title: Quality of after-hours primary care in The Netherlands: adherence to national guidelines.
abstract: OBJECTIVE
  To assess the quality of after-hours clinical care as delivered by general practitioner (GP) cooperatives in The Netherlands.
  
  
  METHODS
  A cross-sectional analysis was undertaken of patient health records of five GP cooperatives during 1 year. We used quality indicators derived from national guidelines for the appropriate prescription of pain medication and antibiotics, clinical performance in emergency cases and referral to medical specialists. Data were collected from electronic health records.
  
  
  RESULTS
  We analysed 7660 patient contacts. Average adherence to the guidelines was 77%. The guidelines on referrals to medical specialists and prescription of pain medication had the highest adherence scores (92% and 90%, respectively). Prescribing antibiotics and treatment in emergency cases had the lowest scores (69% and 71%, respectively). Antibiotics were overprescribed in 42% of the cases and underprescribed in 21%.
  
  
  CONCLUSIONS
  In general, GPs adhered well to after-hours service national guidelines. There is room for improvement in care for people with acute illnesses and in the prescription of antibiotics.
authors.affiliation: IQ Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, PO Box 9101, IQ healthcare 114, 6500 HB Nijmegen, The Netherlands.
authors.forename: Maartje
authors.initials: M
authors.lastname: Willekens
authors.forename: Paul
authors.initials: P
authors.lastname: Giesen
authors.forename: Erik
authors.initials: E
authors.lastname: Plat
authors.forename: Henk
authors.initials: H
authors.lastname: Mokkink
authors.forename: Jako
authors.initials: J
authors.lastname: Burgers
authors.forename: Richard
authors.initials: R
authors.lastname: Grol
mesh_terms: D000328:Adult; D039602:After-Hours Care / Q000592:standards*; D003430:Cross-Sectional Studies; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D016347:Medical Records Systems, Computerized; D008875:Middle Aged; D009426:Netherlands; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000592:standards*; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care / Q000706:statistics & numerical data*