International Journal for Quality in Health Care, 2021, 33(1), 1–5 doi: 10.1093/intqhc/mzab021 Advance Access Publication Date: 2 February 2021 Original Research Article Original Research Article Prioritization and management of calls from older people to GP out-of-hours services SUZANNE SMITH and LUCIA CARRAGHER NetwellCASALA, The Bright Room, Dundalk Institute of Technology, Dublin Road, Dundalk, County Louth A91K584, Ireland Address reprint requests to: Suzanne Smith, NetwellCASALA, The Bright Room, Dundalk Institute of Technology, Dublin Rd., Dundalk, Co Louth A91K584, Ireland. Tel: +353 42 9370497; E-mail: Suzanne.smith@dkit.ie Received 13 October 2020; Editorial Decision 22 January 2021; Revised 18 January 2021; Accepted 2 February 2021 Abstract Background: Urgent out-of-hours medical care is necessary to ensure people can remain living at home into older age. However, older people experience multiple barriers to using out-of-hours ser- vices including poor awareness about the general practitioner (GP) out-of-hours (GPOOH) service and how to access it. In particular, older people are reluctant users of GPOOH services because they expect either their symptoms will not be taken seriously or they will simply be referred to hospital accident and emergency services. The aim of this study was to examine if this expectation was borne out in the manner of GPOOH service provision. Objective: The objective was to establish the urgency categorization and management of calls to GPOOH , for community dwelling older people in Ireland. Methods: An 8-week sample of 770 calls, for people over 65 years, to a GPOOH service in Ireland, was analysed using Excel and Nvivo software. Results: Urgency categorization of older people shows 40% of calls categorized as urgent. Recognition of the severity of symptoms, prompting calls to the GPOOH service, is also refected in a quarter of callers receiving a home visit by the GP and referral of a third of calls to emergency services. The fndings also show widespread reliance on another person to negotiate the GPOOH system, with a third party making 70% of calls on behalf of the older person seeking care. Conclusion: Older people are in urgent need of medical services when they contact GPOOH service, which plays an effective and patient-centred gatekeeping role, particularly directing the oldest old to the appropriate level of care outside GP offce hours. The promotion of GPOOH services should be enhanced to ensure older people understand their role in supporting community living. Key words: GP out-of-hours service, general practice, older people, GP cooperative, telephone triage Introduction With ageing global populations, maintaining independent living is a priority for policymakers and service providers, as highlighted by the coronavirus disease-2019 (COVID-19) pandemic [1–3]. Urgent out-of-hours primary medical services are essential for supporting older people to live in their own homes into old age, but are most effectively utilized when their purpose is understood and service expe- riences meet patient expectations [4–8]. Under the traditional model of out-of-hours care, patients who became ill outside of surgery hours received a home visit from their doctor. However, in Ireland and elsewhere, this model has been replaced by general practitioner (GP) cooperatives, as a response to concerns about overburdened GPs rather than as an evidence-based strategy to enhance patient-centred care [9, 10]. A central element of the GP out-of-hours (GPOOH) cooperative model is seeing patients at a designated treatment centre, which is both time-effcient and clinically preferable. The Irish GPOOH sys- tem is structured to rationalize service delivery, ensuring the most © The Author(s) 2021. Published by Oxford University Press on behalf of International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com 1 Downloaded from https://academic.oup.com/intqhc/article/33/1/mzab021/6126507 by guest on 14 November 2023