Peer-reviewed article
Out-of-hours services in Zealand, Denmark. Consequences of changeover from GP-cooperative to integrated deputized services. A retrospective cohort study.
Stig Nikolaj Fasmer Blomberg, Hauraz Haji, Ole Mazur Hendriksen, Mai-Britt Hägi-Pedersen, Helle Collatz Christensen ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examines how out-of-hours medical services in Denmark changed when they shifted from a GP cooperative model to an integrated regional service called 1818. The research analyzed patient data from 2017 to 2023 and found that overall patient visits declined over this period, with emergency department admissions also decreasing in absolute numbers. The study notes that face-to-face consultations and home visits were more common under the original GP system and were associated with higher admission rates.
Key points
- Patient pathway volumes declined from 412,116 in 2017 to 314,879 in 2022
- Emergency department admissions fell from 64,555 to 59,967 over the study period
- The 1818 service showed higher proportion of ED admissions within 24 hours (19.0% vs. 17.6%)
- GP out-of-hours service had higher rates of face-to-face consultations (31.4% vs. 27.1%) and home visits (9.4% vs. 3.4%)
- Admissions rate fell from 8.2 per 100,000 inhabitants to 7.1 per 100,000 inhabitants
Limitations
This study focuses on health service organization and patient pathways in adult populations, with a median patient age of 35 years. It does not specifically measure child health outcomes or well-being and does not evaluate interventions designed to improve children's health or development.
Abstract
OBJECTIVES: Out-of-hours services (OOHS) worldwide exhibit diverse organisational models, especially within the European Union. This study aims to describe the transformation of OOHS in Region Zealand, Denmark, from a General Practitioner cooperative (GP-OOHS) to a regional organization/service, known as the 1818 Medical Helpline (1818). STUDY DESIGN: Retrospective cohort study. METHODS: GP-OOHS data (January 2017-October 2023) during the transition from GP-cooperative to Regional Service (October 2022) were analysed. Coded and timestamped services retrieved from the billing system were used to identify patient pathways, defined as services within a 12-hour window. Descriptive statistics were applied. RESULTS: A total of 2,572,951 patient pathways were recorded, with 2,258,072 under GP-out-of-hours service and 314,879 under the 1818. Overall, patient pathway volumes declined from 412,116 in 2017 to 314,879 in 2022, and admissions fell from 64,555 to 59,967. The median patient age was 35 years. The GP-out-of-hours service had a higher average monthly volume of patient pathways (32,726 vs. 25,940), while 1818 showed a higher proportion of emergency department admissions within 24 h (19.0% vs. 17.6%), the number of admissions fell from 8.2 per 100,000 inhabitants to 7.1 per 100,000 inhabitants. Interrupted time series analysis showed that the previously increasing tendency in ED admissions flattened following the transition. Although the absolute number of children admitted decreased, the proportion of admissions increased due to overall decline in patient pathways. Face-to-face consultations (31.4% vs. 27.1%) and home visits (9.4% vs. 3.4%) were more frequent in GP-out-of-hours service, both being associated with higher admission rates. CONCLUSIONS: OOHS patient pathways declined over the study period and continued to decline following the organizational change. The absolute number of emergency department admissions also decreased, while the relative proportion of admissions increased. These findings indicate a continued decline in OOHS activity and a slight shift toward more acute cases after the reorganisation.