Attitudes to after-hour calls in Barbadian family practice - abstract

A 6-month prospective study was carried out at the General Practice Unit in Wildey and at two privately run group practices. An after-hour call was defined as any request for care outside regular office hours. Information recorded by the doctor included estimation of the necessity of the call and his or her reaction to it. Wherever possible, patients were contacted at a later date by an interveiwer who recorded the type of management, the patient's perception of his or her main reason for calling and the satisfaction with the service received. A total of 557 calls were made, representing 3.0 percent of the total workload (office visits and AH visits). Of the 339 patients interviewed the majority gave discomfort and anxiety as their main reason for calling. Two hundred and twenty-nine of all patients (41.1 percent) were managed on the telephone. One hundred and thirty-six of these were among the group of patients interviewed. Only 6(4.4 percent) were dissatisfied with the service received. Three hundred and seventy of all calls (65.4 percent) were judged by the doctor as being necessary. Only 68 (12.0 percent) were judged to be totally unnecessary. The majority of calls (61.4 percent) engendered interest and satisfaction with only 99 (18.2 percent) evoking anger and frustration. Surprisingly, only 4.0 percent of 52 patients interviewed, who belonged to the latter group, were dissatisfied with the service received. This study has shown that a great deal of satisfaction can be derived from doing after-hour work. Areas of educational importance have also been identified, such as the need for teaching the skills of "telephone medicine", dealing with anger and frustration and the "very unnecessary" call (AU)

After-hour calls in family practice in Barbados

The demand by the people in the community of the Caribbean for after-hour medical care is largely unknown. Apart from a few family/general practioners, most of this is provided by the casualty departments of general hospitals. The reasons for this with its many disadvantages, are at first being discussed in this study. In Barbados the situation is expected to be different with the anticipated implementation of the National Health Service. Each participating doctor would then be required to sign a contract ensuring that after-hours emergency services are available to all patients on his panel after his normal office hours. Conceivably, both the participating doctors and the administrators of the National Health Service will be interested in knowing more about these "emergencies". This 6-month study in a section of Barbadian Family Practice has revealed a call rate ranging from 366/1000 patients/year in young children to only 35/1000 patients/year in the geriatric age group. The after-hour encounters are a small fraction, 3.0 percent, of the total practice consultations with most of them being during the early evening and the daylight period of the weekends. Only a small percentage of callers, 6.8 percent needed to be referred to the hospital. The attitude of doctors to after-hour calls was also studied. Interest and satisfaction were found in most calls, especially in those associated with pain. The role of the telephone in the management of after-hour calls has been highlighted. Calls concerning young children and those made to doctors with families were more likely to be managed on the telephone. One recommendation is to extend office-hours into the early evening period on weekdays and the daytime period on weekends even at the cost of availability during the traditional office hours, 08.00 - 16.30 hrs. Other areas in need of future research have also been identified. This information should assist in the organization of one's own practice and in the teaching of Family Medicine in the Caribbean (AU)