OOH: demands, referral patterns, frequent attenders characteristics in a Veneto Region (Italy) LHA

Introduction The aim of this study was to describe the characteristics of patients admitted to an Out-of-Hours service (OoHs), the related outputs and to analyse deeply the frequent attenders (FAs)’s phenomena. Methods This study was a retrospective cohort study on electronic population-based records, linked with the mortality registry and with patients’ exemption from health care charges. A FA was defined as a patient with 3 contacts in 12 months. A logistic regression model was constructed to identify independent variables associated with this outcome. Results 23,980 OoHs contacts (CTCs) in 2011 at a Local Health Authority in the Veneto Region were registered. Rates were higher for the oldest and youngest age groups and for females. More than half of CTCs concerned patients who were seen by a physician, about 1/3 of CTCs related problems managed by phone, about 10% of CTCs were referred to other services. Many factors, including demographic, process-logistic and clinical variables were associated with the decision to visit the patient (rather than provide a phone advice), or to refer patients to ED or to a specialist. Some OOH doctors were more likely than their colleagues to refer a patient to ED. FA status was associated with clinical variables (such as psychiatric disease), socio-demographic variables (sex, age and income level), and also with the feature of their GPs’ association. Conclusion Our study shows that OoHs meet composite and variously expressed demands. The determining factors associated with cases referred to other health care services should be considered when designing clinical pathways in order to ensure a continuity of care. The unwarranted variability in OOH physicians’ performance needs to be addressed. The determinants of OoHs FA include patients’ clinical conditions, several socio-economic characteristics (including income level) and their GPs’ organizational format. Key message This is the first study found that also socio-demographic and logistic features of the contact change the propensity of OOH physician to refer patients to ED or to specialist visit.