title: Out-of-Hours Care Collaboration between General Practitioners and Hospital Emergency Departments in the Netherlands.
abstract: OBJECTIVE
  In the Netherlands, general practitioners (GPs) and emergency departments (EDs) collaborate increasingly in what is called an Urgent Care Collaboration (UCC). In UCCs, GPs and EDs share 1 combined entrance and joint triage. The objective of this study was to determine if GPs treat a larger proportion of out-of-hours patients in the UCC system, and how this relates to patient characteristics.
  
  
  METHODS
  This observational study compared patients treated within UCCs with patients treated in the usual care setting, that is, GPs and EDs operating separately. Data on the characteristics of the patients, their consultations, and their health problems were derived from electronic medical records. We performed χ(2) tests, independent sample t tests, and multiple logistic regression analyses.
  
  
  RESULTS
  A significantly higher proportion of patients attended their on-call GP within the UCC system. The proportion of ED patients was 22% smaller in UCCs compared to the usual care setting. Controlled for patient and health problem characteristics the difference remained statistically significant (OR=0.69; CI 0.66-0.72) but there were substantial differences between regions. Especially patients with trauma were treated more by general practitioners. Controlled for case mix, patients in the largest UCC-region were 1.2 times more likely to attend a GP than the reference group.
  
  
  CONCLUSIONS
  When GPs and EDs collaborate, GPs take a substantially higher proportion of all out-of-hours patients.
authors.affiliation: From Scientific Center for Transformation in Care and Welfare (Tranzo), Tilburg University, Tilburg, the Netherlands (ESJvG-vR, BRM, DHdB); GP Cooperative Zuidoost Brabant, Eindhoven, the Netherlands (ESJvG-vR, GPW); and The Netherlands Institute for Health Services Research (NIVEL), Utrecht, the Netherlands (CJY, SMB, DHdB). l.vanrooij@spoedpost.nu.
authors.forename: Elisabeth Sybilla Johanna
authors.initials: ES
authors.lastname: van Gils-van Rooij
authors.affiliation: From Scientific Center for Transformation in Care and Welfare (Tranzo), Tilburg University, Tilburg, the Netherlands (ESJvG-vR, BRM, DHdB); GP Cooperative Zuidoost Brabant, Eindhoven, the Netherlands (ESJvG-vR, GPW); and The Netherlands Institute for Health Services Research (NIVEL), Utrecht, the Netherlands (CJY, SMB, DHdB).
authors.forename: Christoffel Joris
authors.initials: CJ
authors.lastname: Yzermans
authors.affiliation: From Scientific Center for Transformation in Care and Welfare (Tranzo), Tilburg University, Tilburg, the Netherlands (ESJvG-vR, BRM, DHdB); GP Cooperative Zuidoost Brabant, Eindhoven, the Netherlands (ESJvG-vR, GPW); and The Netherlands Institute for Health Services Research (NIVEL), Utrecht, the Netherlands (CJY, SMB, DHdB).
authors.forename: Sjoerd Michael
authors.initials: SM
authors.lastname: Broekman
authors.affiliation: From Scientific Center for Transformation in Care and Welfare (Tranzo), Tilburg University, Tilburg, the Netherlands (ESJvG-vR, BRM, DHdB); GP Cooperative Zuidoost Brabant, Eindhoven, the Netherlands (ESJvG-vR, GPW); and The Netherlands Institute for Health Services Research (NIVEL), Utrecht, the Netherlands (CJY, SMB, DHdB).
authors.forename: Berthold Rudy
authors.initials: BR
authors.lastname: Meijboom
authors.affiliation: From Scientific Center for Transformation in Care and Welfare (Tranzo), Tilburg University, Tilburg, the Netherlands (ESJvG-vR, BRM, DHdB); GP Cooperative Zuidoost Brabant, Eindhoven, the Netherlands (ESJvG-vR, GPW); and The Netherlands Institute for Health Services Research (NIVEL), Utrecht, the Netherlands (CJY, SMB, DHdB).
authors.forename: Gerben Paul
authors.initials: GP
authors.lastname: Welling
authors.affiliation: From Scientific Center for Transformation in Care and Welfare (Tranzo), Tilburg University, Tilburg, the Netherlands (ESJvG-vR, BRM, DHdB); GP Cooperative Zuidoost Brabant, Eindhoven, the Netherlands (ESJvG-vR, GPW); and The Netherlands Institute for Health Services Research (NIVEL), Utrecht, the Netherlands (CJY, SMB, DHdB).
authors.forename: Dingenus Herman
authors.initials: DH
authors.lastname: de Bakker
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000458:organization & administration*; D002648:Child; D002675:Child, Preschool; D003299:Cooperative Behavior; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D058006:General Practice / Q000458:organization & administration*; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D055815:Young Adult
keywords: Efficiency; Emergency Medicine; Health Care Systems; Primary Health Care