Why do patients call out-of-hours following a recent consultation with their GP? A qualitative study in one general practice.

Abstract

BACKGROUND: The reasons for the increase in demand for out-of-hours primary care are not clear. OBJECTIVES: We aimed to elicit the proportion of patients who call out-of-hours within 2 days of a GP consultation, and to explore the reasons for the out-of-hours call. METHOD: In one inner-city general practice, details were collected of all out-of-hours calls, over a 6-week period. Patients who called out-of-hours within 2 days of a GP consultation were identified and interviewed. Twenty semi-structured interviews were analysed using standard qualitative techniques. RESULTS: Fifteen per cent of the out-of-hours calls occurred within 2 days of a GP consultation. The reasons for the calls recorded by the doctor out-of-hours and described by the patient at interview were similar. In two-thirds of cases the calls were related to the initial problem, but there was no evidence suggesting dissatisfaction with the first contact as a reason for the call. Less than a quarter of calls were for ongoing acute medical problems, and a quarter were about medication prescribed at the first consultation. A third of the patients had mental health problems with other physical, social and emotional problems. Many of this group were high users of this and other health services, including accident and emergency and private medicine. Some people called with specific queries or were seeking general information to enhance their understanding of illness. CONCLUSION: This small study in one inner-city practice indicates that patients do not appear to call out-of-hours due to dissatisfaction with a previous consultation. There seems to be a wide variety of reasons why this pattern of service use occurs. The diversity of patients and problems and the prevalence of people with multiple problems highlights current challenges in inner-city primary health care.