Effect of a reorganized after-hours family practice service on frequent attenders.
OBJECTIVE
A governmental reorganization of the after-hours general practice service in Denmark was launched in January 1992. The biggest change was the introduction of mandatory county-wide telephone triage systems staffed by general practitioners. This study assesses the effect of this reorganization on the use of services by frequent attenders (FAs).


METHODS
From 1990 to 1994, methods of contact and annual costs per attender were analyzed in an ecological time-trend study based on aggregated administrative data collected from the database of the Public Health Insurance, Aarhus County, Denmark (600,000 inhabitants). The study only included attenders ages 18 and over. FAs were defined as the group that, within each calendar year (12 months), had 4 or more contacts with the after-hours family practice service.


RESULTS
FAs made up 9.5% of the attenders and accounted for more than 40% of the contacts and the aggregate costs. The effect of the reorganization was a 12% decrease in the number of attenders, a 16% decrease in the number of contacts, and a 29% decrease in the costs. Reorganization had a significantly bigger effect on FA attendance than on non-FA attendance, and more than half of the overall reduction in use of services could be ascribed to changes in FA behavior.


CONCLUSIONS
The reorganization of the after-hours service produced a significant fall in attendance and costs, especially with respect to adult FAs.
Vedsted
P
P
Department of General Practice, University of Aarhus, Denmark. pv@alm.au.dk
Olesen
F
F
D000293:Adolescent; D000328:Adult; D003718:Denmark; D005194:Family Practice / Q000458:organization & administration*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009819:Office Visits / Q000706:statistics & numerical data*; D010821:Physicians, Family / Q000600:supply & distribution; D012189:Retrospective Studies; D016526:Workload