The Issue
In response to concerns about the quality and safety of health care provided after physician offices close for the day, new models have sprung up in several countries to provide patients with quality after-hours care. The authors of this Commonwealth Fund–supported study evaluated one such alternative—large-scale cooperative services—that has been gaining currency in Europe.
What the Study Found
In the United Kingdom, primary care cooperatives have commonly taken the form of nurse-led telephone-consultation systems. They have resulted in 69 percent fewer telephone contacts with doctors, 38 percent fewer walk-in patients, and 23 percent fewer house calls. Physician involvement, when required, is often obtained through the government's National Health Service Direct or private trusts.
Denmark, meanwhile, has created a system of cooperatives, organized by county, that has led to a dramatic increase in telephone consultations and greatly reduced numbers of physician house calls. After the system's establishment, the percentage of physicians working more than 10 hours a week after hours dropped from 50 percent to 10 percent.
In the Netherlands, nearly all physicians participate in after-hours primary care cooperatives. Physicians' on-call duties have consequently lightened since the cooperatives were established, shrinking from about 19 hours a week to four hours.
Conclusions
Local or regional integration appears to be a promising model for after-hour services. In the three countries studied, it produced "lighter workloads for doctors, fewer face-to-face contacts, and fewer house calls, all connected to fewer costs." Unanswered questions remain, however, about how such arrangements affect patients.