Evidence map›Paper›PMID 30872553›Full record

Observational studyBMJ open2019

Use of out-of-hours primary care in affluent and deprived neighbourhoods during reforms in long-term care: an observational study from 2013 to 2016.

Tessa Jansen, Robert A Verheij, Francois G Schellevis, Anton E Kunst

Abstract readObservational Study
In one paragraph

Observational study in BMJ open, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

4 authors.

Tessa JansenDepartment of Primary Care, Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands.
Robert A VerheijDepartment of Primary Care, Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands.
Francois G SchellevisDepartment of Primary Care, Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands.
Anton E KunstDepartment of Public Health, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesMajor long-term care (LTC) reforms in the Netherlands in 2015 may specifically have disadvantaged socioeconomically deprived groups to acquire LTC, possibly impacting the use of acute care. We aimed to demonstrate whether LTC reforms coincided with changes in the use of out-of-hours (OOH) primary care services (PCSs), and to compare changes between deprived versus affluent neighbourhoods.

designEcological observational retrospective study using routinely recorded electronic health records data from 2013 to 2016 and population registry data.

settingData from 15 OOH PCSs participating in the Nivel Primary Care Database (covering approximately 6.5 million inhabitants) in the Netherlands. PCS utilisation data on neighbourhood level were matched with sociodemographic characteristics, including neighbourhood socioeconomic status (SES).

participantsElectronic health records from 6 120 384 OOH PCS contacts in 2013-2016, aggregated to neighbourhood level. OUTCOME MEASURES AND ANALYSES: Number of contacts per 1000 inhabitants/year (total, high/low-urgency, night/evening-weekend-holidays, telephone consultations/consultations/home visits).Multilevel linear regression models included neighbourhood (first level), nested within PCS catchment area (second level), to account for between-PCS variation, adjusted for neighbourhood characteristics (for instance: % men/women). Difference-in-difference in time-trends according to neighbourhood SES was assessed with addition of an interaction term to the analysis (year×neighbourhood SES).

resultsBetween 2013 and 2016, overall OOH PCS use increased by 6%. Significant increases were observed for high-urgency contacts and contacts during the night. The largest change was observed for the most deprived neighbourhoods (10% compared with 4%-6% in the other neighbourhoods; difference not statistically significant). The increasing trend in OOH PCS use developed practically similar for deprived and affluent neighbourhoods. A a stable gradient reflected more OOH PCS use for each lower stratum of SES.

conclusionsLTC reforms coincided with an overall increase in OOH PCS use, with nearly similar trends for deprived and affluent neighbourhoods. The results suggest a generalised spill over to OOH PCS following LTC reforms.

Indexed as

Socioeconomic FactorsAdolescentAdultAfter-Hours CareAgedAged, 80 and overChildChild, PreschoolFemaleHealth Care ReformHumansInfantLong-Term CareMaleMiddle AgedNetherlandslong-term careorganisation of health servicesout-of-hoursprimary caresocioeconomic inequalities

Identifiers

PMID30872553
PMCPMC6429913

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.