title: Analysis of users and reasons for use of a physician-on-call service in an Italian local health unit.
abstract: In recent years, several countries have proposed changes to primary care organisation.
  
  
  
  Our study investigated the characteristics of 'physician-on-call' usage in a local health unit of Lombardy (ASL MI1).
  
  
  
  We analysed the incoming calls to the Operative Medical Central Station and collected the user characteristics, the call reasons and the outcomes from 1 October to 31 December 2012. Then, we randomly extracted 10% of the call sample from this period. We focused on two outputs: telephone advice (TA) and emergency department referral. We fit a logistic regression model to identify potential predictors of these outputs.
  
  
  
  In total, we evaluated 2146 calls. Women made most of the calls. Older age was associated with the referral to emergency care [adjusted odds ratio (aOR) 3.1], while paediatric calls were associated with TA (aOR 1.9). Information requests were related to TA (aOR 2.3), while cardiovascular symptoms (aOR 3.5), pain (aOR 2.6) and traumas (aOR 4.7) were linked to emergency care.
  
  
  
  Our study outlined the increasing use of TA, particularly for calls regarding paediatric patients. In contrast, calls for elderly patients were more frequently referred to emergency care. These findings led to the implementation of an age-targeted educational programme. Overall, our observations highlighted that women used the physician-on-call service more frequently than men. Furthermore, some reasons for calling were significantly associated with emergency care.
authors: Department of Primary Care, ASL MI1, Milan, Italy.
authors: Alessandra
authors: A
authors: Colombo
authors: Department of Public Health, University of Torino, Torino, Italy, fabrizio.bert@unito.it.
authors: Fabrizio
authors: F
authors: Bert
authors: Department of Public Health, University of Torino, Torino, Italy.
authors: Elisa
authors: E
authors: Camussi
authors: Department of Public Health, University of Torino, Torino, Italy.
authors: Maria Rosaria
authors: MR
authors: Gualano
authors: Department of Primary Care, ASL MI1, Milan, Italy.
authors: Domenico
authors: D
authors: Arensi
authors: Risk Management, ASL MI1, Milan, Italy.
authors: Domenico
authors: D
authors: Castaldo
authors: Department of Public Health, University of Torino, Torino, Italy.
authors: Roberta
authors: R
authors: Siliquini
authors: Department of Primary Care, ASL MI1, Milan, Italy.
authors: Maria Elena
authors: ME
authors: Pirola
mesh_terms: D000293:Adolescent; D000328:Adult; D039602:After-Hours Care / Q000706:statistics & numerical data*; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D037001:Directive Counseling; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006792:House Calls / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007558:Italy; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000458:organization & administration*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012737:Sex Factors; D017216:Telemedicine / Q000706:statistics & numerical data*; D013689:Telephone; D013997:Time Factors; D055815:Young Adult
keywords: Emergency; organisation; out-of-hour services; physician-on-call; primary care; telephone consultations.