title: Daytime use of general practice and use of the out-of-hours primary care service for patients with chronic disease: a cohort study.
abstract: BACKGROUND
  The importance of proactive chronic care has become increasingly evident. Yet, it is unknown whether the use of general practice (GP) during daytime may affect the use of Out-of-Hours (OOH) Primary Care Service for people with chronic disease. We aimed to analyse the association between use of daytime general practice (GP) and use of OOH services for heart disease, lung disease, diabetes, psychiatric disease, or cancer. In particular, we intended to study the association between OOH contacts due to chronic disease exacerbation and recent use of daytime GP.
  
  
  METHODS
  Data comprised a random sample of contacts to the OOH services ('LV-KOS2011'). Included patients were categorised into the following chronic diseases: heart disease, lung disease, diabetes, psychiatric disease, or cancer. Information on face-to-face contacts to daytime GP was obtained from the Danish National Health Insurance Service Registry and information about exacerbation or new episodes from the LVKOS2011 survey. Associations between number of regular daytime consultations and annual follow-up consultations during one, three, six, and 12 months prior to index contacts, and outcomes of interest were estimated by using logistic regression.
  
  
  RESULTS
  In total, 11,897 patients aged ≥ 18 years were included. Of these, 2,665 patients (22.4%) were identified with one of the five selected chronic diseases; 673 patients (5.7%) had two or more. A higher odds ratio (OR) for exacerbation as reason for encounter (RFE) at the index contact was observed among patients with psychiatric disease (OR = 2.15) and cancer (OR = 2.17) than among other patients for ≥2 daytime recent contacts. When receiving an annual follow-up, exacerbation OR at index contact lowered for patients with lung disease (OR = 0.68), psychiatric disease (OR = 0.42), or ≥2 diseases (OR = 0.61).
  
  
  CONCLUSIONS
  Recent and frequent use of daytime GP for patients with the selected chronic diseases was associated with contacts to the OOH services due to exacerbation. These findings indicate that the most severely chronically ill patients tend to make more use of general practice. The provision of an annual follow-up daytime GP consultation may indicate a lower risk of contacting OOH due to exacerbation.
authors.affiliation: Department of Public Health, Research Unit for General Practice, Aarhus University, DK-Bartholins Allé 8000 Aarhus C, Aarhus, Denmark. lone.flarup@feap.dk.
authors.forename: Lone
authors.initials: L
authors.lastname: Flarup
authors.forename: Grete
authors.initials: G
authors.lastname: Moth
authors.forename: Morten Bondo
authors.initials: MB
authors.lastname: Christensen
authors.forename: Mogens
authors.initials: M
authors.lastname: Vestergaard
authors.forename: Frede
authors.initials: F
authors.lastname: Olesen
authors.forename: Peter
authors.initials: P
authors.lastname: Vedsted
mesh_terms: D000208:Acute Disease / Q000628:therapy*; D000293:Adolescent; D000328:Adult; D039602:After-Hours Care / Q000706:statistics & numerical data*; D000368:Aged; D001071:Appointments and Schedules; D002908:Chronic Disease / Q000628:therapy*; D015331:Cohort Studies; D003718:Denmark; D003920:Diabetes Mellitus / Q000628:therapy; D018450:Disease Progression; D005260:Female; D058006:General Practice / Q000706:statistics & numerical data*; D006331:Heart Diseases / Q000628:therapy; D006801:Humans; D008171:Lung Diseases / Q000628:therapy; D008297:Male; D001523:Mental Disorders / Q000628:therapy; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy; D011320:Primary Health Care / Q000706:statistics & numerical data*; D055815:Young Adult