Accessing Primary Health Care: A Community Survey of Issues regarding General Practice and Emergency Department Services in an Outer Metropolitan Area

2006 ◽  
Vol 12 (3) ◽  
pp. 78 ◽  
Author(s):  
AJ McGaw ◽  
P Jayasuriya ◽  
C Bulsara ◽  
S C Thompson
Keyword(s):  
General Practice ◽  
After Hours Care ◽  
Gp Services ◽  
After Hours ◽  
Appointment Availability ◽  
Gp Visits ◽  
Quota Sampling ◽  
Respiratory Conditions ◽  
Financial Issues ◽  
Specific Health

This survey aimed to identify views of residents of an outer metropolitan location towards general practice (GP) services, after-hours care and their use of emergency departments (ED). Four hundred respondents were selected randomly using quota sampling and interviewed by telephone. Respondents wanted a GP who was "easy to talk to", who listened and was interested in them, competent, straightforward and thorough. Of those who were dissatisfied, the main concerns were GPs' unwillingness to listen to the patient and rushing the consultation. GP visits occurred for specific health problems - most commonly fever, tiredness and respiratory conditions. Preventive advice regarding health and lifestyle issues was not mentioned as a reason for attending GPs. Appointment availability and financial issues impeded access to GPs. Most people who used an ED did so because of the unavailability of GP services, showing that access block starts in general practice, with the severity of their illness/injury being the second major reason.

scholarly journals Access to same day, next day and after-hours appointments: the views of Australian general practitioners

2012 ◽  
Vol 36 (3) ◽  
pp. 325 ◽  
Author(s):  
Mark F. Harris ◽  
Patrick G. Powell Davies ◽  
Mahnaz Fanaian ◽  
Nicholas A. Zwar ◽  
Siaw-Teng Liaw
Keyword(s):  
General Practice ◽  
Quality Improvement ◽  
Information Systems ◽  
Information Management ◽  
General Practitioners ◽  
Systems Of Care ◽  
Secondary Analysis ◽  
Comprehensive Approach ◽  
After Hours Care ◽  
After Hours

Objective. To evaluate factors associated with the availability of same or next day appointments and after-hours access reported by Australian general practitioners (GPs). Methods. Secondary analysis of a survey of primary care practitioners conducted by the Commonwealth Fund in 2009 in 11 countries. Analysis of factors likely to be associated with reported availability of same or next day appointments and after-hours access. Findings. Of 1016 Australian GPs, 78.8% reported that most patients in their practice had access to an appointment on the same or next day and 50% that their practice had arrangements for after-hours access. Access to same or next day care was better in practices where practitioners reported larger numbers of patients seen per GP per week and reviewed their performance against annual targets, but worse in rural areas and practices routinely reviewing outcomes data. Arrangements for after-hours care were more common among GPs who were planning to retire in the next 5 years; worked in practices with high electronic functioning information systems; and received and reviewed clinical outcome data and incentives for performance. Conclusions. Improving after-hours access requires a comprehensive approach which includes incentives, improvements to information management and organised systems of care with review of data on clinical outcomes. What is known about the topic? Access to general practice is an important priority for the health system and the subject of several reforms and initiatives over the past decade in Australia. Access to same or next day appointments and after-hours has been an increasing concern related to workforce availability, and limited access to general practice is one factor influencing the demand on hospitals, especially their emergency departments. What does this paper add? This paper reports on secondary analysis of a survey of over 1000 general practitioners in Australia. Responses to questions about access to same or next day appointments or after-hours arrangements were analysed for associations with practitioner and practice characteristics and their processes and systems of care. Access to same day appointments is particularly challenging in rural general practice but is more likely to be reported by GPs working in larger practices. Incentives, quality improvement and better information management may be important strategies to improve after-hours access. What are the implications for practitioners? Strategies to improve access to appointments and to after-hours care need to be considered as part of a comprehensive approach which includes financial incentives, strengthening information systems and quality improvement activities.

scholarly journals After-hours general practice clinics are unlikely to reduce low acuity patient attendances to metropolitan Perth emergency departments

2004 ◽  
Vol 28 (3) ◽  
pp. 285 ◽  
Author(s):  
Yusuf Nagree ◽  
Tor N O Ercleve ◽  
Peter C Sprivulis
Keyword(s):  
General Practice ◽  
Emergency Departments ◽  
Attendance Rates ◽  
Discharge Rates ◽  
Gp Services ◽  
After Hours ◽  
The Difference

Objective: To model the effectiveness of afterhours general practice (GP) in reducing metropolitan Perth emergency departments? (ED) low acuity patient (LAP) attendances and costs. Methods: We estimated LAP attendances by comparison of the product of (A) the difference between self-referred and GP-referred ED discharge rates and (B) total self-referred attendances (LAP attendances = A - B). We then compared after-hours ED LAP attendance rates and costs with inner metropolitan 'working-week' ED LAP attendance rates and costs, when GP services are maximally available. Results: Working-week LAP attendances comprised 8.2% (95% CI, 8.0%?8.4%) of inner metropolitan ED attendances. Excess weekend and evening LAP attendances were estimated to comprise 16.5% (95%CI, 15.9%?17.0%) and 4.5% (95%CI, 4.1%?4.9%) of outer and inner metropolitan ED attendances respectively and totalled less than 3.0% of ED costs. Conclusions: Low acuity patients form a relatively constant, inexpensive proportion of ED workloads. After-hours GP LAP services are unlikely to significantly reduce ED attendances or costs.

scholarly journals Emergency medicine and "acute" general practice: comparing apples with 0ranges

2000 ◽  
Vol 23 (2) ◽  
pp. 152 ◽  
Author(s):  
Sue Ieraci ◽  
Paul Cunningham ◽  
Janet Talbot-Stern
Keyword(s):  
Emergency Medicine ◽  
General Practice ◽  
Cost Effectiveness ◽  
Service Provision ◽  
Patient Population ◽  
Waiting Times ◽  
Service Planning ◽  
Precise Analysis ◽  
Gp Services ◽  
After Hours

Emergency Departments (EDs) operate at the interface between the inpatient and ambulatory sectorsof health care. Because of shared funding between the Commonwealth and States for ambulatory care,there has been intense focus on the ED patient population, and the potential to shift the locus of carefor non-inpatients.One of the frequently cited models for the provision of after-hours GP services is the Balmain GeneralPractice Casualty (GPC). This paper analyses the GPC model, looking in detail at casemix, clinicalquality, waiting times and cost-effectiveness. It is argued that the services provided and the casemix ofthe patient population of GPC and EDs are distinctly different. Cost-effectiveness for GPC has notbeen objectively established.Health service planning should recognise the distinct but complementary roles of general practice andemergency medicine. Evaluation of alternative models of service provision should critically examine theavailable evidence, and comparisons should be based on a precise analysis of equivalent services.

scholarly journals GP services in Australia: presentation profiles during usual practice hours and after-hours periods

2020 ◽  
Vol 26 (2) ◽  
pp. 117
Author(s):  
Jannah Baker ◽  
Helena Britt ◽  
Christopher Harrison
Keyword(s):  
Patient Characteristics ◽  
Service Planning ◽  
Cross Sectional ◽  
Usual Practice ◽  
Management Actions ◽  
Representative Study ◽  
After Hours Care ◽  
Gp Services ◽  
After Hours ◽  
Reasons For Encounter

After-hours general practitioner (GP) services can reduce emergency department demand, which is currently increasing in Australia. Understanding GP after-hours care may assist in service planning. From April 2014 to March 2015, 986 GPs recorded 38275 consultations with start and finish times in the Bettering the Evaluation and Care of Health (BEACH) study, a national, cross-sectional, representative study of GP activity. GP and patient characteristics and the content of encounters in usual-hours and after-hours were compared. Significantly more after-hours than usual-hours encounters were with: GPs aged 60+ years; in metropolitan practices; and practices with 10+ GPs. Patients seen after-hours were more often: male; aged 15–64 years; new to practice; and less likely to hold a Commonwealth Concession Card. They were more likely to be prescribed antibiotics and less likely to: have chronic problems managed; be referred; receive psycholeptic or psychoanaleptic prescription; and undergo a procedure. Throat symptoms, fever and injury were more common reasons for encounter, while infections and injury were more frequently managed problems after-hours. The patient mix, GP characteristics, problems managed and management actions in after-hours care differ from those in usual-hours care in Australia. This greater understanding of after-hours care is the first step to informed resource allocation to improve the delivery of after-hours primary care.

scholarly journals Quality of after-hours care

2003 ◽  
Vol 8 (7) ◽  
pp. 417-418
Author(s):  
Kristie Cramer ◽  
Terry P Klassen
Keyword(s):  
After Hours Care ◽  
After Hours

scholarly journals Emergency department utilisation by older people in metropolitan Melbourne, 2008–12: findings from the Reducing Older Patient’s Avoidable Presentations for Emergency Care Treatment (REDIRECT) study

2018 ◽  
Vol 42 (2) ◽  
pp. 181 ◽  
Author(s):  
Danielle Mazza ◽  
Christopher Pearce ◽  
Angela Joe ◽  
Lyle R. Turner ◽  
Bianca Brijnath ◽  
...  
Keyword(s):  
General Practice ◽  
General Practitioner ◽  
Older People ◽  
Older Patients ◽  
Medical Officer ◽  
Public Hospitals ◽  
Out Of Hours ◽  
Gp Services ◽  
Emergency Department Utilisation ◽  
Lost Opportunity

Objective Older patients are over-represented in emergency departments (ED), with many presenting for conditions that could potentially be managed in general practice. The aims of the present study were to examine the characteristics of ED presentations by older patients and to identify patient factors contributing to potentially avoidable general practitioner (PAGP)-type presentations. Methods A retrospective analysis was performed of routinely collected data comprising ED presentations by patients aged ≥70 years at public hospitals across metropolitan Melbourne from January 2008 to December 2012. Presentations were classified according to the National Healthcare Agreement definition for PAGP-type presentations. Presentations were characterised according to patient demographic and clinical factors and were compared across PAGP-type and non-PAGP-type groups. Results There were 744 519 presentations to the ED by older people, of which 103 471 (13.9%) were classified as PAGP-type presentations. The volume of such presentations declined over the study period from 20 893 (14.9%) in 2008 to 20 346 (12.8%) in 2012. External injuries were the most common diagnoses (13 761; 13.3%) associated with PAGP-type presentations. Sixty-one per cent of PAGP-type presentations did not involve either an investigation or a procedure. Patients were referred back to a medical officer (including a general practitioner (GP)) in 58.7% of cases. Conclusion Older people made a significant number of PAGP-type presentations to the ED during the period 2008–12. A low rate of referral back to the primary care setting implies a potential lost opportunity to redirect older patients from ED services back to their GPs for ongoing care. What is known about the topic? Older patients are increasingly attending EDs, with a proportion attending for problems that could potentially be managed in the general practice setting (termed PAGP-type presentations). What does this paper add? This study found that PAGP-type presentations, although declining, remain an important component of ED demand. Patients presented for a wide array of conditions and during periods that may indicate difficulty accessing a GP. What are the implications for practitioners? Strategies to redirect PAGP-type presentations to the GP setting are required at both the primary and acute care levels. These include increasing out-of-hours GP services, better triaging and appointment management in GP clinics and improved communication between ED clinicians and patients’ GPs. Although some strategies have been implemented, further examination is required to assess their ongoing effectiveness.

scholarly journals After-Hours Care In The United Kingdom, Denmark, And The Netherlands: New Models

2006 ◽  
Vol 25 (6) ◽  
pp. 1733-1737 ◽  
Author(s):  
Richard Grol ◽  
Paul Giesen ◽  
Caro van Uden
Keyword(s):  
United Kingdom ◽  
The Netherlands ◽  
The United Kingdom ◽  
After Hours Care ◽  
New Models ◽  
After Hours
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