Bridging the gap between primary and secondary care: a utilisation evaluation of an otolaryngology GPwSI programme
William Brundell
1 * , Nadina Thwaites 2 , Sharon Arrol 3 , Bruce Arroll 4 , Christin Coomarasamy 5 , Randall Morton 2
1 Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.
2 Otolaryngology, Middlemore Hospital, Counties Manukau Health, Auckland, New Zealand.
3 Health Intelligence and Informatics, Middlemore Hospital, Counties Manukau Health, Auckland, New Zealand.
4 General Practice and Primary Health Care, The University of Auckland, Auckland, New Zealand.
5 Data Insight Analyst, Westpac, Auckland, New Zealand.
Journal of Primary Health Care 15(1) 67-70 https://doi.org/10.1071/HC22113
Published: 21 December 2022
© 2023 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of The Royal New Zealand College of General Practitioners. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)
Abstract
Introduction: Counties Manukau Health Otolaryngology programme for general practitioners with special interest (GPwSI) was developed to provide a group of GPs with tools to manage low complexity, secondary otolaryngology (ORL) problems in their local communities. After clinical triaging, the medical records were retrieved to assess patient outcomes from community (GPwSI) review. This programme provides an example of how the aims of the Health NZ reforms may work in practice, by bridging primary and secondary services.
Aim: To assess whether the GPwSI programme provides patients with suitable specialty care in the community, compared to a specialised, hospital outpatient otolaryngology clinic (OPC).
Methods: This is a retrospective study of patients with an assigned priority of three (non-urgent) referred to Middlemore Hospital for a first specialist assessment (FSA) during 2018–19.
Results: Of the 6231 patients referred, one-fifth (22%) were directed to the GPwSI service, and the remainder (78%) were arranged to be seen in the OPC. GPwSI patients were more likely to be seen for their FSA earlier than OPC patients (RR 1.55, 95% CI 1.46–1.64, P < 0.05). Most patients (99%) referred for surgery by GPwSIs and about one-quarter (23%) of GPwSI patients (315/1345; 23%) were assigned to GPwSI follow up, of which almost all (95%) were managed within the GPwSI programme.
Discussion: Patients being seen through the GPwSI programme are suitably managed in the community, more efficiently than if they were to be seen in an outpatient specialist clinic.
Keywords: general practitioners, health services, models of care, New Zealand health reforms, New Zealand health strategy, otolaryngology, performance and evaluation, primary health care.
References
[1] Department of the Prime Minister and Cabinet. The Health and Disability System Review. (DPMC, CAB-20-SUB-0369); 2020. Available at https://dpmc.govt.nz/sites/default/files/2021-04/heallth-reform-white-paper-summary-apr21.pdf[2] Jones R, Rosen R, Tomlin Z, et al. General practitioners with special interests: evolution and evaluation. J Health Serv Res Policy 2006; 11 106–109.
| General practitioners with special interests: evolution and evaluation.Crossref | GoogleScholarGoogle Scholar |
[3] Yellamaty V, Ball L, Crossland L, et al. General practitioners with special interests: an integrative review of their role, impact, and potential for the future. Aust J Gen Pract 2019; 48 639–643.
| General practitioners with special interests: an integrative review of their role, impact, and potential for the future.Crossref | GoogleScholarGoogle Scholar |
[4] Winpenny EM, Miani C, Pitchforth E, et al. Improving the effectiveness and efficiency of outpatient services: a scoping review of interventions at the primary–secondary care interface. J Health Serv Res Policy 2017; 22 53–64.
| Improving the effectiveness and efficiency of outpatient services: a scoping review of interventions at the primary–secondary care interface.Crossref | GoogleScholarGoogle Scholar |
[5] Salisbury C, Noble A, Horrocks S, et al. Evaluation of a general practitioner with special interest service for dermatology: randomised controlled trial. BMJ 2005; 331 1441–1446.
| Evaluation of a general practitioner with special interest service for dermatology: randomised controlled trial.Crossref | GoogleScholarGoogle Scholar |
[6] Botting J, Correa A, Duffy J, et al. Safety of community-based minor surgery performed by GPs: an audit in different settings. Br J Gen Pract 2016; 66 e323–e328.
| Safety of community-based minor surgery performed by GPs: an audit in different settings.Crossref | GoogleScholarGoogle Scholar |
[7] Taneja A, Singh PP, Tan JPL, et al. Efficacy of general practitioners with specialty interests for surgical procedures. ANZ J Surg 2015; 85 344–348.
| Efficacy of general practitioners with specialty interests for surgical procedures.Crossref | GoogleScholarGoogle Scholar |
[8] Salmon P, Mortimer N, Rademaker M, et al. Surgical excision of skin cancer: the importance of training. Br J Dermatol 2010; 162 117–122.
| Surgical excision of skin cancer: the importance of training.Crossref | GoogleScholarGoogle Scholar |
[9] Te Whatu Ora. Changing the System. Wellington: Health NZ. Available at https://www.tewhatuora.govt.nz/whats-happening/changing-the-system/ [Accessed 18 July 2022].
[10] Jeffreys M, Smiler K, Loschmann LE, et al. Prevalence and Consequences of Barriers to Primary Health Care. Wellington: Ministry of Social Development; 2021. Available at https://www.msd.govt.nz/documents/about-msd-and-our-work/publications-resources/research/barriers-to-primary-health-care/prevalence-and-consequences-of-barriers-to-primary-health-care.pdf
