The Transformation of out of hours Primary Medical Care Delivery and its Effect on Client Satisfaction

摘要

Background Systems for providing out of hours primary medical care have changed significantly in Europe over the last twenty years. Clients now rarely see their own family doctor for out of hours care, which is largely managed by family doctor out ofhours cooperatives. Objectives The primary objective of this study was to examine client satisfaction with out of hours care provided by a family doctor cooperative. The secondary objective of this study was to investigate the impact of age, gender, socio-economic status, health status, rurality status and call outcome on clients' satisfaction with this new form of out of hours care. Methods All clients contacting the service over a designated 24-day period were forwarded a postal questionnaire. HealthStatus was recorded using the Short Form-12 (SF-12) health survey. Clients' satisfaction was measured by using a version of the McKinley questionnaire. Results The response rate was 55% (531/966). Overall satisfaction levels were high with 88% of clientsrating the service as either excellent or good. Logistic regression, modelling for the simultaneous effects of age, gender, socio-economic status, call outcome and health status on overall satisfaction found that client's age, gender, rurality status and call outcome did not significantly affect overall satisfaction levels. Clients with lower physical and mental health status scores were significantly less likely to be satisfied with their out of hours care (Odds ratio 1.04 [95% CI 1.01-1.07], p=0.017and 1.03 [95% CI 1.00-1.06], p=0.046 respectively). Discussion Family doctor cooperatives have significantly altered the way out of hours care is delivered yet the findings of this study provide reassurance to those concerned about the impact on client satisfaction of out of hours care provided by a family doctor cooperative. This finding has important implications for the future planning of out of hours primary care services and may provide a blueprint and stimulus for potential change within out of hours veterinary practice.