Entry Points to the Health System: a review of the emerging community models for management of non-life threatening urgent conditions relevant to Australia

Abstract

Problem: The number of presentations to Emergency Departments (EDs) is increasing at levels above population growth rates and these increases are becoming unsustainable.
 Objective: To review evidence for emerging entry points to the health system for patients with non-life threatening urgent conditions (NLTUC) in order to consider more effective healthcare services in Australia.
 Methods: An in-depth review of the Emerald, Medline, CINAHL, Web of Science, Proquest Business and Medical databases from January 2005 to April 2016 matching ‘acute care’ or ‘urgent care’ with general practice andother health providers found thirteen entry point models with five currently relevant to Australia.
 Results: Studies examining five emerging entry points were found including urgent care community pharmacy, new prehospital practitioner community care, advanced nurse enhancement of primary care, designated urgent care clinics and integrated primary care centers. Evidence for these emerging models of community healthcare is presented including emerging initiatives, cost implications, subsequent admission to hospital, satisfaction, mortality, care, treatment time, subsequent referrals, testing and health outcomes.
 Conclusion: These emerging models of community healthcare need to be trialed and studied in the Australian context to evaluate whether they provide patients with NLTUC with a safe cost-effective option with similar outcomes to EDs. Implementation of these models can be examined further to determine their effectiveness in potentially reducing the increasing rate of presentation to EDs.
 Abbreviations: APCN – Advanced Primary Care Nurse; ECP – Emergency Care Practitioners; ED – Emergency Department; GP – General Practitioner; IPCC – Integrated Primary Care Centre; PP – Paramedic Practitioners; NLTUC – Non-Life Threatening Urgent Conditions; UCC – Urgent Care Clinics; UCCP – Urgent Care Community Pharmacy.

Urgent care in the community: an observational study

“…As many of the patients in our study presented with conditions that are in the nurse practitioner (NP) scope of practice (Table 3) (Nursing and Midwifery Board of Australia, 2021), and are often seen by NPs in other countries (Adie et al, 2017), adequately funded NPs are a solution to the Australian workforce problems caused by the lack of availability of GPs when required (Australian Bureau of Statistics, 2019). The RACGP supports the colocated role of the NP within GP-led general practice teams (RACGP, 2016), but the remuneration by the primary care funder Medicare (Australian Government Department of Health, 2020) makes it difficult for private general practices to compete with public hospital for the service of the NP.…”