title: Streamline triage and manage user expectations: lessons from a qualitative study of GP out-of-hours services.
abstract: BACKGROUND
  Several models of GP out-of-hours provision exist in the UK but there is little detail about their effectiveness to meet users' needs and expectations.
  
  
  OBJECTIVE
  To explore users' needs, expectations, and experiences of out-of-hours care, and to identify proposals for service redesign.
  
  
  METHODS
  Service providers in urban (GP cooperative), mixed (hospital based), rural (private) locations in Wales.
  
  
  METHODS
  Sixty recent service users or carers (20 in each location).
  
  
  METHODS
  Semi-structured telephone interviews; thematic analysis.
  
  
  RESULTS
  Users' concerns were generally consistent across the three different services. Efficiency was a major concern, with repetitive triage procedures and long time delays at various stages in the process being problematic. Access to a doctor when required was also important to users, who perceived an obstructive gatekeeping function of preliminary contacts. Expectations moderated the relationship between user concerns and satisfaction. Where expectations of outcome were unfulfilled, participants reported greater likelihood of reconsulting with the same or alternative services for the same illness episode. Accurate expectations concerning contacts with the next administrative, nursing, or medical staff professional were managed by appropriate information provision.
  
  
  CONCLUSIONS
  Users require more streamlined and flexible triage systems. Their expectations need to be understood and incorporated into how services advise and provide services for users, and actively managed to meet the aims of both enhancing satisfaction and enabling users to cope with their condition. Better information and education about services are needed if users are to derive the greatest benefit and satisfaction. This may influence choices about using the most appropriate forms of care.
authors.affiliation: Department of Primary Care and Public Health, School of Medicine, Cardiff University, Cardiff, UK.
authors.forename: Jennifer N
authors.initials: JN
authors.lastname: Egbunike
authors.forename: Chris
authors.initials: C
authors.lastname: Shaw
authors.forename: Alison
authors.initials: A
authors.lastname: Porter
authors.forename: Lori A
authors.initials: LA
authors.lastname: Button
authors.forename: Paul
authors.initials: P
authors.lastname: Kinnersley
authors.forename: Kerry
authors.initials: K
authors.lastname: Hood
authors.forename: Sue
authors.initials: S
authors.lastname: Bowden
authors.forename: Sue
authors.initials: S
authors.lastname: Bale
authors.forename: Helen
authors.initials: H
authors.lastname: Snooks
authors.forename: Adrian
authors.initials: A
authors.lastname: Edwards
mesh_terms: D000328:Adult; D039602:After-Hours Care / Q000458:organization & administration / Q000592:standards*; D002648:Child; D002675:Child, Preschool; D003266:Continuity of Patient Care / Q000592:standards; D005194:Family Practice / Q000458:organization & administration / Q000592:standards*; D006801:Humans; D007223:Infant; D007407:Interviews as Topic; D017060:Patient Satisfaction; D014218:Triage / Q000458:organization & administration / Q000592:standards*; D014852:Wales