Unmet need for referred services as measured by general practice

Abstract

INTRODUCTION Unmet needs are a key indicator of the success of a health system. Clinicians and funders in Christchurch, Canterbury, New Zealand were concerned that unmet health need was hidden. AIM The aim of this survey was to estimate the proportion of patients attending general practice who were unable to access clinically indicated referred services. METHODS The survey used a novel method to estimate unserviced health needs. General practitioners (GPs, n = 54) asked their patients (n = 2135) during a consultation about any health needs requiring a referred service. If both agreed that a service was potentially beneficial and not available, this was documented on an e-referral system for review. The outcomes of actual referrals were also reviewed. RESULTS The patient group was broadly representative of the Canterbury population, but over-sampled female and middle-aged people and under-sampled Māori. Data adjusted to regional demographics showed that 3.6% of patients had a GP-confirmed unserviced health need. Elective orthopaedic surgery, general surgery and mental health were areas of greatest need. Unserviced health needs were significantly (P ≤ 0.05) associated with greater deprivation, middle-age, and receiving high health-use subsidies. DISCUSSION To our knowledge, this is the first survey of GP and patient agreement on unserviced referred health needs. Measuring unserviced health needs in this way is directly relevant to service planning because the gaps identified reflect clinically indicated services that patients want and need. The survey method is an improvement on declined referral rates as a measure of need. Key factors in the method were using a patient-initiated GP consultation and an e-referral system to collect data.

Exploring the Use of Washington Group Questions to Identify People with Clinical Impairments Who Need Services including Assistive Products: Results from Five Population-Based Surveys

“…Though literature is limited, the rationale for this statement could be that people who report a difficulty in functioning may be more likely to consider that they need services, and therefore uptake related services, creating a “service demand.” In contrast, people who report having no difficulty may be unlikely to uptake referrals for services. For example, a study in New Zealand found that measuring unserviced health needs through a patient-initiated general practitioner consultation was directly relevant to service planning because the gaps identified reflected clinically indicated services that patients want and need [ 46 ]. Similarly, this relationship has been evidenced for mental health, where perceived mental health need has been shown to be predictive of seeking services [ 47 , 48 ].…”

From the Editor: Keeping on our toes

“…12 They did what no one else has done before: actually asking GPs and patients together what services they thought patients needed and then measuring whether they were received, finding that 3.6% did not. The exercise of common sense (ahead of comfortable methods) in research design places this research a step ahead in usefulness.…”