid national figures and future research of these services are important both for local services and policy makers