{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,14]],"date-time":"2025-12-14T15:04:18Z","timestamp":1765724658872,"version":"3.48.0"},"reference-count":18,"publisher":"BMJ","issue":"10","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2015,8,17]]},"published-print":{"date-parts":[[2015,10]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Dutch primary out-of-hours care is provided by general practice cooperatives (GPCs). Although most GPCs use the same standardised triage system, differences between GPCs exist in the urgency assigned to patients\u2019 health problems. This cross-sectional study aims to provide insight into factors associated with the variation in assigned urgency between GPCs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design and methods<\/jats:title>\n                    <jats:p>Data were derived from routine electronic health records of 895\u2005253 patients who attended 17 GPCs in 2012. Patients\u2019 gender, age, travel distance to the GPC, and the use of a computer-based decision support system for triage were investigated as possibly affecting assigned urgency. Multilevel linear regression analyses were executed for the 3 most frequently presented health problems (cystitis\/other urinary infection, laceration\/cut and fever).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Variation in urgency levels between GPCs was significant for the selected health problems (p=0.00). Assigned urgency was mainly related to patient gender and age. It was not associated with the use of a computer-based decision support system, or with travel distance to the GPC. Most variation in urgency (93.4\u201396.7%) could be ascribed to variation in patient characteristics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>There is significant variation in urgency levels between GPCs, even for the same health problem. This variation is mainly associated with differences in characteristics of individuals contacting the GPCs, rather than with variables such as patients\u2019 travel distance or the use of a computer-based decision support system. Since patient characteristics are likely to affect patients\u2019 clinical need, our results are an indication of the adequate functioning of the triage system.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2015-008421","type":"journal-article","created":{"date-parts":[[2015,10,16]],"date-time":"2015-10-16T20:22:58Z","timestamp":1445026978000},"page":"e008421","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":10,"title":["Factors associated with variation in urgency of primary out-of-hours contacts in the Netherlands: a cross-sectional study"],"prefix":"10.1136","volume":"5","author":[{"given":"Marieke","family":"Zwaanswijk","sequence":"first","affiliation":[{"name":"NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Markus M J","family":"Nielen","sequence":"additional","affiliation":[{"name":"NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karin","family":"Hek","sequence":"additional","affiliation":[{"name":"NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert A","family":"Verheij","sequence":"additional","affiliation":[{"name":"NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2015,10,15]]},"reference":[{"key":"2025121407004908000_5.10.e008421.1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.25.6.1733"},{"key":"2025121407004908000_5.10.e008421.2","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6963-9-105"},{"key":"2025121407004908000_5.10.e008421.3","unstructured":"Netherlands Triage System. http:\/\/de-nts.nl (accessed 20 Feb 2015)."},{"key":"2025121407004908000_5.10.e008421.4","unstructured":"VHN, Vereniging Huisartsenposten Nederland. Benchmarkbulletin 2012. Utrecht, The Netherlands: VHN, 2013. In Dutch."},{"key":"2025121407004908000_5.10.e008421.5","unstructured":"Gijsen R , Kommer GJ , Bos N , et al . [How urgent are the health problems at the out-of-hours service?]. In: Volksgezondheid Toekomst Verkenning, Nationaal Kompas Volksgezondheid. Bilthoven, The Netherlands: RIVM, 2010. Nationaal Kompas Volksgezondheid\\Zorg\\Sectoroverstijgend\\Acute zorg\\Huisartsenposten. In Dutch. http:\/\/www.nationaalkompas.nl"},{"key":"2025121407004908000_5.10.e008421.6","first-page":"207","article-title":"[How urgent is the presented morbidity at the out-of-hours service?]","volume":"48","author":"Giesen","year":"2005","journal-title":"Huisarts Wetenschap"},{"key":"2025121407004908000_5.10.e008421.7","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1186\/1472-6963-13-222","article-title":"Distance and utilisation of out-of-hours services in a Norwegian urban\/rural district: an ecological study","volume":"13","author":"Raknes","year":"2013","journal-title":"BMC Health Serv Res"},{"key":"2025121407004908000_5.10.e008421.8","unstructured":"Joseph AE , Phillips DR . Accessibility and utilization: geographical perspectives on health care delivery. 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NIVEL Primary Care Database, http:\/\/www.nivel.nl\/node\/3094. (accessed 24 Oct 2014). In Dutch."},{"key":"2025121407004908000_5.10.e008421.15","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-155-2-201107190-00006"},{"key":"2025121407004908000_5.10.e008421.16","first-page":"215","article-title":"[Out-of-hours service and emergency department: to integrate or not to integrate?]","volume":"51","author":"Moll van Charante","year":"2008","journal-title":"Huisarts Wetenschap"},{"key":"2025121407004908000_5.10.e008421.17","doi-asserted-by":"crossref","first-page":"364659","DOI":"10.1155\/2013\/364659","article-title":"The impact on emergency department utilization and patient flows after integrating with a general practitioner cooperative: an observational study","volume":"2013","author":"Thijssen","year":"2013","journal-title":"Emerg Med Int"},{"key":"2025121407004908000_5.10.e008421.18","unstructured":"Smits M , Peters Y , Keizer E , et al . 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