title: General practice cooperatives: long waiting times for home visits due to long distances?
abstract: BACKGROUND
  The introduction of large-scale out-of-hours GP cooperatives has led to questions about increased distances between the GP cooperatives and the homes of patients and the increasing waiting times for home visits in urgent cases. We studied the relationship between the patient's waiting time for a home visit and the distance to the GP cooperative. Further, we investigated if other factors (traffic intensity, home visit intensity, time of day, and degree of urgency) influenced waiting times.
  
  
  METHODS
  Cross-sectional study at four GP cooperatives. We used variance analysis to calculate waiting times for various categories of traffic intensity, home visit intensity, time of day, and degree of urgency. We used multiple logistic regression analysis to calculate to what degree these factors affected the ability to meet targets in urgent cases.
  
  
  RESULTS
  The average waiting time for 5827 consultations was 30.5 min. Traffic intensity, home visit intensity, time of day and urgency of the complaint all seemed to affect waiting times significantly. A total of 88.7% of all patients were seen within 1 hour. In the case of life-threatening complaints (U1), 68.8% of the patients were seen within 15 min, and 95.6% of those with acute complaints (U2) were seen within 1 hour. For patients with life-threatening complaints (U1) the percentage of visits that met the time target of 15 minutes decreased from 86.5% (less than 2.5 km) to 16.7% (equals or more than 20 km).
  
  
  CONCLUSIONS
  Although home visits waiting times increase with increasing distance from the GP cooperative, it appears that traffic intensity, home visit intensity, and urgency also influence waiting times. For patients with life-threatening complaints waiting times increase sharply with the distance.
authors.affiliation: Centre for Quality of Care Research (WOK), Radboud University Nijmegen Medical Centre, KWAZO 114, Nijmegen, The Netherlands. P.Giesen@voha.umcn.nl
authors.forename: Paul
authors.initials: P
authors.lastname: Giesen
authors.forename: Nieke
authors.initials: N
authors.lastname: van Lin
authors.forename: Henk
authors.initials: H
authors.lastname: Mokkink
authors.forename: Wil
authors.initials: W
authors.lastname: van den Bosch
authors.forename: Richard
authors.initials: R
authors.lastname: Grol
mesh_terms: D039602:After-Hours Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D019058:Community Networks / Q000458:organization & administration* / Q000706:statistics & numerical data; D003299:Cooperative Behavior; D003430:Cross-Sectional Studies; D004630:Emergencies / Q000145:classification; D005194:Family Practice / Q000458:organization & administration* / Q000706:statistics & numerical data; D019538:Health Care Surveys; D006297:Health Services Accessibility; D006792:House Calls / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D009426:Netherlands; D013689:Telephone; D013997:Time Factors; D014186:Transportation; D014218:Triage; D014850:Waiting Lists