Aboriginal and Torres Strait Islander Health Performance Framework - 2010

3.14 Access to after-hours primary care

Page last updated: 26 May 2011

Why is it important?:

‘After hours’ is usually taken to mean services provided on Sunday, before 8am and/or after 1pm on Saturday, or at any time other than 8am to 8pm on weekdays. An important component of comprehensive primary care services is the capacity for patients to access services after hours. In the absence of after-hours primary health care, patients with more urgent needs may delay seeking care. In many circumstances, it is preferred that the primary health care doctor is consulted first. For example, for people with chronic conditions, the primary health care doctor will know about the patient’s condition and history, and be able to make an informed judgment about the treatment required. For some patients, work and school commitments make it difficult to access primary care during normal working hours. These patients are increasingly looking for more convenient arrangements. All these issues apply to Aboriginal and Torres Strait Islander peoples. Indeed, several factors (such as the higher prevalence of chronic conditions and higher incidence of injury) suggest that after-hours services may be more important for Indigenous Australians.

GPs employ various after-hours arrangements including: practice-based services (GPs within a practice looking after their own patients after hours); deputising services (commercial companies employing doctors to provide an after-hours service); emergency departments (primary care patients attend emergency departments after hours due to a lack of other services); co-operatives (GPs from different practices forming a non-profit making organisation to provide care for their own patients after hours); primary care centres (patients attending a centre rather than being seen in their own home or in the emergency department after hours); telephone triage and advice services (the use of telephone consultations for primary care patients seeking medical help after hours) (Leibowitz et al. 2003).

Over recent years, the need to provide additional support for GPs in the provision of after-hours services has been recognised. There are special Medicare items for the provision of after-hours consultations, with increased benefit rates. However, these have been insufficient to ensure after-hours GP services are comprehensive. The Australian Government has provided funding through several programs to improve provision, including financial, through Practice Incentives Program (PIP) payments; trials of alternative arrangements (Dunt et al. 2002); and through the General Practice After Hours Program. The establishment of ‘GP super clinics’ will also partially address issues concerning the adequacy of after-hours coverage in some regions.

Findings:

Over the period April 2004 to March 2009, 95% of Indigenous GP encounters were with practices offering after-hours care arrangements. This compared with 99% of other Australian GP encounters. Types of arrangements included 'practice does its own', 'referral to other services', 'deputising service', 'cooperative with other practices' and 'other arrangements'. Deputising service for after-care arrangements were more than twice as common in practices attended by other Australians.

In 2008–09, approximately 60% of OATSIH funded Aboriginal and Torres Strait Islander Primary health care services provided care outside of normal operating hours. The most common services provided outside of normal operating hours were transport (78%) and transfer/admission to hospital (76%). Approximately 73% provided services for emotional and social wellbeing/mental health; 61% provided diagnosis and treatment of illness/disease; 58% provided treatment of injury; 56% provided antenatal/maternal care; 31% provided hospital inpatient/outpatient care; and 25% provided care in police station/lock-up/prison.

Data on services provided by emergency departments are limited to public hospitals mainly located in major cities (those classified as principal referral, specialist women’s and children’s hospitals or large hospitals). In the period 2006–07 and 2007–08, there were 467,115 episodes of care for Aboriginal or Torres Strait Islander patients in emergency departments located in these hospitals, representing 4% of all episodes of care. Around half (225,182) emergency department episodes of care for Indigenous patients occurred after hours. This is similar for non-Indigenous patients.

For Indigenous patients there were 302,457 emergency department episodes of care in the period 2006–07 and 2007–08 that were classified as semi-urgent or non-urgent (triage category 4 and 5). Around 65% of Indigenous presentations to emergency departments after hours were for semi-urgent or non-urgent triage categories.

Implications:

The provision of after-hours GP consultations is much lower in areas where Indigenous Australians make up a higher proportion of the population. This reflects geographic factors (such as poor access to after-hours GPs generally in rural and remote areas), but it also suggest generally poorer access to these services. While Indigenous Australians make up 2.5% of the population, they represent 5% of emergency department episodes in hospitals for which data on after hours care are collected. Around half of these episodes occurred after hours. A better understanding is required of the needs of Aboriginal and Torres Strait Islander peoples for health services after hours, and the best ways of providing coverage.

Under National Health Reform, the Australian Government will establish a national after-hours telephone-based General Practice medical advice and diagnostic service. The new Medicare Locals to be established progressively from July 2011, will be funded to plan and ensure the availability of face-to-face after hours services for their region. These services will be integrated with the new telephone-based GP service.

Figure 174 – Rate of GP encounters, by whether the GP has after-hours arrangements in place, by Indigenous status of the patient, April 2004 to March 2009


Figure 174 – Rate of GP encounters, by whether the GP has after-hours arrangements in place, by indigenous status of the patient, April 2004 to March 2009
Source: AIHW analysis of Medicare Database
Text description of figure 174 (TXT 1KB)

Figure 175 – Non-admitted patient emergency care episodes for triage categories 4 (semi-urgent) and 5 (non-urgent) by time of day and Indigenous status, Australia, 2006–07 to 2007–08


Figure 175 – Non-admitted patient emergency care episodes for triage categories 4 (semi-urgent) and 5 (non-urgent) by time of day and Indigenous status, Australia, 2006–07 to 2007–08
Note: These data are limited to public hospitals mainly located in major cities classified as principal referral, specialist women’s and children’s hospitals or large hospitals.
Source: AIHW analysis of National Non-admitted Patient Emergency Department Care Database
Text description of figure 175 (TXT 1KB)

Table 68 – Non-admitted patient emergency care episodes after hours, by Indigenous status, 2006–07 to 2007–08

Time of presentation
Number
Percent
Indig.
Non-Indig.
Not stated
Total
Indig.
Non-Indig.
Not stated
Total
All emergency department episodes
On Sundays
67,883
1,542,960
68,484
1,679,327
15
16
16
16
Before 8am or after 1pm on Saturday
50,889
1,040,499
48,246
1,139,634
11
11
11
11
Before 8am or after 8pm on a weekday
106,410
2,119,772
98,071
2,324,253
23
21
23
22
Total after hours
225,182
4,703,231
214,801
5,143,214
48
47
50
48
Not after hours
241,933
5,212,591
217,966
5,672,490
52
53
50
52
Total
467,115
9,915,822
432,767
10,815,704
100
100
100
100
Semi-urgent or non-urgent (triage category 4 and 5) emergency department episodes
On Sundays
44,407
945,232
40,676
1,030,315
15
16
17
16
Before 8am or after 1pm on Saturday
31,866
605,237
26,767
663,870
11
10
11
10
Before 8am or after 8pm on a weekday
63,430
1,160,704
51,587
1,275,721
21
20
21
20
Total after hours
139,703
2,711,173
119,030
2,969,906
46
46
48
46
Not after hours
162,754
3,178,808
127,307
3,468,869
54
54
52
54
Total
302,457
5,889,981
246,337
6,438,775
100
100
100
100
Note: These data are limited to public hospitals mainly located in major cities classified as principal referral, specialist women’s and children’s hospitals or large hospitals.
Source: AIHW analysis of National Non-admitted Patient Emergency Department Care Database

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