After Hours Care and Accessibility

Abstract

Background: It is estimated that a group of patients preferentially attend the health centres ambulatory out-of-hours clinic (AC) rather than making an appointment with their family doctor (FD). Objectives: To characterise the profile of AC users and analyse a possible relationship between AC attendance and FD appointment accessibility at the health centre. Type of Study: exploratory, cross-sectional, descriptive, analytical. Setting: Alameda Health Centre, Lisbon. Population: Patients seen consecutively at the Alameda Health Centre (HC) Acute Care Ambulatory Clinic (AC), during a two-month (May and June, 2000) period. Variables: Demographical variables and indirect accessibility indicators (waiting lists, duration of symptoms, and latest FD appointment). Data on the patients seen at the AC were collected during a two-month period from both the AC and FD clinical records. Results: 974 patients were observed. Average AC user profile: female, 33 years old, single, working, enrolled in the HC patient roster, with a short-duration acute clinical picture, of which 46% infective and 14% musculoskeletal. Older patients tended to have more protracted symptoms at time of AC attendance. The same applied to actively working patients (Mann-Whitney p=0.001; _2 p=0.002). It was not shown that these patients either were on longer waiting lists, had not had an FD appointment for longer, or had associated chronic conditions. Most had seen their doctor in the two preceding months. Conclusions: AC attendance seems to be basically determined by the acute episode itself regardless of FD accessibility.