Material and method
The material consists of data from all electronic reimbursement cards submitted by doctors on out-of-hours duty in the period 2008–2019, previously used in preparation of the Annual statistics from out-of-hours emergency health care (3). Anonymised data files were provided by the Norwegian Health Economics Administration (Helfo)/the register for control and payment of reimbursements for health care (KUHR). We have no information that can identify the municipality or out-of-hours service in question, nor the form of payment, but each therapist has been assigned a unique number that enables aggregation of fee codes per doctor.
An increasing number of out-of-hours facilities have a fixed salary scheme for their on-duty doctors, and this has previously meant that many reimbursement cards were sent with the out-of-hours facility's or the municipality's organisation number, with no information about the treating physician. Since 2016, however, all billing must include information to identify the therapist who provided the treatment. Nurses in local emergency medical communications centres often provide advice to patients, but cannot complete a reimbursement card in their own name. These telephone contacts must therefore be linked to an identifiable doctor. How and to what extent this is done in practice is likely to vary from one out-of-hours facility to the next.
Consultations and home visits (fee codes 2ad, 2ae, 2ak, 2fk, 11ad or 11ak, hereafter referred to as consultations) and telephone contacts (fee codes 1bd, 1bk, 1be and 1 g) were registered. The sum total of all out-of-hours contacts was defined as the sum of consultations and telephone contacts. Contacts that were coded with diagnostic codes for respiratory infections (R71–R83) or three general, non-specific diagnoses (A29, A97 and A99) were included. For each year, we estimated the proportions that these diagnostic groups accounted for in the total number of consultations or telephone contacts.
The Annual statistics from out-of-hours emergency primary health care were assessed by the data protection officer of the Norwegian Labour and Welfare Administration (NAV) and the data protection officer for research (3). Since no individuals can be identified in the material, either directly or indirectly, the project is not subject to notification pursuant to the Personal Data Act.
Since the material includes all electronic reimbursement cards and does not constitute a sample, the differences identified are genuine and not fraught with statistical uncertainty. The data are therefore presented without confidence intervals, and no statistical tests have been undertaken.