After-hours presentations to community-based primary care in the Australian Capital Territory
Katelyn Barnes A B * , Jason Agostino B C , Dagmar Ceramidas A B and Kirsty Douglas A BA Academic Unit of General Practice, Office of Professional Leadership and Education, ACT Health Directorate, Canberra, ACT, Australia.
B Medical School, College of Health and Medicine, Australian National University, Canberra, ACT, Australia.
C Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, ACT, Australia.
Australian Journal of Primary Health 28(3) 232-238 https://doi.org/10.1071/PY21261
Submitted: 10 November 2021 Accepted: 17 January 2022 Published: 17 March 2022
© 2022 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of La Trobe University. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)
Abstract
Backgound: This study describes patient characteristics and presentations to community-based primary care medical services in the after-hours period.
Methods: A cross-sectional survey completed by practitioners was voluntarily conducted over one weeknight and weekend in 2019 at 31 of 51 extended hours general practices (GP), three of three medical deputising services and three of three nurse-led walk-in clinics (WICs).
Results: Of 3371 community-based after-hours presentations, 934 consultation records were obtained (overall response: 28%). Emergency departments reported 524 triage code 4 and 5 patients within the study period. Problems managed in community-based after-hours services were most often rated as non-urgent (n = 482; 51.6%) and new (n = 606; 64.9%). The most common community-based after-hours presentations were diagnostic or disease related (e.g. infections or injury; n = 667; 59.5%). The most common body systems impacted were respiratory (n = 329; 29.6%), skin (n = 164; 16.4%) and general/unspecified (e.g. fever; n = 164; 16.4%). Community-based after-hours services reported different types of presentations, with medical deputising services reporting more urgent presentations, GPs reporting more procedural presentations and walk-in clinics reporting more skin-related issues (e.g. wound care).
Conclusions: Community-based after-hours medical services contribute significantly to after-hours medical care in the ACT. Patients are self-selecting community-based after-hours medical services appropriately based on problems managed by practitioners.
Keywords: emergency medicine, health policy, health-seeking behaviour, health services research, health service utilisation, health systems, primary care.
References
Australian Bureau of Statistics (2019) Population by age and sex tables. Available at https://www.abs.gov.au/statistics/people/population/national-state-and-territory-population/dec-2019 [Accessed July 2021]Australian Government Department of Health (2021a) Medicare Benefits Schedule – Item 5020. Available at http://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&qt=ItemID&q=5020 [Accessed July 2021]
Australian Government Department of Health (2021b) After hours primary health care. Available at https://www1.health.gov.au/internet/main/publishing.nsf/Content/primary-ahphc#:~:text=The%20PIP%20After%20Hours%20Incentive,to%20provide%20after%20hours%20access
Australian Government Services Australia (2016) After Hours Incentive Guidelines. Available at https://www.servicesaustralia.gov.au/organisations/health-professionals/services/medicare/practice-incentives-program/what-are-individual-incentives/after-hours-incentives
Australian Institute of Health and Welfare (2020) Use of emergency departments for lower urgency care: 2015–16 to 2018–19. Available at https://www.aihw.gov.au/reports/primary-health-care/use-of-ed-for-lower-urgency-care-2018-19/contents/lower-urgency-care/summary
Baker J, Britt H, Harrison C (2020) GP services in Australia: presentation profiles during usual practice hours and after-hours periods. Australian Journal of Primary Health 26, 117–123.
| GP services in Australia: presentation profiles during usual practice hours and after-hours periods.Crossref | GoogleScholarGoogle Scholar | 32307031PubMed |
Britt H, Miller GC, Bayram C, Henderson J, Valenti L, Harrison C, Pan Y, Charles J, Pollack AJ, Chambers T (2016) ‘A decade of Australian general practice activity 2006–07 to 2015–16.’ (Sydney University Press: Sydney, NSW, Australia)
Classification Committee of the World Organization of Family Doctors (1998) ‘ICPC-2: International Classification of Primary Care.’ 2nd edn. (Oxford University Press: Oxford, UK)
Desborough J, Hall Dykgraaf S, de Toca L, Davis S, Roberts L, Kelaher C, Kidd M (2020) Australia’s national COVID-19 primary care response. The Medical Journal of Australia 213, 104–106.
| Australia’s national COVID-19 primary care response.Crossref | GoogleScholarGoogle Scholar | 32623740PubMed |
Duwalage KI, Burkett E, White G, Wong A, Thompson MH (2021) Identifying and quantifying general practice‐type emergency department presentations. Emergency Medicine Australasia 33, 1049–1058.
| Identifying and quantifying general practice‐type emergency department presentations.Crossref | GoogleScholarGoogle Scholar | 34002478PubMed |
Health Policy Analysis (2020) Evaluation of PHN After Hours Program, Final report Volume 2 Main Report. Commonwealth Department of Health, Canberra, ACT, Australia.
Jackson, C (2014) Review of after hours primary health care: Report to the Minister for Health and Minister for Sport. (Canberra, ACT, Australia) Available at https://www1.health.gov.au/internet/main/publishing.nsf/Content/primary-ahphc-review
Roy T (2021) Canberra emergency department wait times are the worst in the country, but the Health Minister says she’ll fix it in nine months. ABC News 1 February 2021. Available at https://www.abc.net.au/news/2021-02-01/act-plans-to-reverse-emergency-wait-times-within-nine-months/13106742
Thompson MI, Lasserson D, McCann L, Thompson M, Heneghan C (2013) Suitability of emergency department attenders to be assessed in primary care: survey of general practitioner agreement in a random sample of triage records analysed in a service evaluation project. BMJ Open 3, e003612
| Suitability of emergency department attenders to be assessed in primary care: survey of general practitioner agreement in a random sample of triage records analysed in a service evaluation project.Crossref | GoogleScholarGoogle Scholar | 24319279PubMed |
