The effect of an out-of-hours reform on attendance at casualty wards. The Danish example

Abstract

Objective - A reorganisation of the out-of-hours general practice service in Denmark was launched in January 1992. The biggest changes were in a mandatory telephone triage staffed by GPs and the replacement of small rota systems with county-based health centres. We aimed to analyse the effect of this out-of-hours reform on the number of contacts with the casualty wards. Design - A register-based ecologic time-trend study of the mean number of annual contacts per inhabitant from 1988 to 1997. Setting - The County of Aarhus. Subjects - All 630000 inhabitants in the county. Main outcome measures - Mean number of annual contacts with casualty wards per inhabitant. Intercepts derived from two regression models. Results - The mean number of contacts with casualty wards rose significantly during the whole period. Given this constant increase in contact rates, a regression model showed that the increase in the attendance rate with casualty wards after the reform was statistically insignificant. Conclusions - The decrease in the total number of contacts with the out-of-hours primary health care after the reform was not met by a corresponding increase in casualty ward contacts. A clear-cut significant increase in the use of casualty wards following the out-of-hours reform could not be demonstrated.