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(Try buying a light bulb or a magazine after 6 p.m. in Amsterdam, where the political elite have decreed that workers' well-being requires that shops be open only during standard office hours, precisely when most people can't shop).
At this time, local RCFs had limited access to primary care physicians, ACP was not widely promoted in RCF and there were few alternatives to ED attendance for management of acute illness outside standard office hours.
The fact that female PCPs spend less time in off-hours care, and are less likely to serve patients at home and in nursing homes, could increase the reliance on already-stretched emergency departments and walk-in clinics as a source of primary health care, and force a rethinking of how medical care is delivered to patients outside standard office hours and locations.
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We conducted a randomised trial comparing invitations to out-of-hours appointments with standard office hour appointments.
The highest attendance was observed in the group offered an initial office hour appointment with the option to change to out-of-hours (76.1% vs 73.3% for standard office hour, P=0.001), with 7% of invitees exercising the option to change.
A total of 9410 women were allocated to standard office hour appointments, 3519 to office hour appointments with option to change to out-of-hours, 3271 to evening, and 3162 to weekend appointments.
When comparing the three study arms with the standard office hour appointment arm, attendance at initial appointment was significantly lower for evening appointments (OR=0.756, P<0.001) and slightly lower for Saturday appointments.
For static units, higher attendance within 120 days was observed in the option to change group (76.4% vs 73.2%), whereas for mobile units, higher attendance was observed in the standard office hour invitation group (77.1% vs 69.1%).
The highest attendance (76.1%) was observed for the arm offered an initial office hour appointment with the option to change to out-of-hours, compared with 73.3% in the standard office hour arm, 74.8% in the evening arm, and 72.6% in the weekend arm.
Women who were to be invited for routine breast screening were randomised (3 : 1 : 1 : 1) to one of these screening invitations: standard office hour appointment, office hour appointment with the option to change to an out-of-hours appointment, weekday evening appointment, or weekend appointment.
There is also no uniform standard for telephone triage performed during office hours.
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com