Intervention among frequent attenders of the out-of-hours service: a stratified cluster randomized controlled trial.
OBJECTIVE
To investigate whether the number of frequent attenders (FA) contacts with the out-of-hours service can be reduced by deploying a combination of intervention strategies.


METHODS
A stratified cluster randomized controlled trial, each cluster containing a general practice and all its listed patients.


METHODS
The out-of-hours service in the county of Northern Jutland (490,000 inhabitants), Denmark.


METHODS
The following intervention strategies were deployed: predisposition, individual instruction, economic incitement, continuing medical education meetings, feedback/reminder, and patient-mediated intervention.


METHODS
An intervention group of 3500 patients and a control group of 4635 patients.


METHODS
Absolute and relative fall in the number of contacts with the out-of-hours service per patient after 6 and 12 months.


RESULTS
Analysed by group, intervention patients saw a more pronounced decline in the number of contacts than controls, except for two outcomes. However, this difference was only significant after 12 months. For women aged 17-66 years with 5-9 contacts during the previous 12 months, the decrease was significantly more pronounced in the intervention group for all outcomes (p=0.004-0.042). However, for the rest of the subgroups the effect varied more, and in several cases it was more distinct in the control group.


CONCLUSIONS
The data collected point towards an effect of intervention on the use of out-of-hours services even if the responses obtained were not uniform and unequivocal. However, one has to consider the problems of multiple comparisons and in conclusion no convincing effect of the intervention was found.
Christensen
Morten Bondo
MB
Research Unit and Department of General Practice, University of Aarhus, DK-8000 Aarhus, Denmark. mbc@alm.au.dk
Christensen
Bo
B
Mortensen
Jens Tølbøll
JT
Olesen
Frede
F
D000293:Adolescent; D000328:Adult; D039602:After-Hours Care / Q000706:statistics & numerical data*; D000368:Aged; D002648:Child; D002675:Child, Preschool; D016000:Cluster Analysis; D003718:Denmark / Q000453:epidemiology; D005194:Family Practice / Q000193:education / Q000458:organization & administration / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008875:Middle Aged; D009819:Office Visits / Q000706:statistics & numerical data*; D010342:Patient Acceptance of Health Care