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Journal of Primary Health Care Journal of Primary Health Care Society
Journal of The Royal New Zealand College of General Practitioners
RESEARCH ARTICLE (Open Access)

How is enrolment with a general practice associated with subsequent use of the emergency department in Aotearoa New Zealand? A cohort study

Megan Pledger https://orcid.org/0000-0003-1669-8346 1 * , Maite Irurzun-Lopez 1 , Nisa Mohan 1 , Jacqueline Cumming 1
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- Author Affiliations

1 Te Hikuwai Rangahau Hauora - Health Services Research Centre, Te Wāhanga Tātai Hauora – Wellington Faculty of Health, Te Herenga Waka - Victoria University of Wellington, PO Box 600, Wellington 6140, New Zealand.

* Correspondence to: megan.pledger@vuw.ac.nz

Handling Editor: Tim Stokes

Journal of Primary Health Care 16(2) 135-142 https://doi.org/10.1071/HC24023
Submitted: 19 February 2024  Accepted: 26 April 2024  Published: 9 May 2024

© 2024 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

Around 5% of the people in Aotearoa New Zealand (NZ) are not enrolled with a general practice.

Aim

This study aimed to explore the utilisation of general practice by enrolment status and subsequent use of an emergency department.

Methods

We compared a cohort of respondents from New Zealand Health Surveys (2013/14–2018/19) on self-reported general practice utilisation and their substitutes, according to their enrolment status (enrolled and not enrolled). They were then followed up to examine their subsequent use of an emergency department. Time to an emergency department presentation was modelled with proportional hazards regression models with enrolment status as the explanatory variable. Confounding variables used were sex, age group, prioritised ethnicity, the New Zealand Deprivation Index and self-rated health.

Results

Those not enrolled were more likely to be young, male, Asian, more socioeconomically deprived and with better health status than those enrolled. Generally, those not enrolled utilised general practice services less. Those not enrolled who had used an emergency department were more likely to have used it as a substitute for general practice (40% vs 26%). Modelling showed that those not enrolled took longer to access an emergency department. Adjusting for confounding variables did not change that interpretation.

Discussion

Those not enrolled were younger and healthier and may have a perception that enrolment isn’t necessary. As a group, they were more likely to be socioeconomically deprived and to use an emergency department, which is free at a public hospital in NZ, as a substitute for primary care which suggests that cost may influence their choices.

Keywords: Aotearoa New Zealand, emergency department, general practice, health equity, primary health care, primary health care enrolment, primary healthcare organisations, survival analysis.

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