Effect of the intervention
SECONDARY
Dutch GPs believe that a stricter triage and annual feedback to triage nurses will reduce the number of non-urgent visits to the out-of-hours cooperatives [The decision to seek health care is a complex process influenced by several factors, such as personal, social, and cultural, as well as characteristics of the health care system [Hence, there may be several reasons for the lacking effect of our educational intervention on the primary and secondary outcomes. Strategies aimed at reducing out-of-hours attendance by improving the skills of individual nurses imply that they perform an active gatekeeping role, keeping low-urgency patients out of the cooperatives. From this perspective, an educational intervention similar to the one described in the present study could be expected to have a direct effect on the out-of-hours attendance, particularly because nurses report that the decision regarding the need for a doctor’s consultation is generally made in co-operation between the nurse and caller [However, our e-learning course and group discussion of 90 minutes each may be too limited to oust the external factors telephone triage nurses describe as decisive and non-controllable [