Activity in out-of-hours services in Norway, th Nordic Congress of General Practice May 2009, Copenhagen Elisabeth Holm Hansen, Erik Zakariassen, Steinar Hunskår

Norway has a two-level public health care system LEVEL 1 Municipalities Primary Health care Emergency medical services 24 hours a day Casualty clinics with or without nurses LEMC LEVEL 2 Regional Health Authorities Hospital EMCC /113 Ambulance services National Air ambulance

Background In Norway, no valid activity statistics from the primary health care out-of-hours services The National Centre for Emergency Primary Health Care has initiated a project called The Watchtowers Aim: Provide information to enable monitoring, evaluation and comparison of activities in primary health care emergency services

Material and methods Day and night recording during one year of all requests to seven casualty clinics covering a total of 18 municipalities Variables: Time, gender, age, mode of contact, priority grade and first response initiated

Results During 2007 a total of requests were registered, 399 contacts per 1000 inhabitants Estimated mean number of requests to Norwegian Casualty Clinics per inhabitant per year: 0,4 55 % women Mean age 35 years

Contacts according to population (%)

Mode of contact (%) Telephone from patient or patients family65 % Direct attendance26 % Health personnel 6 % National emergency medical communication centres (EMCC) 2 % Police etc 1%

Priority degree (%)

Responses for all contacts Per centRate per 1000 inhabitants Appointment with a doctor63251 Advice by telephone, doctor1038 Handled by nurse2496 Call-out of doctor and ambulance1,77 Home visits by doctor1,66 Total100

Validation of contact registrations Reimbursement claims for 2006: 1.3 mill consultations by doctor in out-of-hours work 392 contacts per 1000 inhabitants Estimated national figures in our project 2007; 1,2 mill consultations by doctor in out-of-hours work 399 contacts per 1000 inhabitants

Interpretations Norway has a high rate of contacts to the out-of- hours services compared to other countries Norway has a large share of non-urgent cases Mode of contact influences action taken Valid national figures and future research of these services are important both for local services and policy makers