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

Abstract

Background. Almost half of Australian after-hours emergency department (ED) presentations are rated as 'non-urgent' by clinicians and are suggested to be managed by community-based services, such as general practice (GP). This paper reports patient reasons for presenting for medical care after hours, and reasons for selection of specific services across a health system. Methods. A cross-sectional survey was conducted across the Australian Capital Territory. Patients voluntarily completed questionnaires in waiting rooms during the after-hours periods of one weekday and one weekend in 2019 at 28/51 extended hours GPs, 3/3 medical deputising services (MDS), 3/3 nurse-led walk-in-clinics (WICs), and 2/2 public emergency departments (EDs). Results. Of 3371 presentations, 1992 patients completed a survey, with 58% from GPs (n = 1149), 16% from WIC (n = 317), 10% from MDS (n = 193), and 17% from EDs (n = 333). Most patients presented with self-rated new issues (n = 987, 49.5%) and were uncertain of the urgency of their issues (n = 723, 36.7%). Common reasons for presenting to WIC, MDS, and EDs included the problem occurring after hours, and patients concern about the issue. Common reasons for presenting to GP were related to personal preference for after-hours care. Conclusions. Patients present to after-hours medical services for both perceived need and convenience. Most patients appear to be self-selecting after-hours services appropriately aligned with advertised services; except for GP patients who were attending after hours for care that is often non-urgent and could be seen in usual working hours. This study should be replicated to account for local health systems, and coronavirus disease 2019 (COVID-19)-related changes to health care.

Low agreement among patients and clinicians about urgency and safety to wait for assessment in primary care after hours medical care: results of cross-sectional matched surveys

“…This study examines data collected from a broader project that explored presentations in after-hours primary care [ 11 , 14 ]. A cross-sectional survey voluntarily completed by practitioners and patients was undertaken in May/June, 2019 from 6pm on Thursday to 8am Monday; covering one weeknight and weekend.…”

“…Participants and recruitment processes have been reported [ 11 , 14 ]. Briefly, potential participants included (i) any person presenting to a study site during the study period, without obvious barriers to consent, and (ii) any clinician providing care at any medical service in the ACT, open after 6pm Thursday or Friday for at least two hours, or anytime Saturday or Sunday.…”

“…Data was collected from 50 General Practices with varied billing practices, three Medical Deputising Services (MDS) staffed by GPs generally incurring a co- payment; three Nurse led Walk in Centres (WICs) offering services free at point-of-care; and two public EDs, with services free at point-of-care. Patients can choose to attend any of the services, though are dependent on opening hours and availability of clinicians [ 11 ]. GP services are site specific with some providing “walk-in” options, and most open until 6pm weekdays and at least 4 h on Saturday morning; WICs are a “walk in” service only, open 7am-10pm every day; MDS is an appointment and “walk in” service available after 6pm weekdays and anytime on weekends; and ED is a “walk in” service open at all times.…”

“…Patients seeing non-consenting practitioners were still eligible to take part in the patient survey, but could not contribute matched patient data. Unmatched patient data are reported elsewhere [ 11 ].…”

“…Current understanding of Australian patient and clinician sense of urgency are only from ED settings; with only one international study set in community-based after-hours services [ 12 ]. While after-hours primary care in Australia manages a mixture of urgent and non-urgent presentations [ 11 , 14 – 16 ]; studies report unmatched proportions of patient perceived urgency and clinician reported appropriateness of presentations [ 7 , 9 , 10 , 12 ], with only two papers considering case-by-case basis [ 12 , 13 ]. As such discordance between patient perceived and clinician perceived urgency of a presenting problem may underpin the concept of “potentially avoidable” presentations to after-hours medical services.…”