The out-of-hours care system in Switzerland and in nine European countries, a comparative analysis

Background: the OOHC organization is in evolution in most of the western countries. The traditional model (the GP taking care of his own patients 24/7) tends to evolve towards bigger-scale organizations. Switzerland undergoes the same evolution. The OOHC system is different in each of the twenty-six Swiss cantons, and no comprehensive comparative review was ever published. In this context of change, it could be useful for decision makers to have this information, and in addition, to know which innovating OOHC models have been implemented in Europe so far. Aims: 1) To describe in detail the Swiss out-of-hours care (OOHC) system based on internet information and a survey sent to key informants. 2) To compare the organization of the OOHC system of nine Europeans countries. Methodology: 1) information was gathered on the internet using OOHC related key-words. We designed a survey and filled it according to this information, and then sent it to the key informants of each twenty-six cantons. 2) An extensive literature review was made about nine European countries that we chose based on their geographical proximity to Switzerland, and to which countries we thought could have been implementing innovating models in the field of OOHC. Results: 1) Finding information about OOHC on the internet was easily feasible in 100% of the cantons. The answer rate to the survey was 50%. In 25/26 cantons, the medical cantonal society was responsible for organizing the OOHC, in 1/26 it was shared with the State. Inter-cantonal collaboration was active in 10/26 cantons. To take part in the OOHC was mandatory in 100% of the cantons. Duties were remunerated in 46% of the cantons that answered. Innovating models implemented in Switzerland were: a unique cantonal number (20/26 cantons, 17/20 using a non-surtaxed number), a telephonic regulation (17/26 cantons), the use of nurses for the latter (15/17 cantons), GP-cooperatives (16/26 cantons, 15/16 integrated to the hospitals), Baden’s model (hospital-integrated GP-cooperatives (H-GPs) managed alternatively by general practioners (GPs) and hospital’s doctors, 10/16 of the H-GPs), Lyss Model (at night, the hospital answer the calls, the on-call GP being called only if needed; 5/26 cantons), the use of private societies to do part of the home visits (12/26 cantons). 2) The main innovating models across Europe were the implementation of GP-cooperatives (Netherlands, Denmark, Sweden, UK), the increasing role of telenurses (nurses used for telephonic triage), the creation of new specific OOHC professions (UK). The UK has a special system of integrated care. During the literature review, several interesting points stood out: emergency department’s overcrowding is a global OOHC critical issue (that GP-Cs seem to have an efficacy in reducing); too much innovation and creation of new professions leads to explosion of the costs (UK); specific populations tend to be left out of the new OOHC model (older people, disabled); patient’s education about the new OOHC system is crucial for an efficient use and patients’ satisfaction. Limitations: 1) the 50% answer rate to the survey obligated us to rely a lot on the information found on the internet; 1) and 2) the accuracy and correctness of the latter is not guaranteed. Conclusion: the Swiss OOHC system varies amongst the cantons. The same main innovating models were implemented as in some European countries: telephone triage (done by nurses) and GP-cooperatives. The latter have produced numerous studies that can be taken into account while redesigning the OOHC system