General practice consultation patterns and patient factors predicting older patients' use of out-of-hours services: a nationwide register-based cohort study.

Abstract

Out-of-hours primary care services cannot provide the same continuity and coordination of care as daytime general practice. Thus, patients with high risk of complex care trajectories should, when possible, be seen by the GP during daytime opening hours. However, little is known about how provision of daytime consultation services affects older patients' out-of-hours healthcare seeking. To analyse how patient characteristics and general practices' patterns of daytime consultations relates to their older patients' use of out-of-hours services. This was a register-based cohort study of all Danish citizens aged ≥75 years in the Northern, Central, Southern, and Zealand Region of Denmark in 2017-2021. The general practices' frequencies of daytime consultations were adjusted for patient population characteristics. Latent profile analysis identified group patterns of daytime consultation types and frequencies. Zero-inflated Poisson regression was used to analyse how patient characteristics and practice pattern of daytime consultations were associated with older patients' use of out-of-hours primary care. Increasing age, multimorbidity, number of drugs, level of home healthcare services, and non-Western ethnicity were associated with being a user of out-of-hours services and higher frequency of consultations. Older patients in the general practices that provided substantially more daytime consultations than most general practices had no fewer consultations in out-of-hours primary care services. Use of out-of-hours primary care services depends more on patient characteristics than general practice organisation of daytime consultations. The findings suggest that increasing the number of daytime consultations may not reduce use of out-of-hours services.