title: After-hours services in capitation-funded primary care practice: use and satisfaction.
abstract: OBJECTIVE
  To examine patients' use of and satisfaction with the nurse-staffed Telephone Health Advisory Service (THAS) and physician after-hours care in a rostered Family Health Organization, as well as physicians' satisfaction with both types of services.
  
  
  METHODS
  Cross-sectional telephone survey.
  
  
  METHODS
  A Family Health Organization in Hamilton, Ont.
  
  
  METHODS
  Nineteen family physicians and their patients who used an after-hours service during 9 selected weeks between March and December of 2007.
  
  
  METHODS
  Distribution of encounters directed to the on-call physician or to the THAS; types of health problems; and patient and physician satisfaction.
  
  
  RESULTS
  A total of 817 calls were recorded from 774 patients. Of these patients, 606 were contacted and 94.4% (572/606) completed encounter-specific surveys: 358 completed the on-call physician survey and 214 completed the THAS survey. Mean age of respondents was 40.8 years; most were women, and approximately one-third called on behalf of children. Most calls (66.8%, 546/817) were made directly to the on-call physicians. The most common problems were respiratory (34.3%, 271/789), gastrointestinal (10.1%, 80/789), and genitourinary (9.3%, 73/789). Most patients reported being very satisfied with the after-hours care provided by the THAS (62.5%, 125/200) or the on-call physicians (70.9%, 249/351). Almost all callers who bypassed the THAS knew about it (89.8%, 316/352), but either felt their problems were too serious or wished to talk to a physician. Most physicians agreed or strongly agreed that they were satisfied with their colleagues' on-call care (81.0%, 17/21); 47.6% (10/21) agreed that the THAS was helpful in managing on-call duty.
  
  
  CONCLUSIONS
  When direct after-hours physician contact is available, a minority of patients uses a nurse-staffed triage. Physicians find the arrangements onerous and would prefer to see after-hours care managed and remunerated differently.
authors.affiliation: Department of Family Medicine at McMaster University, Hamilton, Ont. ineimani@mcmaster.ca
authors.forename: Ieva
authors.initials: I
authors.lastname: Neimanis
authors.forename: Janusz
authors.initials: J
authors.lastname: Kaczorowski
authors.forename: Michelle
authors.initials: M
authors.lastname: Howard
mesh_terms: D000328:Adult; D039602:After-Hours Care / Q000592:standards / Q000706:statistics & numerical data*; D001294:Attitude to Health; D002204:Capitation Fee / Q000706:statistics & numerical data*; D004632:Emergency Medical Services / Q000458:organization & administration / Q000592:standards; D005194:Family Practice / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017146:Models, Organizational; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D057184:Practice Patterns, Nurses' / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000592:standards*