Better health and ageing for all Australians

Aboriginal and Torres Strait Islander Health Performance Framework (HPF) 2012

Tier 3—Accessible—3.16 Access to after-hours primary health care

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Why is it important?:

'After-hours' services are usually services provided on Sunday, before 8am and/or after 12pm on Saturday, or at any time other than 8am to 6pm on weekdays. The after-hours period can be further categorised into the unsociable period (11pm to 7am) and the sociable periods (7am to 8am and 6pm to 11pm). 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.

Many patients are provided with after-hours primary care services by their regular general practitioner (GP) or at their usual health service. Common approaches include extended hours clinics, on-call arrangements, the provision of home visits, and cooperative arrangements that involve GPs from several practices participating in a shared roster system. It is often preferable for after-hours primary care to be provided by a patient's usual GP, as they are more likely to know about the patient's condition and history, and to be able to make an informed judgment about the treatment required. However, as this is not always possible a number of other after-hours primary care arrangements exist. These include medical deputising services (where GPs contract another service to provide after-hours services on their behalf), dedicated after-hours services (GP and/or nurse lead clinics that only open during the after-hours period) and telephone triage and advice services (which involve telephone based nurses and/or GPs providing advice and directing people to the most appropriate point of care). Many patients also attend emergency departments during the after-hours period.

The Medicare Benefits Schedule (MBS) includes after hours items that provide increased benefit rates to medical practitioners. Rates are highest for urgent after hours consultations where practitioners are required to provide a home visit, or return to the clinic specifically for that consultation.

Findings:

BEACH survey data collected from April 2006 to March 2011 suggest that 90% of GP encounters among Indigenous Australians were with practices that had after-hours care arrangements in place. This compared with 98% of GP encounters among other Australians.

In 2010–11, 55% 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 emotional and social wellbeing/mental health services (provided by 69% of services); followed by transport (68%). Other services provided include: transfer/admission to hospital (66%); diagnosis and treatment of illness/disease (58%); antenatal/maternal care (53%); treatment of injury (53%); hospital inpatient/outpatient care (28%); and care in police station/lock-up/prison (24%).

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 2008–09 and 2009–10, there were 533,170 episodes of care for Aboriginal or Torres Strait Islander patients in emergency departments located in these hospitals, representing 5% of all episodes of care. Around 58% (307,001) of emergency department episodes of care for Indigenous patients occurred after hours. This is similar for non-Indigenous patients. For Indigenous patients there were 335,796 emergency department episodes of care in the period 2008–09 and 2009–10 that were classified as semi-urgent or non-urgent (triage category 4 and 5). Around 61% 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 3% of the population, they represent 5% of emergency department episodes in hospitals for which data on after-hours care are collected. Over 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 has committed to improving access to after-hours primary care services by establishing the after-hours GP helpline (a national after-hours telephone-based GP medical advice service) and funding Medicare Locals to plan and ensure the availability of face-to-face after-hours services for their region.

The after-hours GP helpline commenced on 1 July 2011 and enables people who require after-hours medical advice to speak to a GP over the telephone when necessary. As of 14 May 2012 the helpline has taken over 133,000 calls.

From early 2012 several Medicare Locals commenced activities to meet the priority after-hours needs of their region and by mid-2013 each Medicare Local will support the provision of comprehensive after-hours arrangements. Medicare Local-funded after-hours services will be integrated with the after-hours GP helpline and will help to ensure that all communities across Australia have better and more consistent access to after-hours care.

The establishment of 'GP Super Clinics' will also help to improve access to after-hours primary care, as the majority of GP Super Clinics will offer opening hours that extend into the after-hours period.Top of Page
Figure 186—Rate of GP encounters, by whether the GP has after-hours arrangements in place, by Indigenous status of the patient, April 2006–March 2007 to April 2010–March 2011
Figure 186—Rate of GP encounters, by whether the GP has after-hours arrangements in place, by Indigenous status of the patient, April 2006–March 2007 to April 2010–March 2011

Source: AIHW analysis of BEACH survey of general practice, AGPSCC

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Figure 187—Non-admitted patient emergency care episodes for triage categories 4 (semi urgent) and 5 (non-urgent), by time of day and Indigenous status, 2008–09 to 2009–10
Figure 187—Non-admitted patient emergency care episodes for triage categories 4 (semi urgent) and 5 (non-urgent), by time of day and Indigenous status, 2008–09 to 2009–10

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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Table 48—Non-admitted patient emergency care episodes after hours, by Indigenous status, 2006–07 to 2007–08
All emergency department episodes
Time of presentation
Indigenous Number
Non-Indigenous Number
Indigenous Percent
Non-Indigenous Percent
On Sundays
77,680
1,631,318
15.0
15.0
Before 8am or after 12pm on Saturday
61,699
1,186,682
12.0
10.5
Before 8am or after 6pm on a weekday
167,622
3,081,612
31.0
29.0
Total after hours
307,001
5,899,612
58.0
56.0
Not after hours
226,169
4,673,866
42.0
44.0
Total
533,170
10,573,478
100.0
100.0

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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Semi-urgent or non-urgent (triage category 4 and 5) emergency department episodes
Time of presentation
Indigenous Number
Non-Indigenous Number
Indigenous Percent
Non-Indigenous Percent
On Sundays
50,042
978,340
15
16
Before 8am or after 12pm on Saturday
37,584
675,707
11
11
Before 8am or after 6pm on a weekday
98,235
1,670,191
29
27
Total after hours
185,864
3,324,238
55
54
Not after hours
149,932
2,825,793
45
46
Total
335,796
6,150,031
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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