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Our finding that more variation between GP cooperatives existed for high urgency contacts than low urgency contacts, may indicate differences in substitution of emergency care, or the presence of Emergency Departments near the GP cooperative [ 8].
Explained variance (R-squared) of the multilevel models ranged from 8% (high urgency contacts) to 52% (home visits).
Associations between sociodemographic characteristics and urgency of the primary OOH contact, followed parallel patterns for high urgency and low urgency contacts.
We found that neighbourhoods with more 0 to 4 year old inhabitants were associated with more (telephone) consultations, low urgency contacts, and contacts for infections.
Low urgency contacts represented a small majority of the total number of contacts, indicating that almost half of the contacts (48%) took place for (highly) urgent matters.
However, particularly for GP high urgency contacts, contacts for somatic symptoms and illnesses, and contacts for long-term health conditions, a substantial part of the variance between GP cooperatives can be ascribed to factors other than neighbourhood population characteristics.
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Low-urgency contacts are contacts that could be postponed until the next day without increased risks.
Nevertheless, the multilevel models also showed that a considerable amount of variation in demand between GP cooperatives remained unexplained by sociodemographic characteristics, particularly regarding high-urgency contacts.
These low-urgency contacts contribute to the overcrowding crisis of hospital emergency departments (ED) [ 1- 3] and to the high utilisation rates of other out-of-hours emergency medical services, such as general practitioner (GP) cooperatives in the Netherlands [ 4, 5] (Table 1).
The urgency of contacts was not associated with the use of a computer-based decision support system for triage, or with the distance between the patient's home and the out-of-hours service.
Subsequently, multilevel linear regression analyses with two-level hierarchically structured data (patients within GPCs) were used to investigate whether the urgency of contacts was associated with patients' gender, age, the distance between patient's home and the GPC, and the use of a computer-based decision support system by the GPC.
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