title: General practitioners' satisfaction with and attitudes to out-of-hours services.
abstract: BACKGROUND
  In recent years, Dutch general practitioner (GP) out-of-hours service has been reorganised into large-scale GP cooperatives. Until now little is known about GPs' experiences with working at these cooperatives for out-of-hours care. The purpose of this study is to gain insight into GPs' satisfaction with working at GP cooperatives for out-of-hours care in separated and integrated cooperatives.
  
  
  METHODS
  A GP cooperative separate from the hospital Accident and Emergency (A&E) department, and a GP cooperative integrated within the A&E department of another hospital. Both cooperatives are situated in adjacent geographic regions in the South of The Netherlands. One hundred GPs were interviewed by telephone; fifty GPs working at the separated GP cooperative and fifty GPs from the integrated GP cooperative. Opinions on different aspects of GP cooperatives for out-of-hours care were measured, and regression analysis was performed to investigate if these could be related to GP satisfaction with out-of-hours care organisation.
  
  
  RESULTS
  GPs from the separated model were more satisfied with the organisation of out-of-hours care than GPs from the integrated model (70 vs. 60 on a scale score from 0 to 100; P = 0.020). Satisfaction about out-of-hours care organisation was related to opinions on workload, guarantee of gatekeeper function, and attitude towards out-of-hours care as being an essential part of general practice. Cooperation with medical specialists was much more appreciated at the integrated model (77 vs. 48; P < 0.001) versus the separated model.
  
  
  CONCLUSIONS
  GPs in this study appear to be generally satisfied with the organisation of GP cooperatives for out-of-hours care. Furthermore, GPs working at the separated cooperative seem to be more satisfied compared to GPs working at the integrated cooperative.
authors.affiliation: Department of Integrated Care, Research Institute Caphri, University Hospital Maastricht, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands. caro.vanuden@hag.unimaas.nl
authors.forename: Caro J T
authors.initials: CJ
authors.lastname: van Uden
authors.forename: Fred H M
authors.initials: FH
authors.lastname: Nieman
authors.forename: Gemma B W E
authors.initials: GB
authors.lastname: Voss
authors.forename: Geertjan
authors.initials: G
authors.lastname: Wesseling
authors.forename: Ron A G
authors.initials: RA
authors.lastname: Winkens
authors.forename: Harry F J M
authors.initials: HF
authors.lastname: Crebolder
mesh_terms: D000328:Adult; D039602:After-Hours Care; D001071:Appointments and Schedules; D001291:Attitude of Health Personnel; D003299:Cooperative Behavior; D019033:Delivery of Health Care, Integrated; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005194:Family Practice / Q000458:organization & administration; D005260:Female; D006801:Humans; D007400:Interprofessional Relations; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010821:Physicians, Family / Q000523:psychology*; D012017:Referral and Consultation; D011795:Surveys and Questionnaires