In this study we have investigated type of equipment, drugs and laboratory analyses that doctors on call in Norwegian OOH services can expect to be available for them. A response rate of 85 % provides us with a representative sample from OOH services organized in different ways. We have not investigated skills or whether the equipment has been used correctly, only the availabilty of equipment. The overview provided is just a reflection of reality and should not be regarded as recommended standards for properly equipped OOH services. It also remains unknown whether less equipped GP offices or OOH services can lead to erroneous medical diagnoses or prehospital treatment. This should be investigated in follow-up studies.
The study shows that Norwegian OOH services share premises with GP offices to a large extent and that the repertoire of equipment and analyses are determined by whether premises are shared or not. OOH services without shared premises have a narrower repertoire. This may be explained by the fact that many of the larger OOH services have a central location with a short distance to ambulance, hospital and pharmacy (2). Types of equipment requiring much competence, and expensive machines – such as ultrasound and X-ray – are not readily available in Norwegian OOH services. Some equipment is mainly available because it is used in the GP office; e.g. rectoscope/anoscope, spirometer and equipment for indirect laryngoscopy. However, equipment used for casting, gastric lavage and intraosseous needle, is used most often when there is a certain distance to hospital; i.e. in smaller OOH services and in rural districts. In certain OOH districts the health trust is responsible for all patients calls with the priority grade «red response» (1); this can be explained by the lower availability of equipment for medical emergencies and drugs found at OOH services that do not share premises with others. We also found that A and B drugs are less available in these services. This may have several explanations; the most likely is that strict requirements for handling, storage and prescription of these drugs cause OOH services that consider they can manage without them to not have them on stock. When open-around-the clock pharmacies are in the vicinity, the patients can get the drugs there.
Laboratory analyses are used in connection with one third of patient consultations, according to NAV (the Norwegian Labour and Welfare Administration) statistics from 2006. CRP-analyses are used most often, as shown by fees for CRP being included in 93 % of remuneration cards for laboratory analyses (3). In our study we see that a large majority of OOH services use tests that are simple and quick, while few of them use more costly and time-consuming equipment and tests – such as those needed for clinical chemical analyses and cell counts.
Some of the differences we have found can be explained by centrality of the service and whether or not premises are shared, but lack of requirements on availability of equipment indicate that economical factors should also be taken into account. National guidelines on types of equipment required in the OOH services would dimish these differences. The general advice provided in «Handbook for OOH services» is closest to what could be regarded as national guidance. It is not known to what extent the OOH services use this Handbook or other guidelines, so meaningful comparisons cannot be made between our findings and available recommendations. National guidelines that outline the types of required equipment and the level of competence for health personnel working in OOH services should therefore be developed.
In OOH services with shared premises, the regular personnel at the GP office usually perform quality controls (external and internal) of the laboratory equipment that is also used by personnel working in the OOH services (including different doctors on call). In general, nurses and doctors on call have little training and experience with laboratory work. All Norwegian GP offices are members of NOKLUS, but this study shows that more than one fourth of OOH services without shared premises are not part of the quality assurance system of NOKLUS. Some also do not have access to guidelines for laboratory equipment or the NOKLUS folders. It should be investigated further whether this reduces the quality of analyses from the OOH services.
The information we have collected about hepatitis B vaccination provides little information about vaccination coverage, as most of those educated the last years have been vaccinated and doctors on call are their own employers (not employees of the OOH services). However, it does show that most OOH services emphasize safety for their employees, even though many of them still let vaccination be optional.
The frequency of training in advanced cardiopulmonary resuscitation is highly variable; it is lowest for doctors on call in larger OOH services without shared premises, while that for assisting personnel increases with the size of the service provider. This probably reflects that larger OOH services, with assisting and administrative personnel in a larger professional environment, have a better ability to organize systematic training. It is difficult to organize systematic training for all personnel in intermunicipal OOH services, because the doctors who take on duties are often not familiar with the district; many of them live in other municipalities and some of them work in hospitals in more densely populated areas and take on extra duties (4) – (6). The fact that many doctors practice cardiopulmoary resuscitation less often than once a year, can make it difficult to maintain the necessary competence over time (7, 8). Cooperation with ambulance personnel and other health professionals may also suffer because of this.