An after hours gp clinic in regional Australia: appropriateness of presentations and impact on local emergency department presentations

Abstract

BackgroundAfter hours general practice clinics provide medical attention for clients with non-emergency situations but are seeking immediate treatment and unable to wait for a general practitioner during routine opening hours. Evidence on the impact that after hours clinics have on emergency department presentations is equivocal. This study explored outcomes of the Bathurst After Hours General Practice Clinic (BAHGPC). Specifically it examined: clients’ perceived urgency of, and satisfaction with their presentation to the BAHGPC; general practitioners’ perception of the appropriateness of presentations to the BAHGPC; and whether the frequency of non-urgent and semi-urgent emergency department presentations at Bathurst Base Hospital has changed since the opening of the BAHGPC.MethodsClients presenting to the BAHGPC from 01/02/2015 to 30/06/2015 were asked to participate in the client presentation survey and follow-up satisfaction survey. General practitioner surveys were completed for individual clients from 01/12/2014 to 30/06/2015 to document the appropriateness of each presentation. Descriptive statistics are used to describe survey responses. Thematic analysis was applied for qualitative responses. Emergency department presentations were retrieved from the Emergency Department Data Collection. A comparison of presentations in the two years prior and subsequent to the opening of the BAHGPC was conducted using independent T-tests and Chi-square tests to compare mean presentations and proportional data for the different time periods examined.ResultsMost clients (76%) presenting to the BAHGPC classified their visit as essential. General practitioners considered most presentations to be appropriate (87%). Sixty percent (60%) of clients would have gone to the emergency department had the BAHGPC not been operational. Client satisfaction was high and 99% would use the clinic again. A significant reduction in total non-urgent presentations to the Emergency Department occurred in the two years since the opening of the BAHGPC clinic compared to the two years prior (418.5 vs. 245.5; P < 0.05).ConclusionsThere was concordance between general practitioners and clients regarding the appropriateness of presentations to the BAHGPC. The findings of this study highlight that after hours general practitioner clinics are an essential service in regional areas and contribute to reducing the burden of non-urgent presentations to the local emergency department.Electronic supplementary materialThe online version of this article (10.1186/s12875-017-0657-6) contains supplementary material, which is available to authorized users.

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

“…In Australia, general practitioners (GPs) are usually the first point of healthcare contact and vital to managing disease and providing continuity of care. Increasingly, patients expect availability of 24-h care, presenting after usual practice hours to after-hours primary care services or to hospital emergency departments (ED) (Ifediora and Rogers 2017;Payne et al 2017). The number of ED presentations increased by 67% from 4.5 million in financial year 2004-05 to 7.5 million in 2015-16 (Australian Institute of Health and Welfare 2009; Australian Institute of Health and Welfare 2016), with the rate of increase exceeding the rate of population growth (Payne et al 2017).…”

“…Increasingly, patients expect availability of 24-h care, presenting after usual practice hours to after-hours primary care services or to hospital emergency departments (ED) (Ifediora and Rogers 2017;Payne et al 2017). The number of ED presentations increased by 67% from 4.5 million in financial year 2004-05 to 7.5 million in 2015-16 (Australian Institute of Health and Welfare 2009; Australian Institute of Health and Welfare 2016), with the rate of increase exceeding the rate of population growth (Payne et al 2017). An estimated 10-40% of ED presentations represent clients who could be managed in primary care and detract ED services and resources from more urgent presentations (Payne et al 2017).…”

“…While not all low-urgency presentations to ED could be seen appropriately by a GP, they are often used as a proxy for primary care-type visits. Establishment of two after-hours primary care clinics in rural towns in New South Wales, Australia, has been shown to reduce 'low-urgency' or 'non-urgent' presentations to nearby ED departments by 8% of all ED presentations (Buckley et al 2010) or a 41% reduction in 'non-urgent' ED presentations (Payne et al 2017). Similarly, a patient self-report survey has demonstrated the potential for after-hours house-call services across Australia to reduce primary care-type presentations to ED (Ifediora and Rogers 2017).…”

Effectiveness of hospital emergency department regionalization and categorization policy on appropriate patient emergency care use: a nationwide observational study in Taiwan

“…Nonetheless, need-driven factors were the most important predictors of appropriate ED use [ 55 ]. Conversely, common factors for inappropriate ED use include greater trust in the hospital than in the primary care setting [ 56 ], greater convenience [ 57 ], time saving [ 58 , 59 ], or lack of primary care access [ 60 ]. One Taiwanese nationwide validation study reported that an increase in the availability of ambulatory care physicians or facilities did not decrease non-emergency ED use [ 61 ].…”

Effectiveness of Hospital Emergency Department Regionalization and Categorization Policy on Appropriate Patient Emergency Care Use - A nationwide long-term observational study in Taiwan

“…Previous studies concluded that ED utilization varies by insurance status, socioeconomic status, race, and other sociodemographic factors [19,72]. Common factors for inappropriate ED use include greater trust in the hospital than in primary care [48] or greater convenience [38] and time savings [73,74]. Previous Billings/NYU-ED classi cation algorithm [40,75] designed to monitor different groups' ambulatory care sensitive conditions [76] or safety-net role of ED use [40,77].…”