Exploring the measure of potentially avoidable general practitioner-type presentations to the emergency department in regional Queensland using linked, patient-perspective data
Mary O’Loughlin
A D , Jane Mills B , Robyn McDermott A C and Linton R Harriss A
A Australian Institute of Tropical Health and Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, PO Box 6811, Cairns, Qld 4870, Australia. Email: robyn.mcdermott@jcu.edu.au; linton.harriss@jcu.edu.au
B La Trobe Rural Health School, Bendigo Campus, Edwards Road, Flora Hill, Bendigo , Vic. 3552. Email: jane.mills@latrobe.edu.au
C School of Health Sciences, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia.
D Corresponding author. Email: mary.oloughlin@my.jcu.edu.au
Australian Health Review - https://doi.org/10.1071/AH19210
Submitted: 13 September 2019 Accepted: 12 May 2020 Published online: 30 October 2020
Journal Compilation © AHHA 2020 Open Access CC BY-NC-ND
Abstract
Objective To explore measures of potentially avoidable general practitioner (PAGP)-type presentations to the emergency department (ED) of a large regional hospital in northern Queensland.
Methods Linkage of an ED administrative dataset to a face-to-face patient survey of local residents (n = 1000); calculation of Australian Institute of Health and Welfare (AIHW) and Australasian College of Emergency Medicine (ACEM) measures of PAGP-type presentations to the ED; and exploration of these measures with patient-perspective linked data.
Results PAGP-type presenters to the ED were younger in age (median age in years: total cohort: 49; AIHW 38, P < 0.001; ACEM 36, P < 0.001); with the odds of having a chronic condition being less likely for AIHW PAGP-type presenters than other ED presenters (OR (95% CI) 0.54 (0.38–0.77): P = 0.001)) after adjustment for age. PAGP-type presenters nominated reasons of convenience rather than urgency as their rationale for attending the ED, irrespective of measure. The number of PAGP-type presentations to the ED identified by the AIHW measure was more than three-fold higher than the ACEM measure (AIHW: n = 227; ACEM: n = 67). Influencing factors include the low proportion of ED attendees who had a medical consultation time of <1 h at this hospital site (1-month survey period: 17.8%); and differences between the patient self-report and ED administrative record for ‘self-referral to the ED’ (Self-referred: Survey 71% vs EDIS 93%, P < 0.001).
Conclusions Identification of PAGP-type presentations to the ED could be enhanced with improvements to the quality of administrative processes when recording patient ‘self-referral to the ED’, along with further consideration of hospital site variation for the length of medical consultation time.
What is known about the topic? PAGP-type presentations to the ED are an Australian National Healthcare Agreement progress indicator. Methods of measuring this indicator have been under review since 2012 and debate remains on how to accurately determine the measure.
What does this paper add? By using patient perspective-linked data to explore different measures of PAGP-type presentations to EDs, this paper identifies issues with measure elements and suggests ways to improve these measures.
What are the implications for practitioners? Measure elements of patient ‘self-referral to the ED’ and ‘medical consultation time’ require further consideration if they are to be used to measure PAGP-type presentations to the ED.
References
[1] Council of Australian Governments. National Healthcare Agreement: PI 19–Selected potentially avoidable GP-type presentations to emergency departments, 2018. Canberra: COAG; 2018.[2] National Health Performance Authority. Healthy Communities: potentially preventable hospitalisations in 2013–14. Sydney, Australia: National Health Performance Authority; 2015.
[3] Australian Institute of Health and Welfare. Australia’s health 2014. Australia’s health series no. 14. Canberra: AIHW; 2014.
[4] SCRGSP (Steering Committee for the Review of Government Service Provision). Report on Government Services 2019. Canberra: Productivity Commission, Commonwealth of Australia; 2019. Available at https://www.pc.gov.au/research/ongoing/report-on-government-services [Verified 9 September 2020]
[5] Nagree Y, Gosbell A, McCarthy S, Moore K, Mountain D. Determining the true burden of general practice patients in the emergency department: getting closer. Emerg Med Australas 2013; 25 487–90.
| Determining the true burden of general practice patients in the emergency department: getting closer.Crossref | GoogleScholarGoogle Scholar | 24308612PubMed |
[6] Standing Council on Health. National Strategic Framework for Rural and Remote Health. Canberra: Australian Government; 2011.
[7] Cheek C, Allen P, Shires L, Parry D, Ruigrok M. Low-acuity presentations to regional emergency departments: what is the issue? Emerg Med Australas 2016; 28 145–52.
| Low-acuity presentations to regional emergency departments: what is the issue?Crossref | GoogleScholarGoogle Scholar | 26708775PubMed |
[8] Australian Institute of Health and Welfare. Australian hospital statistics 2012–13: emergency department care. Canberra: AIHW; 2013.
[9] Australian Institute of Health and Welfare. Emergency department care 2016–17: Australian hospital statistics. Health services series no. 80. Cat. no. HSE 194. Canberra: AIHW; 2017.
[10] Australian Institute of Health and Welfare. Australia’s health 2018. Australia’s health series no. 16. AUS 221. Canberra: AIHW; 2018.
[11] Nagree Y, Camarda VJ, Fatovich DM, Cameeron PA. Quantifying the proportion of general practice and low-acuity patients in the emergency department. Med J Aust 2013; 198 612–15.
| Quantifying the proportion of general practice and low-acuity patients in the emergency department.Crossref | GoogleScholarGoogle Scholar | 23919709PubMed |
[12] Australasian College for Emergency Medicine. ACEM policy on the Australasian triage scale. Melbourne: Australasian College for Emergency Medicine.; 2013.
[13] Allen P, Cheek C, Foster S, Ruigrok M, Wilson D, Shires L. Low acuity and general practice-type presentations to emergency departments: a rural perspective. Emerg Med Australas 2015; 27 113–8.
| Low acuity and general practice-type presentations to emergency departments: a rural perspective.Crossref | GoogleScholarGoogle Scholar | 25720647PubMed |
[14] Borland M, Skarin D, Nagree Y. Comparison of methods used to quantify general practice-type patients in the emergency department: a tertiary paediatric perspective. Emerg Med Australas 2017; 29 77–82.
| Comparison of methods used to quantify general practice-type patients in the emergency department: a tertiary paediatric perspective.Crossref | GoogleScholarGoogle Scholar | 27681837PubMed |
[15] Sprivulis P. Estimation of the general practice workload of a metropolitan teaching hospital emergency department. Emerg Med 2003; 15 32–7.
| Estimation of the general practice workload of a metropolitan teaching hospital emergency department.Crossref | GoogleScholarGoogle Scholar |
[16] O’Loughlin M, Harriss L, Thompson F, McDermott R, Mills J. Exploring factors that influence adult presentation to an emergency department in regional Queensland: a linked, cross-sectional, patient perspective study. Emerg Med Australas 2019; 31 67–75.
| Exploring factors that influence adult presentation to an emergency department in regional Queensland: a linked, cross-sectional, patient perspective study.Crossref | GoogleScholarGoogle Scholar | 29851305PubMed |
[17] Stephens AS, Broome RA. Patterns of low acuity patient presentations to emergency departments in New South Wales, Australia. Emerg Med Australas 2017; 29 283–90.
| Patterns of low acuity patient presentations to emergency departments in New South Wales, Australia.Crossref | GoogleScholarGoogle Scholar | 28320067PubMed |
[18] Unwin M, Kinsman L, Rigby S. Why are we waiting? Patients’ perspectives for accessing emergency department services with non-urgent complaints. Int Emerg Nurs 2016; 29 3–8.
| Why are we waiting? Patients’ perspectives for accessing emergency department services with non-urgent complaints.Crossref | GoogleScholarGoogle Scholar | 27776980PubMed |
[19] FitzGerald G, Toloo G, Aitken P, Keijzers G, Scuffham P. Public use and perceptions of emergency departments: a population survey. Emerg Med Australas 2015; 27 336–42.
| Public use and perceptions of emergency departments: a population survey.Crossref | GoogleScholarGoogle Scholar | 26095210PubMed |
[20] Queensland Audit Office. Emergency department performance reporting. Report 3: 2014–15. Brisbane, Qld: The State of Queensland; 2014.
