Reorganization of the Danish out-of-hours primary care - a descriptive study

BACKGROUND: Increasing demand for healthcare due to demographic changes and shortage of healthcare professionals challenges the provision of unplanned care. In Denmark, different organizational changes across all regions have been implemented to meet these challenges. This provides great potential for research on the effect of different organizational choices on the use and quality of healthcare. Thus, we aim to provide a comprehensive overview of the current organizational models for acute unplanned out-of-hours primary care (OOHPC) across the five Danish regions, incorporating key contextual factors to characterize these regional systems.

METHODS: Nationwide cross-sectional survey study on OOHPC models in all Danish regions (North, Central, Southern, Capital, and Zealand). Survey questions covered a list of predefined topics created in the author group. One survey was completed per region.

RESULTS: OOHPC models differ across regions and time of day. In the North, Central, and Southern regions from 4 PM-11 PM, general practitioner (GP) cooperatives deliver OOHPC (telephone triage, tele- and clinic consultations, and home visits). From 11 PM-8 AM, the regional emergency medical services provide OOHPC in the North (GPs/physicians, paramedics) and Central (physicians, nurses, paramedics) regions. In the Southern region, the administrative responsibility of the OOHPC lies with the emergency department, but GPs provide healthcare aided by paramedics. The Capital, Central (nights), and Zealand regions have nurses and physicians performing telephone triage. All regions provide clinic consultations with physicians. In the Capital region, these consultations are hospital-based. Currently, no OOHPC data is transferred to national registries in four regions during nighttime.

CONCLUSION: Danish OOHPC models differ substantially regarding the use of healthcare professionals for delivering acute unplanned care. All regions still provide gatekeeping, where OOHPC performs a primary evaluation before a possible hospital contact. Delivery of relevant data to registries has decreased substantially with the current models, potentially creating a barrier for nationwide research on OOHPC.