The authors stated that 19 studies were included; however, this appears in fact to be the number of papers, some of which were reports of the same studies. The number of studies appeared to be 13: 3 RCTs (evidence level II), one pseudo-randomised trial (level III-1), 5 cohort studies (level III-2), and 4 before-and-after studies (level IV). The number of participants was only given for one study.
Based on one RCT and 3 before-and-after studies, the introduction of a telephone triage and advice service may reduce the immediate medical workload; one other RCT showed no difference. The findings from one pseudo-randomised trial indicated that deputising services increased immediate medical workload compared with a GP practice-based service. Cooperatives that use telephone triage and primary care centres and have a low home visiting rate may reduce the immediate medical workload; this result was based on one cohort study that compared that model with a deputising service. One RCT suggested that GPs working in an emergency department reduced the subsequent medical workload compared with accident and emergency staff.
Prescribing was the only aspect of clinical practice for which some evidence was found to suggest differences between the service models. Deputising doctors may prescribe less appropriately than those in practice-based (1 pseudo-randomised trial) or cooperative (1 cohort study) services. In one RCT, experienced GPs working in emergency departments prescribed more appropriately than junior residents and registrars.
Dissatisfaction with telephone consultations was demonstrated in a before-and-after study of telephone triage and advice service, and among patients using cooperative and deputising services in 2 cohort studies. Cohort studies of other service models showed no conclusive difference in patient satisfaction.
One before-and-after study found after-hours cooperatives to be an important factor in the GPs' health status. A cohort study found that GPs in a cooperative were more satisfied with some aspects of out-of-hours care than GPs providing a deputising service.