Association between patient characteristics and recommendations by medical on-call service 116117 in Germany: a cross sectional observational study

Background: Use of emergency departments has increased in recent years. Different efforts address this problem, eg, medical on-call services. The DEMAND intervention is based on a computer-assisted initial telephone assessment implemented at the regional associations of statutory health insurance physicians in Germany. In this intervention, recommendations for healthcare settings suited best to the patients’ health problems were given by telephone. This study aimed to analyse if patient characteristics are associated with the output of the intervention, ie, specific setting recommendations. Methods: This cross-sectional observational study based on a standardised postal survey of patients who received the intervention. Recommended and used settings, and data on sociodemography, health status at the time of the emergency call, past health service use, and health literacy were collected by patient self-report. The study population was characterised by descriptive statistics. For analysing the association between recommendations, and patient characteristics, multilevel, multivariable logistic regression models adjusted for random effects at the level of regions and months of observation within regions were conducted. Results: 1,756 patients participated in the survey. The median age of the patients was 66 years, 59.0% were women and 30.2% living alone. Recommendations for emergency home visits were associated with worse self-rated health (OR 0.67, 95% confidence interval: 0.55/0.81, p<0.001). Telephone counselling was associated with lower age (0.71,0.59/0.85,p<0.001), lower subjective treatment urgency (0.65,0.51/0.82,p<0.001) and health problems not classified as symptoms and complaints (0.41,0.25/0.68,p=0.001) or infections (0.22,0.09/0.57,p=0.002.). Emergency departments were associated with better self-rated health (1.37,1.11/1.70,p=0.003) and health problems classified as injuries (3.12,1.67/5.83,p<0.001). Rescue service were associated with higher age (1.44,1.15/1.81,p=0.002) and a higher subjective treatment urgency (2.51,1.83/3.43,p<0.001). General practices were associated with lower subjective treatment urgency (0.58,0.44/0.76,p<0.001) and health problems not classified as injuries (0.26,0.10/0.68,p=0.006). Emergency practices were associated with lower age (0.60,0.48/0.74,p<0.001), and specialist practices were associated with health problems classified as symptoms or complaints (3.75,1.49/9.45,p=0.005). Conclusions: Most associations between patient characteristics and recommendations were comprehensible and in line with the aim of the intervention. No disparities in access to specific services were identified. However, it should be clarified why patients with better self-rated health were more likely to receive recommendations for emergency departments.