title: Implementation of a general practitioner cooperative adjacent to the emergency department of a hospital increases the caseload for the GPC but not for the emergency department.
abstract: BACKGROUND
  The implementation of general practitioner cooperatives (GPC) for out-of-hours (OOH) primary care, raises the question if the location of a GPC adjacent to a hospital reduces the OOH caseload of the emergency department (ED).
  
  
  METHODS
  Two natural experiments were used in this before-after study, the effect of the implementation of two GPCs in two different regions on the out-of-hours caseload of the local EDs was compared. One GPC was located adjacent to the ED of a general hospital, the other was not. GPCs (or rota systems) and EDs in comparable regions were selected as control groups during the same study period. The study was performed in Flanders (Belgium) with no gatekeeping function for general practitioners (GPs).
  
  
  RESULTS
  After implementation of the GPC there was a significantly increase in caseload at the GPC in the two regions, mainly due to an increase of consultations with small children. There were no significant changes in caseload at the ED services. Self-referrals' to the ED did not change significantly. For the GPs the number of home visits decreased during out-of-hours in one region.
  
  
  CONCLUSIONS
  In a country with no gatekeeping role for GPs, implementing a GPC increased the out-of-hours caseload of the GPCs. The caseload of the EDs stabilised during the study period.
authors.affiliation: a Faculty of Medicine and Health Sciences, Department of General Practice - Primary and Interdisciplinary Care , University of Antwerp , Antwerp , Belgium.
authors.forename: Annelies
authors.initials: A
authors.lastname: Colliers
authors.affiliation: a Faculty of Medicine and Health Sciences, Department of General Practice - Primary and Interdisciplinary Care , University of Antwerp , Antwerp , Belgium.
authors.forename: Roy
authors.initials: R
authors.lastname: Remmen
authors.affiliation: a Faculty of Medicine and Health Sciences, Department of General Practice - Primary and Interdisciplinary Care , University of Antwerp , Antwerp , Belgium.
authors.forename: Marie-Luise
authors.initials: ML
authors.lastname: Streffer
authors.affiliation: a Faculty of Medicine and Health Sciences, Department of General Practice - Primary and Interdisciplinary Care , University of Antwerp , Antwerp , Belgium.
authors.forename: Barbara
authors.initials: B
authors.lastname: Michiels
authors.affiliation: a Faculty of Medicine and Health Sciences, Department of General Practice - Primary and Interdisciplinary Care , University of Antwerp , Antwerp , Belgium.
authors.forename: Stefaan
authors.initials: S
authors.lastname: Bartholomeeusen
authors.affiliation: a Faculty of Medicine and Health Sciences, Department of General Practice - Primary and Interdisciplinary Care , University of Antwerp , Antwerp , Belgium.|b Emergency Department , Antwerp University Hospital , Edegem , Belgium.
authors.forename: Koenraad G
authors.initials: KG
authors.lastname: Monsieurs
authors.affiliation: c General Practice Cooperative Antwerp North , Merksem , Belgium.
authors.forename: Jef
authors.initials: J
authors.lastname: Goris
authors.affiliation: a Faculty of Medicine and Health Sciences, Department of General Practice - Primary and Interdisciplinary Care , University of Antwerp , Antwerp , Belgium.
authors.forename: Samuel
authors.initials: S
authors.lastname: Coenen
authors.affiliation: a Faculty of Medicine and Health Sciences, Department of General Practice - Primary and Interdisciplinary Care , University of Antwerp , Antwerp , Belgium.
authors.forename: Veronique
authors.initials: V
authors.lastname: Verhoeven
authors.affiliation: a Faculty of Medicine and Health Sciences, Department of General Practice - Primary and Interdisciplinary Care , University of Antwerp , Antwerp , Belgium.
authors.forename: Hilde
authors.initials: H
authors.lastname: Philips
mesh_terms: D039602:After-Hours Care / Q000458:organization & administration / Q000706:statistics & numerical data*; D000368:Aged; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D058006:General Practice / Q000458:organization & administration / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D011320:Primary Health Care / Q000706:statistics & numerical data*
keywords: Emergency department; Health services accessibility; Organisation; Out-of-hours care; Primary Care