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The aim of the present study was to investigate these doctors\u2019 role in emergency admissions to somatic hospitals in the Norwegian public healthcare system, where GPs and OOH doctors have a distinct gatekeeper function.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A cross-sectional analysis was performed by linking data from the Norwegian Patient Registry (NPR) and the physicians\u2019 claims database. The referring doctor was defined as the physician who had sent a claim for a consultation with the patient within 24\u2009h prior to an emergency admission. If there was no claim registered prior to hospital arrival, the admission was defined as direct, representing admissions from ambulance services, referrals from nursing home doctors, and admissions initiated by in-hospital doctors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In 2014 there were 497,587 emergency admissions to somatic hospitals in Norway after excluding birth related conditions. Direct admissions were most frequent (43%), 31% were referred by OOH doctors, 25% were referred by GPs, whereas only 2% were referred from outpatient clinics or private specialists with public contract. Direct admissions were more common in central areas (52%), here GPs\u2019 referrals constituted only 16%. The prehospital paths varied with the hospital discharge diagnosis. For anaemias, 46\u201349% were referred by GPs, for acute appendicitis and mental\/alcohol related disorders 52 and 49% were referred by OOH doctors, respectively. For both malignant neoplasms and cardiac arrest 63% were direct admissions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>GPs or OOH doctors referred many emergencies to somatic hospitals, and for some clinical conditions GPs\u2019 and OOH doctors\u2019 gatekeeping role was substantial. However, a significant proportion of the emergency admissions was direct, and this reduces the impact of the GPs\u2019 and OOH doctors\u2019 gatekeeper roles, even in a strict gatekeeping system.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12913-019-4419-0","type":"journal-article","created":{"date-parts":[[2019,8,14]],"date-time":"2019-08-14T07:02:57Z","timestamp":1565766177000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":43,"title":["General practitioners\u2019 and out-of-hours doctors\u2019 role as gatekeeper in emergency admissions to somatic hospitals in Norway: registry-based observational study"],"prefix":"10.1186","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1713-4350","authenticated-orcid":false,"given":"Jesper","family":"Blinkenberg","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sahar","family":"Pahlavanyali","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00d8ystein","family":"Hetlevik","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hogne","family":"Sandvik","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steinar","family":"Hunskaar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2019,8,14]]},"reference":[{"key":"4419_CR1","doi-asserted-by":"publisher","first-page":"e004293","DOI":"10.1136\/bmjopen-2013-004293","volume":"4","author":"TS Deraas","year":"2014","unstructured":"Deraas TS, Berntsen GR, Jones AP, Forde OH, Sund ER. 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The Regional Ethical Committee for Medical and Health Research Ethics, Region West gave permission to use the data without asking the patients for consent. Norwegian Data Protection Authority approved the use of the data for research purposes in this project. The register owners, Statistics Norway and the Norwegian Directorate of Health, approved linkage of registries. The data were pseudo anonymized by third party (Statistics Norway), and analyzed at group level to minimize the risk for individuals to be identified.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"568"}}