title: The impact of standalone call centres and GP cooperatives on access to after hours GP care: a before and after study adjusted for secular trend.
abstract: BACKGROUND
  The After Hours Primary Medical Trials were initiated by the Australian government to redress difficulties in after hours (AH) GP care in areas of high need. The study's objective is to study the impact of two standalone call centres and one GP cooperative offering comprehensive services, in improving consumer access to services for residents of a defined geographic area.
  
  
  METHODS
  A pre-post design was used to evaluate their impact after adjusting for secular trend at a national level. Access was considered in terms of availability, accessibility, affordability, acceptability and responsiveness of care. Unmet need and ease of obtaining AH telephone professional medical advice were also considered. Pre-trial and post-trial telephone surveys of two separate random samples of approximately 350 households using AH services in each trial area as well as in a national sample outside the trial areas.
  
  
  RESULTS
  Consumer acceptability and affordability increased in residents in the area served by the GP cooperative. Access, however measured, did not improve in either of the standalone call centre areas. Reduction in unmet need approached but did not achieve statistical significance in most but not all trial areas.
  
  
  CONCLUSIONS
  Improvements in access in the GP cooperative conformed to expectations based on current and pre-existing AH care arrangements put in place. Absence of improvements in access in the standalone call centres did not conform to expectations but may be partly explained by the reductions in consumer acceptability, following introduction of telephone triage systems reported elsewhere.
authors.affiliation: Program Evaluation Unit, School of Population Health, University of Melbourne, Victoria, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Dunt
authors.forename: Susan E
authors.initials: SE
authors.lastname: Day
authors.forename: Margaret
authors.initials: M
authors.lastname: Kelaher
authors.forename: Michael
authors.initials: M
authors.lastname: Montalto
mesh_terms: D000328:Adult; D039602:After-Hours Care / Q000458:organization & administration*; D001315:Australia; D005194:Family Practice / Q000458:organization & administration*; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000458:organization & administration*; D015277:Hotlines / Q000706:statistics & numerical data*; D006801:Humans; D007253:Information Centers; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D013689:Telephone