After-hours presentations to community-based primary care in the Australian Capital Territory

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.

Why patients attend after-hours medical services: a cross-sectional survey of patients across the Australian Capital Territory

“…In urban and metropolitan Australia, community-based medical services are available and well utilised, servicing specific medical issues (Britt et al 2016;Turner et al 2017; Barnes et al 2022). Common after-hours community-based medical service presentations include a mixture of urgent as well as non-urgent infections, injuries and ongoing care conditions (e.g.…”

“…Common after-hours community-based medical service presentations include a mixture of urgent as well as non-urgent infections, injuries and ongoing care conditions (e.g. depression) (Baker et al 2020; Barnes et al 2022). In contrast, commonly reported potentially avoidable ED presentations include abdominal pain, chest pain, and viral infections (Cheek et al 2016; Australian Institute of Health and Welfare 2020).…”

“…In contrast, commonly reported potentially avoidable ED presentations include abdominal pain, chest pain, and viral infections (Cheek et al 2016; Australian Institute of Health and Welfare 2020). From presentation data alone, it appears after-hours services are being used mostly appropriately (Barnes et al 2022). However, presentation data are reported from practitioner perspectives after assessment of a patient, and after the patient has chosen to present to a specific service (Turner et al 2017;Baker et al 2020; Barnes et al 2022).…”

“…From presentation data alone, it appears after-hours services are being used mostly appropriately (Barnes et al 2022). However, presentation data are reported from practitioner perspectives after assessment of a patient, and after the patient has chosen to present to a specific service (Turner et al 2017;Baker et al 2020; Barnes et al 2022). To better understand health service use, patient health-seeking behaviours must also be considered (Cheek et al 2016; Barnes et al 2022).…”

“…Common reasons for attending after-hours community-based services also include perceived need and urgency (Keizer et al 2015;Payne et al 2017). Current literature on patient reasons for after-hours medical service access only refers to single health services such as EDs or medical deputising services (MDS); and not to other available community-based services such as extended hours GPs or nurse-led clinics that commonly report non-urgent presentations (Barnes et al 2022). As such, it is unclear why patients choose a specific service within a whole health system.…”