How Denmark handles after-hours care

One night on my recent fact-finding mission I had the pleasure of shadowing Birgitte Breum and the Akutteam (a Danish word meaning “acute team”) in Aarhus, Denmark. There is a lot we can learn from how the Danes organize after-hours and urgent care. Nearly every person in Denmark has a family doctor (“GP”) who is contractually obliged to provide timely care for urgent issues. Once the GP practice is closed, there is one number to call in a region to access care after-hours.When you phone the after-hours line, you speak with a GP who triages your need. If it’s something that requires an emergency department visit, then the GP will direct the patient to the ED. If the patient is well enough to go to a clinic, they suggest meeting the “satellite” GP who is staffing the local after-hours clinic that day (there are seven “satellite” GPs in total for this region of about 1.3 million on Denmark’s Jutland peninsula). If the patient is too frail to leave their home but it’s not clear they need emergency care, then the GP triaging would notify the “taxi" GP (GP on call who drives to assess people in their home) or the Akutteam. Read: Dr. Hasan Sheikh: The case against private-pay healthcareThe Akutteam is comprised of nurses like Breum. I joined the team from 5 p.m. to 9 p.m. when there were two nurses working to cover the municipality of about 300,000. These nurses are highly skilled and usually have experience in emergency or acute care settings. A typical call would be from a home-bound elderly person or from a long-term care facility, for example, if a patient has a fever or trouble breathing. They have a special program for people with COPD who can call the nurses directly. While I was with them, they received a call from a long-term care home about a resident whose I.V. had come out—the I.V. was providing antibiotics and was put in during a recent hospital stay. The Akutteam nurse could look up the patient’s history on the online record maintained for all patients who receive home care or are in long-term care (services that are largely run by the municipality). Breum and the Akutteam are determined to help all residents avoid a hospital visit if possible—not just because that saves money for the healthcare system but because it’s ultimately better for the patient.So, in this case, Breum hopped into the Akutteam van and drove over to the care home (with me in the passenger seat!). You can see from the pics that the van is well stocked with equipment to support I.V.s, catheters, oxygen needs, acute treatments, dressings and more. Breum met with the patient in their room, and although it was a difficult insertion, managed to put in a new I.V. and restart antibiotics. (As an aside, the long-term care home was apparently typical for Aarhus but nicer than the ones I’ve visited in Canada—another topic for a post!).All in all, it was a seamless encounter that met the patient’s needs and avoided an unnecessary trip to an emergency room or hospital—one small example of the organized after-hours system in Denmark. A system we desperately need to learn from.E-healthOf course, one of the reasons the system works so well is due to the Danish health IT system. One day I had the pleasure of meeting with Morten Elbæk Petersen, the CEO of sundhed.dk, the Danish e-health platform. This organization started in 2003. Today, all people in Denmark can easily access their health records using a user-friendly website and the “MyHealth” app. The information includes their hospital notes, medication record, immunizations, lab tests and more. The system integrates data from more than 170 different sources. The data remain with the owner but the platform integrates the information into a viewer that both patients and clinicians can access.Key to their success is the shared value that patients’ health data belong to the patient—and a population with a high degree of trust. Notably, the primary purpose of the platform is to empower patients and support patient care—not research or performance measurement/accountability.Over the last two years, I’ve been leading OurCare, the largest pan-Canadian initiative to engage the public about the future of primary care in Canada. Through all our engagements, we heard loudly just how frustrated people in Canada are that they don’t have access to their own health data. Patients and members of the public were unanimous that they want a future where they can access their own health records online and share it with their clinicians and caregivers. This should be technically feasible. What we need is the political will.You can find out more about the Danish e-health portal at sundhed.dkDr. Tara Kiran is a Toronto family doctor at St. Michael’s Hospital and the University of Toronto and leads OurCare—the largest pan-Canadian initiative to engage the public about the future of primary care in Canada.

How Denmark handles after-hours care

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