Rural general practitioners' experience of the provision of out-of-hours care: a qualitative study.
BACKGROUND
Published research into the provision and utilisation of out-of-hours services shows long-term trends towards decreasing personal commitment among general practitioners (GPs). However, the on-call commitments of rural GPs remain especially onerous. There has been little research relating to either rural out-of-hours services or the implications of such services for the families of the providers.


OBJECTIVE
To explore and describe how rural GPs in Ireland perceive and experience out-of-hours care provision.


METHODS
A qualitative study was conducted with 10 rural GPs and their spouses in their homes or practices using one-to-one in-depth interviews.


METHODS
Ten general practices in rural Ireland.


METHODS
The interviews were guided by an interview schedule that was based on pertinent themes that had emerged from previous relevant literature. The interviews were audiotaped, transcribed, and analysed for themes and issues.


RESULTS
Results indicated that rural GPs experience a wide variety of satisfactions from work related to the provision of out-of-hours care. However, the large proportion of time committed to out-of-hours care greatly infringes on their social and family life. The key stressors identified related to organisational system difficulties, especially with regard to locum cover, and unrealistic patient expectations. The stressors were mainly expressed as lack of time off, restrictions on family life, and interruptions.


CONCLUSIONS
System difficulties, such as difficulty with obtaining locums and rota extension, need to be addressed at an organisational level. Patient expectations of the role of the rural GP have significant implications for practitioners and their families.
Cuddy
N J
NJ
Department of General Practice, National University of Ireland, Galway. general.practice@nuigalway.ie
Keane
A M
AM
Murphy
A W
AW
D000328:Adult; D001291:Attitude of Health Personnel; D004632:Emergency Medical Services / Q000458:organization & administration* / Q000592:standards / Q000600:supply & distribution; D005194:Family Practice / Q000458:organization & administration* / Q000592:standards; D005195:Family Relations; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D007494:Ireland; D007588:Job Satisfaction; D008297:Male; D008875:Middle Aged; D009551:Night Care / Q000706:statistics & numerical data; D010342:Patient Acceptance of Health Care; D017060:Patient Satisfaction; D010821:Physicians, Family / Q000523:psychology*; D011787:Quality of Health Care; D019035:Rural Health Services / Q000458:organization & administration* / Q000592:standards / Q000600:supply & distribution; D012424:Rural Population; D018454:Spouses / Q000523:psychology