After-hours calls: a five-year longitudinal study in a family practice group.

The provision of health care outside of regular hours is one of the major challenges in any primary care practice and an important focus of residency teaching in family medicine. In this study were studied the volume and pattern of after-hours calls in a residency based group family practice at the end of the first and fifth year of the practice's existence. During the five-year study interval, the number of registered patients in the practice tripled, whereas the number of scheduled patient visits doubled. After-hours phone calls increased 40 percent, visits 70 percent, and hospitalizations 50 percent. The distribution of calls during the week remained stable over the five-year period, and the problems prompting the calls changed little except for an increase in traumatic injuries and obstetrics, paralleling changes in the services offered by the practice. After-hours utilization decreased as a function of practice volume, suggesting that practice maturation decreases unscheduled demand for medical care. The burden of after-hours calls increased, however, because of the absolute growth in practice size. Residents handled the vast majority of the calls without consultation in both time periods. The rates and patterns of after-hours utilization are strikingly similar to those reported in other studies.