Retrospective analysis of a suburban out-ofhours clinic in Belgium

Introduction: In many countries, out-of-hours medical care is under scrutiny. The aim of this article is to
study the activities recorded by the first out-of-hours clinic that has been opened, as a pilot study, in two
Walloon communes.
Material and method: A retrospective analysis of anonymized data was conducted for 2009. Coding of
diagnoses was conducted using the International Classification of Primary Care (ICPC-2).
Results: A total of 3949 contacts were recorded in 2009 with the out-of-hours clinic, 3294 related to
inhabitants of the two communes covered, which was equivalent to 13% of the total population in question.
Compared to 7.2% of contacts between midnight and 8 a.m., 82.9% of contacts took place between 8 a.m.
and 9 p.m., and 91.6% of contacts were handled locally, with only 8.4% resulting in hospitalization. In
addition, 52% of contacts were with patients aged between 25 and 65; 29.9% of contacts were with
paediatric patients (,15 years). Patients over the age of 65 made up 18% of contacts. The most common
pathologies were respiratory (R). Analysis of flu diagnoses identified two epidemic peaks.
Discussion: The suburban out-of-hours clinic studied fulfilled an important role in managing the demand for
health care. The large majority of health problems were resolved locally, and the inhabitants did not need to
go to hospital. Appointments between midnight and 8 a.m. were in the minority, which points towards
adjusting the organization of the out-of-hours service during the night. The geriatric population is not highly
over-represented contrary to what might be expected considering its largest number of pathologies. The
on-call doctor’s skills profile should take account of the populations and morbidities encountered. Out-ofhours
clinics could possibly play a sentinel role in terms of flu epidemics.
Conclusion: This study describes a pilot suburban out-of-hours clinic which met three of recommendations
set by the KCE in its report on out-of-hours care in general medicine: the organization of an out-of-hours
clinic with logistical support, the use of a single telephone number and merging out-of-hours areas. While
debate exists on the management of out-of-hours care, this study provides evidence on the role of the
physician during these hours.