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Influence of general practice opening hours on delay in seeking medical attention after transient ischaemic attack (TIA) and minor stroke: prospective population based study.

Lasserson DS, Chandratheva A, Giles MF, Mant D, Rothwell PM - BMJ (2008)

Bottom Line: Median (interquartile range) time to call a general practitioner after events out of hours was 24.8 (9.0-54.5) hours for patients who waited to contact their registered practice compared with 1.0 (0.3-2.6) hour in those who used an emergency general practitioner service (P<0.001).In patients with events out of hours who waited to see their own general practitioner, seeking attention within 24 hours was considerably less likely for events at weekends than weekdays (odds ratio 0.10, 95% confidence interval 0.05 to 0.21): 70% with events Monday to Friday, 33% on Sundays, and none on Saturdays.A primary care centre open 8 am-8 pm seven days a week would have offered cover to 73 patients who waited until surgery hours to call their general practitioner, reducing median delay from 50.1 hours to 4.0 hours in that group and increasing those calling within 24 hours from 34% to 68%.

View Article: PubMed Central - PubMed

Affiliation: Department of Primary Health Care, University of Oxford, Headington, Oxford OX3 7LF. daniel.lasserson@dphpc.ox.ac.uk

ABSTRACT

Objective: To assess the influence of general practice opening hours on healthcare seeking behaviour after transient ischaemic attack (TIA) and minor stroke and feasibility of clinical assessment within 24 hours of symptom onset.

Design: Population based prospective incidence study (Oxford vascular study).

Setting: Nine general practices in Oxfordshire.

Participants: 91 000 patients followed from 1 April 2002 to 31 March 2006.

Main outcome measures: Events that occurred overnight and at weekends (out of hours) and events that occurred during surgery hours.

Results: Among 359 patients with TIA and 434 with minor stroke, the median (interquartile range) time to call a general practitioner after an event during surgery hours was 4.0 (1.0-45.5) hours, and 68% of patients with events during surgery hours called within 24 hours of onset of symptoms. Median (interquartile range) time to call a general practitioner after events out of hours was 24.8 (9.0-54.5) hours for patients who waited to contact their registered practice compared with 1.0 (0.3-2.6) hour in those who used an emergency general practitioner service (P<0.001). In patients with events out of hours who waited to see their own general practitioner, seeking attention within 24 hours was considerably less likely for events at weekends than weekdays (odds ratio 0.10, 95% confidence interval 0.05 to 0.21): 70% with events Monday to Friday, 33% on Sundays, and none on Saturdays. Thirteen patients who had events out of hours and did not seek emergency care had a recurrent stroke before they sought medical attention. A primary care centre open 8 am-8 pm seven days a week would have offered cover to 73 patients who waited until surgery hours to call their general practitioner, reducing median delay from 50.1 hours to 4.0 hours in that group and increasing those calling within 24 hours from 34% to 68%.

Conclusions: General practitioners' opening hours influence patients' healthcare seeking behaviour after TIA and minor stroke. Current opening hours can increase delay in assessment. Improved access to primary care and public education about the need for emergency care are required if the relevant targets in the national stroke strategy are to be met.

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Related in: MedlinePlus

Fig 2 Delay in calling regular general practitioner after TIA or minor stroke occurring out of hours
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fig2: Fig 2 Delay in calling regular general practitioner after TIA or minor stroke occurring out of hours

Mentions: Figure 1 shows the number of patients with out of hours events who called within successive two hour time intervals after their registered practice opened. Most (70%) of the patients who waited to call their general practitioner did so within two hours of the practice opening. Figure 2 shows the delay to calling the registered practice after an out of hours event for the first 72 hours after events. As predicted, given that most patients call as soon as possible after the practice opens, in the overnight period on weekdays there was a linear relation between delay and the time of day of the event, with delay reducing as event time approaches practice opening hours. For most patients with events at the weekend, the delay was also related to proximity to earliest opening hours of the practice (that is, Monday morning) and patients with events on a Saturday waited longer to call for medical attention than patients with events on a Sunday. In patients with events out of hours who waited until practice opening hours to call, 70% with events on Monday to Friday rang within 24 hours of symptom onset, but this proportion fell to 33% on Sundays and none on Saturdays. The odds ratio of calling within 24 hours after weekend events compared with weekday events was 0.10 (95% confidence interval 0.05 to 0.21).


Influence of general practice opening hours on delay in seeking medical attention after transient ischaemic attack (TIA) and minor stroke: prospective population based study.

Lasserson DS, Chandratheva A, Giles MF, Mant D, Rothwell PM - BMJ (2008)

Fig 2 Delay in calling regular general practitioner after TIA or minor stroke occurring out of hours
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2548294&req=5

fig2: Fig 2 Delay in calling regular general practitioner after TIA or minor stroke occurring out of hours
Mentions: Figure 1 shows the number of patients with out of hours events who called within successive two hour time intervals after their registered practice opened. Most (70%) of the patients who waited to call their general practitioner did so within two hours of the practice opening. Figure 2 shows the delay to calling the registered practice after an out of hours event for the first 72 hours after events. As predicted, given that most patients call as soon as possible after the practice opens, in the overnight period on weekdays there was a linear relation between delay and the time of day of the event, with delay reducing as event time approaches practice opening hours. For most patients with events at the weekend, the delay was also related to proximity to earliest opening hours of the practice (that is, Monday morning) and patients with events on a Saturday waited longer to call for medical attention than patients with events on a Sunday. In patients with events out of hours who waited until practice opening hours to call, 70% with events on Monday to Friday rang within 24 hours of symptom onset, but this proportion fell to 33% on Sundays and none on Saturdays. The odds ratio of calling within 24 hours after weekend events compared with weekday events was 0.10 (95% confidence interval 0.05 to 0.21).

Bottom Line: Median (interquartile range) time to call a general practitioner after events out of hours was 24.8 (9.0-54.5) hours for patients who waited to contact their registered practice compared with 1.0 (0.3-2.6) hour in those who used an emergency general practitioner service (P<0.001).In patients with events out of hours who waited to see their own general practitioner, seeking attention within 24 hours was considerably less likely for events at weekends than weekdays (odds ratio 0.10, 95% confidence interval 0.05 to 0.21): 70% with events Monday to Friday, 33% on Sundays, and none on Saturdays.A primary care centre open 8 am-8 pm seven days a week would have offered cover to 73 patients who waited until surgery hours to call their general practitioner, reducing median delay from 50.1 hours to 4.0 hours in that group and increasing those calling within 24 hours from 34% to 68%.

View Article: PubMed Central - PubMed

Affiliation: Department of Primary Health Care, University of Oxford, Headington, Oxford OX3 7LF. daniel.lasserson@dphpc.ox.ac.uk

ABSTRACT

Objective: To assess the influence of general practice opening hours on healthcare seeking behaviour after transient ischaemic attack (TIA) and minor stroke and feasibility of clinical assessment within 24 hours of symptom onset.

Design: Population based prospective incidence study (Oxford vascular study).

Setting: Nine general practices in Oxfordshire.

Participants: 91 000 patients followed from 1 April 2002 to 31 March 2006.

Main outcome measures: Events that occurred overnight and at weekends (out of hours) and events that occurred during surgery hours.

Results: Among 359 patients with TIA and 434 with minor stroke, the median (interquartile range) time to call a general practitioner after an event during surgery hours was 4.0 (1.0-45.5) hours, and 68% of patients with events during surgery hours called within 24 hours of onset of symptoms. Median (interquartile range) time to call a general practitioner after events out of hours was 24.8 (9.0-54.5) hours for patients who waited to contact their registered practice compared with 1.0 (0.3-2.6) hour in those who used an emergency general practitioner service (P<0.001). In patients with events out of hours who waited to see their own general practitioner, seeking attention within 24 hours was considerably less likely for events at weekends than weekdays (odds ratio 0.10, 95% confidence interval 0.05 to 0.21): 70% with events Monday to Friday, 33% on Sundays, and none on Saturdays. Thirteen patients who had events out of hours and did not seek emergency care had a recurrent stroke before they sought medical attention. A primary care centre open 8 am-8 pm seven days a week would have offered cover to 73 patients who waited until surgery hours to call their general practitioner, reducing median delay from 50.1 hours to 4.0 hours in that group and increasing those calling within 24 hours from 34% to 68%.

Conclusions: General practitioners' opening hours influence patients' healthcare seeking behaviour after TIA and minor stroke. Current opening hours can increase delay in assessment. Improved access to primary care and public education about the need for emergency care are required if the relevant targets in the national stroke strategy are to be met.

Show MeSH
Related in: MedlinePlus