Morten Bondo Christensen

This study aims to describe patterns of patient flow and resource use in out-of-hours (OOH-PC) clinics with high versus low levels of task shifting from general practitioners (GPs) to nurses. This descriptive register-based study used data from OOH-PC clinics in the Central Denmark Region. Clinics with high levels of task shifting had nurses independently managing pa-tients with minor conditions, whereas in clinics with low levels of task shifting nurses mainly per-formed preparatory tasks. Measures of patient flow included GP time per contact, initial and total waiting time, contact time with a health professional, and treatment time. Resource use measures in-cluded diagnostic tests, X-rays, injury-related procedures, prescriptions, hospital referrals, and fol-low-up contacts. A total of 451,714 contacts were included. The proportion of contacts independently man-aged by nurses was 4% in clinics with low task shifting and 20% in clinics with high task shifting. Clinics with low task shifting had more GP time per contact (median 8 minutes [IQR 5-11] vs. 6 minutes [IQR 2-11]) and longer total waiting time (31 minutes [IQR 14-52] vs. 26 minutes [IQR 11-49]) than clinics with high task shifting. Median contact time (8 minutes) was similar across clin-ic types. Rates of diagnostic testing, X-ray referrals, prescriptions, and follow-up contacts were comparable. This study indicates that OOH-PC clinics with high levels of task shifting release more GP time and reduce waiting times while maintaining similar consultation lengths and overall resource use. Not applicable.

Adults with low socioeconomic position (SEP) are often provided poorer healthcare than adults with high SEP. Parents’ SEP affects their children̵

Background: GPs can use video when performing telephone triage in out-of-hours primary care (OOH-PC) in Denmark. Video use varies considerably among GPs; this variation could be related to GP characteristics. Aim: To investigate associations between GP characteristics and video use in OOH-PC telephone triage. Design & setting: A register-based study using data from the OOH-PC registration system from 1 January 2021 to 31 December 2021. Method: Binomial regression analysis was used to measure the associations between video contacts and triage GP characteristics, thereby calculating risk ratios (RRs) and 95% confidence intervals (CI). Results: Video was used in 10.8% of telephone triage contacts to OOH-PC. Video use was significantly associated with GPs having more shifts in OOH-PC (RR: 1.36–1.93, reference: low number of shifts) and GPs being younger (RR: 0.84–0.67, reference: age<40 years). Central Denmark Region and Region of Southern Denmark had significant higher video-user rates (RR: 1.23–1.46) than North Denmark Region, whereas Region Zealand had significant lower rates (RR = 0.57, 95% confidence interval [CI] = 0.38 to 0.87). The association between video use and GP sex was modified by number of shifts in OOH-PC. Video use was positively correlated with male sex among GPs with low, medium, and high number of shifts (RR = 1.18, 95% CI = 1.07 to 1.29) and negatively correlated with male sex among GPs with very high number of shifts (RR = 0.75, 95% CI = 0.58 to 0.98). Conclusion: Video use was associated with the number of shifts in OOH-PC, GP sex and age, and geographical region.

Out-of-hours primary care (OOH-PC) is essential for treating urgent health problems. However, the high demand for these services has increased the workload. To investigate the interprofessional collaboration in OOH-PC and task shifting from general practitioners (GPs) to nurses, specifically the professional practices and the perceived experiences of GPs and nurses. This explorative case study was based on observations and interviews, using normalisation process theory as the theoretical framework. Observations were conducted in two OOH-PC clinics in the Central Denmark Region, followed by individual semi-structured interviews with five GPs and six nurses working in these clinics. Data were collected from March to October 2022. GPs and nurses worked together in a team-based workflow based on different roles and skills but joint tasks. The nurses handled patients with injuries and performed diagnostic tests. A team-based workflow with task shifting was supported by familiarity within the team, with nurses performing informal coordination tasks and having formal support like protocols, training, and GP supervision. GPs and nurses appreciated the team-based workflow, as it facilitated efficient resource use and high job satisfaction. However, both groups expressed concerns about the sustainability of OOH-PC clinics. Task shifting from GPs to nurses in OOH-PC is feasible in a team-based workflow, resulting in efficient use of available resources and high job satisfaction. However, task shifting should not aim to replace GPs with nurses. Instead, their roles and skills should be seen as complementary, which calls for task sharing.

Background: Many countries have introduced video consultations in primary care both inside and outside of office hours. Despite some relational and technical limitations, general practitioners (GPs) have reported the benefits of video use in the daytime as it provides faster and more flexible access to health care. Studies have indicated that video may be specifically valuable in out-of-hours primary care (OOH-PC), but additional information on the added value of video use is needed. Objective: This study aimed to investigate triage GPs’ perspectives on video use in GP-led telephone triage in OOH-PC by exploring their reasons for choosing video use and its effect on triage outcome, the decision-making process, communication, and invested time. Methods: We conducted a cross-sectional questionnaire study among GPs performing telephone triage in the OOH-PC service in the Central Denmark Region from September 5, 2022, until December 21, 2022. The questionnaire was integrated into the electronic patient registration system as a pop-up window appearing after every third video contact. This setup automatically linked background data on the contact, patient, and GP to the questionnaire data. We used descriptive analyses to describe reasons for and effects of video use and GP evaluation, stratified by patient age. Results: A total of 2456 questionnaires were completed. The most frequent reasons for video use were to assess the severity (n=1951, 79.4%), to increase the probability of self-care (n=1279, 52.1%), and to achieve greater certainty in decision-making (n=810, 33%) (multiple answers were possible for reasons of video use). In 61.9% (n=1516) of contacts, the triage GPs anticipated that the contact would have resulted in a different triage outcome if video had not been used. Use of video resulted in a downgrading of severity level in 88.3% (n=1338) of cases. Triage GPs evaluated the use of video as positive in terms of their decision-making process (n=2358, 96%), communication (n=2214, 90.1%), and invested time (n=2391, 97.3%). Conclusions: Triage GPs assessed that the use of video in telephone triage did affect their triage outcome, mostly by downgrading the level of care needed. The participating triage GPs found video in OOH-PC to be of added value, particularly in communication and the decision-making process.

Objective: The objective is to explore parents’ experiences with telephone contacts to out-of-hours primary care (OOH-PC) that include use of one-way video ( video triage ). Design: A qualitative interview study using Braun and Clarke’s thematic analysis approach. Setting: OOH-PC in the Central Denmark Region. Participants: A convenience sampling strategy was used to include parents of young children (aged 1–5 years), who received video triage in OOH-PC: nine women and one man aged 31–42 years. Data were collected from 26 April to 23 May 2023. Results: Three main themes were developed, each containing two subthemes: Theme 1. Video triage accelerates diagnostic clarity and prompt action, enhancing feeling of safety : Parents experienced that video triage provided faster diagnostic clarification than telephone triage. The visual assessment in video triage reduced uncertainties of describing symptoms and increased the parents’ feeling of safety. Theme 2. Video triage changed the communicative and relational behaviour : Parents found video triage impersonal as it focused on the physical examination. The conversation before activation of video was found important, as it established a feeling of trust and reassurance. Theme 3. Experiences of presence and involvement in video triage : Parents found their active involvement in video triage challenging, as it required divided attention and shared responsibility. Conclusions: Our study indicates the importance of paying attention to the changes in communication and consultation processes afforded by the implementation of one-way video triage. One-way video triage is experienced as a valuable tool for examination, yet it is also perceived to impair the building of trust in the patient–physician relationship.

Objective: To investigate reasons for encounter in telephone triage contacts to an out-of-hours primary care service for which general practitioners (GPs) use video consultations ( video contact ), overall and stratified for patient age and time of day. Design: A cross-sectional questionnaire study among GPs doing telephone triage in an out-of-hours primary care service. The questionnaire was integrated into the electronic patient registration system, popping up after every third video contact. This setup automatically linked patient register data, including age and sex, with the questionnaire data. Setting: The study was conducted from 5 September 2022 to 21 December 2022 at the out-of-hours primary care service in the Central Denmark Region. Participants: 649 volunteer GPs who answered 2452 questionnaires. Main outcome measures: Reasons for encounter in video contacts registered with codes from International Classification of Primary Care (ICPC) coding system, V.2 (ICPC-2). Results: GPs doing telephone triage in out-of-hours primary care used video contacts for a broad range of ICPC-2 codes within few ICPC-2 chapters. 83% of all reasons for encounter were due to symptoms in chapters S ‘Skin’ (34.5%), R ‘Respiratory’ (21.8%), A ‘General and unspecified’ (14.7%) and L ‘Musculoskeletal’ (12.0%) in the ICPC-2 classification system. Video contacts concerning skin and musculoskeletal symptoms were more frequent among older children and adults compared with young children. Respiratory symptoms and general and unspecified symptoms dominated by fever were more frequent among video contacts for young children compared with older children and adults. Conclusion: Our study suggests a focused use of video contacts in an out-of-hours primary care setting; the majority of registered ICPC-2 codes were within few ICPC-2 chapters.

Antibiotic prescription rates can be affected by pandemic measures such as lockdowns, social distancing, and remote consultations in general practice. Therefore, such emergency states may negatively affect antimicrobial stewardship, specifically in out-of-hours (OOH) primary care. As contact patterns changed in the COVID-19 pandemic, it would be relevant to explore the impact on antimicrobial stewardship. To study the impact of the pandemic on antibiotic prescription rates in OOH primary care, overall and per age group. This cross-sectional register-based study used routine data from OOH primary care in the Central Denmark Region. We included all patient contacts in two equivalent time periods: pre-pandemic and pandemic period. The main outcome measure was defined as the number of antibiotic prescriptions per contact (antibiotic prescription rate). The overall antibiotic prescription rate decreased during the first year of the pandemic compared to the pre-pandemic period (RR = 0.97, 95%CI: 0.96-0.98). Likewise, the rate decreased for clinic consultations (RR = 0.63, 95%CI: 0.62-0.64). However, an increase was seen for telephone consultations (RR = 1.73, 95%CI: 1.70-1.76). The decline in clinic consultations was largest for consultations involving children aged 0-10 years (RR = 0.53, 95%CI: 0.51-0.56). Antibiotic prescription rates in Danish OOH primary care decreased during the first year of the COVID-19 pandemic, especially for young children. Prescription rates decreased in clinic consultations, whereas the rates increased in telephone consultations. Further research should explore if antibiotic prescription rates have returned to pre-pandemic levels, and if the introduction of video consultations has affected antibiotic prescription patterns in OOH primary care.

Task shifting from general practitioners (GPs) to other health professionals could solve the increased workload, but an overview of the evidence is lacking for out-of-hours primary care (OOH-PC). To evaluate the content and quality of task shifting from GPs to other health professionals in clinic consultations and home visits in OOH-PC. Four database literature searches were performed on 13 December 2021, and updated in August 2023. We included articles that studied content (patient characteristics, reason for encounter) and/or quality (patient satisfaction, safety, efficiency) of task shifting in face-to-face contacts at OOH-PC. Two authors independently screened articles for inclusion and assessed the methodological quality of included articles using the JBI critical appraisal checklist. Data was extracted and results were synthesised in a narrative summary. The search identified 1,829 articles, resulting in the final inclusion of seven articles conducted in the UK or the Netherlands. Studies compared GPs with other health professionals (mainly nurses). These other health professionals saw patients with less urgent health problems, younger patients, and patients with less complex health problems than GPs. Most studies concluded that other health professionals provided safe and vastly efficient care corresponding to the level of GPs but findings about productivity were inconclusive. The level of safety and efficiency of care provided by other health professionals in OOH-PC seems like that of GPs, although they mainly see patients presenting with less urgent and less complex health problems.

Background: Out-of-hours primary care (OOH-PC) is challenging due to high workloads, workforce shortages, and long waiting and transportation times for patients. Use of video enables triage professionals to visually assess patients, potentially ending more contacts in a telephone triage contact instead of referring patients to more resource-demanding clinic consultations or home visits. Thus, video use may help reduce use of health care resources in OOH-PC. Objective: This study aimed to investigate video use in telephone triage contacts to OOH-PC in Denmark by studying rate of use and potential associations between video use and patient- and contact-related characteristics and between video use and triage outcomes and follow-up contacts. We hypothesized that video use could serve to reduce use of health care resources in OOH-PC. Methods: This register-based study included all telephone triage contacts to OOH-PC in 4 of the 5 Danish regions from March 15, 2020, to December 1, 2021. We linked data from the OOH-PC electronic registration systems to national registers and identified telephone triage contacts with video use (video contact) and without video use (telephone contact). Calculating crude incidence rate ratios and adjusted incidence rate ratios (aIRRs), we investigated the association between patient- and contact-related characteristics and video contacts and measured the frequency of different triage outcomes and follow-up contacts after video contact compared to telephone contact. Results: Of 2,900,566 identified telephone triage contacts to OOH-PC, 9.5% (n=275,203) were conducted as video contacts. The frequency of video contact was unevenly distributed across patient- and contact-related characteristics; it was used more often for employed young patients without comorbidities who contacted OOH-PC more than 4 hours before the opening hours of daytime general practice. Compared to telephone contacts, notably more video contacts ended with advice and self-care (aIRR 1.21, 95% CI 1.21-1.21) and no follow-up contact (aIRR 1.08, 95% CI 1.08-1.09). Conclusions: This study supports our hypothesis that video contacts could reduce use of health care resources in OOH-PC. Video use lowered the frequency of referrals to a clinic consultation or a home visit and also lowered the frequency of follow-up contacts. However, the results could be biased due to confounding by indication, reflecting that triage GPs use video for a specific set of reasons for encounters.