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Katelyn Barnes
16/11/2022
Summary: Cross-sectional survey of afterhours presentations across the whole ACT Health system shows community-based services, especially general practice, contribute significantly to afterhours medical care. Patients are self selecting services aligned with each services' advertised purpose.
The Afterhours project considered what presentations are happening across the whole ACT Health system outside of usual hours.
Afterhours medical services provide care between 6pm and 8am weekdays, before 8am or after midday on Saturday, or anytime on a Sunday or public holiday. Government and media say that too many people present to emergency departments afterhours with things that would be better managed in community-based services, like general practice. In the ACT, community-based services are available afterhours, though it is not known what is being managed by these services afterhours. Researchers from ACT Health Directorate and the Australian National University teamed up with PracNet to conduct a survey of patients and providers to understand where patients present, what issues were presenting afterhours, and patient reasons for seeking care. The survey was conducted in 2019 covering a Thursday night, Friday night, and entire weekend just prior to flu season at 3/3 Nurse led Walk in centres (WICs), 2/2 Canberra afterhours locum medical services (CALMS), 31/50 extended hours General Practice (GP), and 2/2 Public Emergency Departments (EDs) (triage code 4 and 5, or “low acuity” patients only).
Extended hours general practice saw the largest number of patients during the study.
GP dominated afterhours care, with the largest number of sites available and the greatest number of patients seen during the study. Most GPs in this study closed on Saturday afternoon and did not re-open until Monday morning. Saturday morning is considered “in hours” according to MBS. While there was a proportional shift towards presenting to non-GP sites on times other than Saturday morning; data shows no change in types of presentations to each site at different times. Of patients attending a non-GP service, half reported accessing the service because their usual GP was not available. As such, availability of afterhours GP services influenced where people presented, but not why people were presenting afterhours.
Patients are using afterhours health services for different things, mostly aligned with advertised purpose.
Patients self-selected services mostly appropriately, and each service appears to provide a unique role in the afterhours period. ED serviced mostly new and urgent issues with a high proportion of musculoskeletal injuries (data currently unpublished). Patients most often chose ED because of access to facilities such as x-ray and pathology, unavailable in the community afterhours. WICs served a community-nursing type role, seeing mostly new and non-urgent issues, with a high proportion of wound care presentations. Patients chose the WICs for quick, accessible care for things they did not think required a doctor. CALMS served mostly new and urgent issues, with a high proportion of infections. Patients chose CALMS when their usual GP was unavailable, but they were seeking GP type care. Extended hours GP sees a wide range of presentations, though mostly non-urgent and ongoing issues including chronic disease management and preventive health issues. Patients chose GP because it was their usual care provider and afterhours fits best with their other life priorities (e.g., work or caring responsibilities). Clearly, each service in the ACT hybrid model of afterhours care is being used differently.
Findings can help inform strategies to support patients accessing timely care afterhours.
Overall, findings help to understand the way in which afterhours services are being used and may help inform strategies to redirect patients or reorient health services to ensure timely access to appropriate levels of care. Findings have been shared with all included study sites, ACT Health, Canberra Health Services, and Calvary Public Hospital. Future research is needed to explore efficiency of each model of care, and to find out how COVID-19 and associated health service changes influence presentations.
Read our full publications here:
Barnes K, Ceramdias D, Agostino J, Dougals K. Afterhours presentations to community-based primary care in the Australian Capital Territory. Australian Journal of Primary Health. https://doi.org/10.1071/PY21261
Barnes K, Ceramidas D, Douglas K. Why patients attend Afterhours Medical Services: a cross-sectional survey of patients across the Australian Capital Territory. Australian Journal of Primary Health. https://doi.org/10.1071/PY22087
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