scholarly journals 'Just lie there and die': barriers to access and use of general practitioner out-of-hours services for older people in rural Ireland

2019 ◽  
Author(s):  
Suzanne Smith ◽  
Lucia Carragher
Keyword(s):  
General Practitioner ◽  
Older People ◽  
Out Of Hours ◽  
Barriers To Access

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.

Prioritization and management of calls from older people to GP out-of-hours services

2021 ◽  
Vol 33 (1) ◽  
Author(s):  
Suzanne Smith ◽  
Lucia Carragher
Keyword(s):  
Older People ◽  
Service Provision ◽  
Emergency Services ◽  
Oldest Old ◽  
Community Dwelling ◽  
Third Party ◽  
Older Person ◽  
Out Of Hours ◽  
Accident And Emergency ◽  
Community Dwelling Older People

Abstract Background Urgent out-of-hours medical care is necessary to ensure people can remain living at home into older age. However, older people experience multiple barriers to using out-of-hours services including poor awareness about the general practitioner (GP) out-of-hours (GPOOH) service and how to access it. In particular, older people are reluctant users of GPOOH services because they expect either their symptoms will not be taken seriously or they will simply be referred to hospital accident and emergency services. The aim of this study was to examine if this expectation was borne out in the manner of GPOOH service provision. Objective The objective was to establish the urgency categorization and management of calls to GPOOH , for community dwelling older people in Ireland. Methods An 8-week sample of 770 calls, for people over 65 years, to a GPOOH service in Ireland, was analysed using Excel and Nvivo software. Results Urgency categorization of older people shows 40% of calls categorized as urgent. Recognition of the severity of symptoms, prompting calls to the GPOOH service, is also reflected in a quarter of callers receiving a home visit by the GP and referral of a third of calls to emergency services. The findings also show widespread reliance on another person to negotiate the GPOOH system, with a third party making 70% of calls on behalf of the older person seeking care. Conclusion Older people are in urgent need of medical services when they contact GPOOH service, which plays an effective and patient-centred gatekeeping role, particularly directing the oldest old to the appropriate level of care outside GP office hours. The promotion of GPOOH services should be enhanced to ensure older people understand their role in supporting community living.

scholarly journals How does general practitioner discontinuity affect healthcare utilisation? An observational cohort study of 2.4 million Norwegians 2007–2017

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e042391
Author(s):  
Lena Janita Skarshaug ◽  
Silje Lill Kaspersen ◽  
Johan Håkon Bjørngaard ◽  
Kristine Pape
Keyword(s):  
Cohort Study ◽  
General Practitioner ◽  
Service Use ◽  
Hospital Admissions ◽  
Age Groups ◽  
Healthcare Utilisation ◽  
Acute Hospital ◽  
Secondary Outcome ◽  
Out Of Hours ◽  
Adult Age

ObjectivesPatients may benefit from continuity of care by a personal physician general practitioner (GP), but there are few studies on consequences of a break in continuity of GP. Investigate how a sudden discontinuity of GP care affects their list patients’ regular GP consultations, out-of-hours consultations and acute hospital admissions, including admissions for ambulatory care sensitive conditions (ACSC).DesignCohort study linking person-level national register data on use of health services and GP affiliation with data on GP activity and GP characteristics.SettingPrimary care.Participants2 409 409 Norwegians assigned to the patient lists of 2560 regular GPs who, after 12 months of stable practice, had a sudden discontinuity of practice lasting two or more months between 2007 and 2017.Primary and secondary outcome measuresMonthly GP consultations, out-of-hours consultations, acute hospital admissions and ACSC admissions in periods during and 12 months after the discontinuity, compared with the 12-month period before the discontinuity using logistic regression models.ResultsAll patient age groups had a 3%–5% decreased odds of monthly regular GP consultations during the discontinuity. Odds of monthly out-of-hours consultations increased 2%–6% during the discontinuity for all adult age groups. A 7%–9% increase in odds of ACSC admissions during the period 1–6 months after discontinuity was indicated in patients over the age of 65, but in general little or no change in acute hospital admissions was observed during or after the period of discontinuity.ConclusionsModest changes in health service use were observed during and after a sudden discontinuity in practice among patients with a previously stable regular GP. Older patients seem sensitive to increased acute hospital admissions in the absence of their personal GP.

Performance of a new guideline for telephone triage in out-of-hours services in Belgium: A pilot study using simulated patients

2020 ◽  
Vol 33 (4) ◽  
pp. 166-171
Author(s):  
Stefan Morreel ◽  
Hilde Philips ◽  
Annelies Colliers ◽  
Veronique Verhoeven
Keyword(s):  
General Practitioner ◽  
Primary Objective ◽  
Phone Call ◽  
Simulated Patients ◽  
Telephone Triage ◽  
Out Of Hours ◽  
Important Variation ◽  
Phone Calls ◽  
The Right ◽  
Urgency Level

Background Patients in Belgium needing out-of-hours care have two options: the emergency department or the general practitioner on call often organised in a general practitioner cooperative. Currently, there is no triage system in Belgium so patients do not know where to go. Methods Our primary objective was to examine the ability of a newly developed telephone guideline, called 1733, to adequately estimate the urgency of health problems presented by simulated patients. Ten clinical vignettes were presented to 12 operators in a simulated phone call. The operators had to assign a protocol, urgency level and resource to dispatch (ambulance, general practitioner house visit, etc.) to each case. Results A total of 120 phone calls were analysed. The operators chose the right protocol in 69% and the correct urgency level in 35% of the cases. The proportion of under- and over-triage was 26% and 39%, respectively. There was important variation in between the operators. The sensitivity for detecting highly urgent cases was 0.42, the specificity 0.92. Conclusion Using the new Belgian 1733 guideline for telephone triage, operators mostly chose the appropriate protocol but only chose the correct urgency in one out of three cases. In this phase of development, the studied telephone guideline is not ready for implementation.

scholarly journals Do consultation charges deter general practitioner use among older people? A natural experiment

2009 ◽  
Vol 68 (8) ◽  
pp. 1432-1438 ◽  
Author(s):  
Richard Layte ◽  
Anne Nolan ◽  
Hannah McGee ◽  
Ann O'Hanlon
Keyword(s):  
General Practitioner ◽  
Older People ◽  
Natural Experiment

scholarly journals Logistic Issues and Potential Prescribing Costs Associated with use of Neuraminidase Inhibitors for the Treatment of Influenza in Primary Care

2003 ◽  
Vol 96 (2) ◽  
pp. 66-69 ◽  
Author(s):  
Philip R Da Silva ◽  
Jonathan S Nguyen-Van-Tam ◽  
Andrew C Hayward
Keyword(s):  
Primary Care ◽  
At Risk ◽  
General Practitioner ◽  
Primary Care Trust ◽  
Neuraminidase Inhibitor ◽  
Neuraminidase Inhibitors ◽  
Out Of Hours ◽  
Influenza Like Illness ◽  
Co Morbidity ◽  
Risk Patients

In the UK, the National Institute for Clinical Excellence has recommended the use of neuraminidase inhibitors for elderly and at-risk patients who present with influenza-like illness within 36 hours of symptom onset. However, few data exist to enable primary care trusts to evaluate the logistics and costs of prescribing. We sought to determine, during a confirmed influenza outbreak, the proportion of eligible patients who currently present in time to benefit from treatment with a neuraminidase inhibitor, and to develop the findings into a model for evaluating potential prescribing costs. Within a single primary care group, demographic and co-morbidity data were collected on all patients consulting their general practitioner or attending an out-of-hours centre with influenza-like illness during the outbreak period. A typical primary care trust serving 100 000 patients might expect to prescribe a neuraminidase inhibitor to 140 eligible at-risk patients in a season of low influenza activity, rising to 300 in a large epidemic. At-risk patients were more likely than non-at-risk patients to consult within 36 hours of the onset of symptoms. However, only 20% of such patients, rising to 47% in out-of-hours centres, consulted in time to benefit from treatment. The low proportion of elderly and at-risk patients who consult their general practitioner in time to benefit from treatment with a neuraminidase inhibitor emphasizes the overriding importance of annual vaccination in these groups. If the full benefits of neuraminidase inhibitors are to be realized, access to treatment for eligible patients must be improved.

scholarly journals Communicative characteristics of general practitioner-led and nurse-led telephone triage at two Danish out-of-hours services: an observational study of 200 recorded calls

BMJ Open ◽  
2019 ◽  
Vol 9 (6) ◽  
pp. e028434 ◽  
Author(s):  
Emil Vilstrup ◽  
Dennis Schou Graversen ◽  
Linda Huibers ◽  
Morten Bondo Christensen ◽  
Anette Fischer Pedersen
Keyword(s):  
General Practitioner ◽  
Observational Study ◽  
Large Scale ◽  
Patient Flow ◽  
Clinical Decision ◽  
Secondary Outcome ◽  
Telephone Triage ◽  
Out Of Hours ◽  
Safety Issues ◽  
The Impact

ObjectivesOut-of-hours (OOH) telephone triage is used to manage patient flow, but knowledge of the communicative skills of telephone triagists is limited. The aims of this study were to compare communicative parameters in general practitioner (GP)-led and nurse-led OOH telephone triage and to discuss differences in relation to patient-centred communication and safety issues.DesignObservational study.SettingTwo Danish OOH settings: a large-scale general practitioner cooperative in the Central Denmark Region (n=100 GP-led triage conversations) and Medical Helpline 1813 in the Capital Region of Denmark (n=100 nurse-led triage conversations with use of a clinical decision support system).Participants200 audio-recorded telephone triage conversations randomly selected.Primary and secondary outcome measuresConversations were compared with regard to length of call, distribution of speaking time, question types, callers’ expression of negative affect, and nurses’ and GPs’ responses to callers’ negative affectivity using the Mann-Whitney U test and the Student’s t-test.ResultsCompared with GPs, nurses had longer telephone contacts (137s vs 264 s, p=0.001) and asked significantly more questions (5 vs 9 questions, p=0.001). In 36% of nurse-led triage conversations, triage nurses either transferred the call to a physician or had to confer the call with a physician. Nurses gave the callers significantly more spontaneous talking time than GPs (23.4s vs 17.9 s, p=0.01). Compared with nurses, GPs seemed more likely to give an emphatic response when a caller spontaneously expressed concern; however, this difference was not statistically significant (36% vs 29%, p=0.6).ConclusionsWhen comparing communicative parameters in GP-led and nurse-led triage, several differences were observed. However, the impact of these differences in the perspective of patient-centred communication and safety needs further research. More knowledge is needed to determine what characterises good quality in telephone triage communication.

Psychological treatments

2013 ◽  
Author(s):  
Philip Wilkinson
Keyword(s):  
Clinical Trials ◽  
Older People ◽  
Psychotropic Medication ◽  
Psychological Treatment ◽  
Psychological Treatments ◽  
Reminiscence Therapy ◽  
Treatment Services ◽  
Barriers To Access ◽  
The Status ◽  
Potential Benefits

This introduction to psychological treatments reviews the range and applications of talking therapies with older people. Reminiscence therapy is described and reference is made to the therapies addressed in later chapters. The potential benefits of psychological therapy are discussed with guidance on applying findings from clinical trials to individual patients. The wider benefits of an understanding of psychological approaches are outlined; these include use of psychological formulations and augmenting the effects of psychotropic medication. The status of psychological treatment services for older people is reviewed and barriers to access are considered.

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