title: Use of out-of-hours services: the patient's point of view on co-payment a mixed methods approach.
abstract: BACKGROUND
  In many countries out of hours (OOH) care is offered by different health care services. General practitioners (GP) tend to offer services in competition with emergency departments (ED). Patients behaviour depends on a number of factors. In this study, we highlight the knowledge and ideas of patients concerning the co-payment system.
  
  
  METHODS
  We used a mixed methods design, combining quantitative and qualitative research. During two weekends in January 2005, all patients using the ED or the GP OOH service, were invited for an interview with a structured questionnaire. A stratified random sample of patients participated in a semi-structured interview. Both methods add complementary data to answer the research questions.
  
  
  RESULTS
  Most mentioned reasons for seeking help at the ED are: accessibility (15.0%), proximity (6.4%) and competence of the staff (5.6%). Reasons for choosing the GP are: GP is easy to find, minor medical problem or anxiety and confidence in the GP. The odds of not knowing the co-payment system are significantly higher in patients visiting the ED (OR 1.783; 95% CI: 1.493-2.129). Mostly GP users recognize the problem of ED overuse. They suggested especially to provide clear information about the tasks of the different services and about the payment system, to reduce ED overuse.
  
  
  CONCLUSIONS
  When intending to shift from ED to GP services for minor medical problems, aiming at just one measure is no option. Information campaigns aiming to address the entire population, can clarify the role of each player in out-of-hours care.
authors.affiliation: Department of Primary and Interdisciplinary Care of the University of Antwerp, Belgium (PICA-UA), Wilrijk, Belgium. Hilde.philips@ua.ac.be
authors.forename: H
authors.initials: H
authors.lastname: Philips
authors.forename: R
authors.initials: R
authors.lastname: Remmen
authors.forename: P
authors.initials: P
authors.lastname: De Paepe
authors.forename: W
authors.initials: W
authors.lastname: Buylaert
authors.forename: P
authors.initials: P
authors.lastname: Van Royen
mesh_terms: D000293:Adolescent; D000328:Adult; D039602:After-Hours Care / Q000191:economics / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D001530:Belgium; D002648:Child; D002675:Child, Preschool; D002755:Choice Behavior; D004632:Emergency Medical Services / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D058006:General Practice / Q000706:statistics & numerical data; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006300:Health Services Misuse / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000191:economics / Q000706:statistics & numerical data*; D036301:Qualitative Research; D012051:Reimbursement Mechanisms / Q000191:economics; D011795:Surveys and Questionnaires; D055815:Young Adult