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

## TL;DR

This study examines how patient characteristics influence healthcare setting recommendations by a German on-call service, finding that factors like age and health status are linked to specific care options.

## Contribution

The study identifies specific associations between patient characteristics and healthcare setting recommendations using a large observational dataset.

## Key findings

- Emergency home visits were most frequently recommended and linked to worse self-rated health.
- Younger patients were more likely to receive telephone counseling and emergency practice recommendations.
- Emergency departments were associated with better self-rated health and injuries, while rescue services were linked to higher age and treatment urgency.

## Abstract

Use of emergency departments has increased in recent years. Different efforts address this problem, eg, medical on-call services. The basis of the DEMAND intervention is computer-assisted initial telephone assessment implemented at regional associations of statutory health insurance physicians in Germany. In this intervention, recommendations for healthcare settings were given over the telephone by medical staff. Recommendations were provided using the software SmED which calculates neural networks. This study aimed to analyse if patient characteristics are associated with the output of the intervention, ie, specific setting recommendations.

Between January 2020 and March 2021, patients aged 18 years and older of the DEMAND intervention from eight intervention sites received a standardised postal survey. 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 self-report. Multilevel, multivariable logistic regression models adjusted for random effects at the level of regions and months of observation within regions were conducted.

Of 9473 contacted individuals, 1756 (18.5 %) participated in the survey. Median age was 66 years, 59.0% were women and 30.2% living alone. The most frequently recommended service was emergency home visits (40.1%). Recommendations for this setting were associated with worse self-rated health (odds ratio 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 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).

Most associations between patient characteristics and recommendations were comprehensible and in line with the aim of the intervention. However, it should be clarified why patients with better self-rated health were more likely to receive recommendations for emergency departments.