AgedCare+GP: description and evaluation of an in-house model of general practice in a residential aged-care facility

Abstract

This paper describes a medical model to provide in-house GP services to residents of aged-care facilities. Access to GP services for aged-care residents is decreasing, partially due to the changing demographic of the Australian GP workforce. The model we have developed is an in-house GP (AgedCare+GP) trialled in a publicly funded residential aged-care facility (RACF). The service model was based on the GP cooperative used in our after-hours general practice (AfterHours+GP). Briefly, the service model involves rostering a core group of GPs to provide weekly sessional clinics at the RACF. Financial contributions from appropriate Medicare Benefits Schedule (MBS) items for aged-care planning (including chronic conditions) provided adequate funds to operate the clinic for RACF residents. Evaluation of the service model used the number of resident transfers to the local emergency department as the primary outcome measure. There were 37 transfers of residents in the 3 months before the commencement of the AgedCare+GP and 11 transfers over a 3-month period at the end of the first year of operation; a reduction of almost 70%. This project demonstrates that AgedCare+GP is a successful model for GP service provision to RACF residents, and it also reduces the number of emergency department transfers.

Appropriateness of transferring nursing home residents to emergency departments: a systematic review

“…The lack of availability of a GP was a potential explanation for the increase in ED transfers [4, 13, 34, 49, 51, 65]. Seven studies suggested that timely attendance by a GP allowed early medical assessment of an ill resident, early clinical diagnosis and initiation of treatment at the NH, reducing the number of ED transfers [6, 13, 27, 44, 63, 66, 67]. These GPs were usually not on-site; they only visited the NH through scheduled appointments and on an on-call basis [19, 40, 45, 51].…”

“…By improving the availability of general practitioners during working hours as well as during out-of-hours, NH residents will have earlier access to appropriate medical care. This may increase appropriate referral decisions [9, 13, 15, 20, 41, 43, 51, 62, 67, 75]. Marshall et al observed a reduction of 34% in overall transfers from NHs to EDs attributable to improved onsite primary care, with consistent physician and team engagement and improvements in continuity of care [13].…”

“…Improving interprofessional collaboration between GPs, NH staff and EDs should be encouraged because it prevents inappropriate transfer of NH residents [13, 15, 20, 34, 50, 62, 67, 70]. Nursing staff will feel safer and more confident knowing why, when and how they can rely on a GP [13, 15, 19, 34, 37, 50, 51, 62].…”

Hospital admissions and place of death of residents of care homes receiving specialist healthcare services: Protocol for a systematic review

“…Similar initiatives have been trialled internationally (Clarkson et al., ). For example, Pain, Stainkey, and Chapman (), described an in‐house model of general practice in Australia whereby a core group of GPs were rostered to provide weekly sessional clinics in a care home, whilst as part of the Evercare demonstration programme in the US, nurse practitioners assessed and managed residents on an ongoing basis, supplementing the support provided by primary care practitioners (Kane, Keckhafer, Flood, Bershadsky, & Siadaty, ). Comparable services have been described in Canada (Klaasen, Lamont, & Krishnan, ; McAiney et al., ) and pharmacy‐led services have been reported in countries including Spain, Australia and the US (Crotty et al., ; Maack, Miller, Johnson, & Dewey, ; Martínez, Mondéjar, Gómez, & Torres, ).…”

“…Similar initiatives have been trialled internationally (Clarkson et al, 2018). For example, Pain, Stainkey, and Chapman (2014), described an in-house model of general practice in Australia whereby Why is this review needed?…”