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Willson KA, Lim D, Toloo G, FitzGerald G, Kinnear FB, Morel DG. Potential role of general practice in reducing emergency department demand: A qualitative study. Emerg Med Australas 2022; 34:717-724. [PMID: 35306746 PMCID: PMC9790648 DOI: 10.1111/1742-6723.13964] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/27/2022] [Accepted: 02/28/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To inform local, state and national strategies intended to reduce demand for ED care, the present study aimed to identify key factors influencing the current provision of acute care within primary healthcare (PHC) and explore the policy and system changes potentially required. METHODS Semi-structured interviews with key stakeholders were audio-recorded, transcribed verbatim and analysed through content and thematic approaches incorporating the Walt and Gilson health policy framework. RESULTS Eleven interviews were conducted. Five key considerations were highlighted, namely the barriers and enablers for general practitioners (GPs) in providing acute care, barriers to patient use of PHC instead of ED, suggestions for new PHC models and improvements for current ED models. Additionally, economic issues relating to clinic funding and GP remuneration, complexities of state or federal funding and management of urgent care centres (UCC) were identified. Potential policy changes included GP clinics incorporating emergency appointments, GP triage, further patient streaming and changes to the ED medical workforce model, as well as linking hospitals with PHC clinics. Suggested system changes included improving rapid access to non-GP specialists, offering qualifications for urgent care within PHC, developing integrated information technology systems and educating patients regarding appropriate healthcare system pathways. CONCLUSION The present study suggested that while PHC has the potential to attenuate the demands for ED services, a whole-of-system approach focusing on realignment of priorities and integrated changes are needed.
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Affiliation(s)
- Katie A Willson
- College of Medicine and Public HealthFlinders UniversityAdelaideSouth AustraliaAustralia
| | - David Lim
- College of Medicine and Public HealthFlinders UniversityAdelaideSouth AustraliaAustralia,School of Health SciencesWestern Sydney UniversitySydneyNew South WalesAustralia
| | - Ghasem‐Sam Toloo
- School of Public Health and Social Work, Centre for Healthcare Transformation, Faculty of HealthQueensland University of TechnologyBrisbaneQueenslandAustralia
| | - Gerry FitzGerald
- School of Public Health and Social WorkQueensland University of TechnologyBrisbaneQueenslandAustralia
| | - Frances B Kinnear
- Emergency ServicesThe Prince Charles HospitalBrisbaneQueenslandAustralia,Faculty of MedicineThe University of QueenslandBrisbaneQueenslandAustralia
| | - Douglas G Morel
- Emergency DepartmentRedcliffe HospitalBrisbaneQueenslandAustralia
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2
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O'Cathain A, Simpson R, Phillips M, Knowles E. Tendency to call an ambulance or attend an emergency department for minor or non-urgent problems: a vignette-based population survey in Britain. Emerg Med J 2022; 39:436-442. [PMID: 35273021 PMCID: PMC9132851 DOI: 10.1136/emermed-2020-210271] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 02/15/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND There are concerns about high levels of demand for emergency health services. The aim was to identify the characteristics of the British population with a tendency to contact emergency medical services and EDs for minor or non-urgent problems. METHODS A survey of the British adult population in 2018. Six vignettes were constructed about illness in adults (cough/sore throat or diarrhoea/vomiting), injury in adults (sore rib or back pain) and fever in children (occurring weekday or weekend). RESULTS The response rate was 42%, with 2906 respondents. 11% (319/2716) of respondents selected to contact an ambulance and 43% ED, mainly for the vignettes about fever in children and sore rib. Males, people from ethnic minority communities and older people had a tendency to contact emergency services for minor problems. Tendency to call an ambulance was also characterised by 'low resources' (manual or unskilled occupations, no car, low health literacy), worry that a symptom might be serious, distress (feeling overwhelmed by health problems) and frequent use of EDs. For EDs, there was an attraction to EDs because of availability of tests. CONCLUSION Whereas use of emergency ambulances for minor or non-urgent problems appeared to be driven by people's lack of resources, including lack of transport, use of EDs appeared to be driven by their attractive characteristic of offering tests quickly.
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Affiliation(s)
- Alicia O'Cathain
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Rebecca Simpson
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | | | - Emma Knowles
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
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3
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O Loughlin M, Mills J, McDermott R, Harriss LR. Exploring the measure of potentially avoidable general practitioner-type presentations to the emergency department in regional Queensland using linked, patient-perspective data. AUST HEALTH REV 2021; 45:90-96. [PMID: 33121590 DOI: 10.1071/ah19210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 05/12/2020] [Indexed: 11/23/2022]
Abstract
Objective To explore measures of potentially avoidable general practitioner (PAGP)-type presentations to the emergency department (ED) of a large regional hospital in northern Queensland. Methods Linkage of an ED administrative dataset to a face-to-face patient survey of local residents (n=1000); calculation of Australian Institute of Health and Welfare (AIHW) and Australasian College of Emergency Medicine (ACEM) measures of PAGP-type presentations to the ED; and exploration of these measures with patient-perspective linked data. Results PAGP-type presenters to the ED were younger in age (median age in years: total cohort: 49; AIHW 38, P<0.001; ACEM 36, P<0.001); with the odds of having a chronic condition being less likely for AIHW PAGP-type presenters than other ED presenters (OR (95% CI) 0.54 (0.38-0.77): P=0.001)) after adjustment for age. PAGP-type presenters nominated reasons of convenience rather than urgency as their rationale for attending the ED, irrespective of measure. The number of PAGP-type presentations to the ED identified by the AIHW measure was more than three-fold higher than the ACEM measure (AIHW: n=227; ACEM: n=67). Influencing factors include the low proportion of ED attendees who had a medical consultation time of <1h at this hospital site (1-month survey period: 17.8%); and differences between the patient self-report and ED administrative record for 'self-referral to the ED' (Self-referred: Survey 71% vs EDIS 93%, P<0.001). Conclusions Identification of PAGP-type presentations to the ED could be enhanced with improvements to the quality of administrative processes when recording patient 'self-referral to the ED', along with further consideration of hospital site variation for the length of medical consultation time. What is known about the topic? PAGP-type presentations to the ED are an Australian National Healthcare Agreement progress indicator. Methods of measuring this indicator have been under review since 2012 and debate remains on how to accurately determine the measure. What does this paper add? By using patient perspective-linked data to explore different measures of PAGP-type presentations to EDs, this paper identifies issues with measure elements and suggests ways to improve these measures. What are the implications for practitioners? Measure elements of patient 'self-referral to the ED' and 'medical consultation time' require further consideration if they are to be used to measure PAGP-type presentations to the ED.
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Affiliation(s)
- Mary O Loughlin
- Australian Institute of Tropical Health and Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, PO Box 6811, Cairns, Qld 4870, Australia. ; ; and Corresponding author.
| | - Jane Mills
- La Trobe Rural Health School, Bendigo Campus, Edwards Road, Flora Hill, Bendigo , Vic. 3552.
| | - Robyn McDermott
- Australian Institute of Tropical Health and Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, PO Box 6811, Cairns, Qld 4870, Australia. ; ; and School of Health Sciences, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia
| | - Linton R Harriss
- Australian Institute of Tropical Health and Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, PO Box 6811, Cairns, Qld 4870, Australia. ;
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4
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O’Cathain A, Knowles E, Long J, Connell J, Bishop-Edwards L, Simpson R, Coster J, Abouzeid L, Bennett S, Croot E, Dickson JM, Goodacre S, Hirst E, Jacques R, Phillips M, Turnbull J, Turner J. Drivers of ‘clinically unnecessary’ use of emergency and urgent care: the DEUCE mixed-methods study. HEALTH SERVICES AND DELIVERY RESEARCH 2020. [DOI: 10.3310/hsdr08150] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
There is widespread concern about the pressure on emergency and urgent services in the UK, particularly emergency ambulances, emergency departments and same-day general practitioner appointments. A mismatch between supply and demand has led to interest in what can be termed ‘clinically unnecessary’ use of services. This is defined by the research team in this study as ‘patients attending services with problems that are classified as suitable for treatment by a lower urgency service or self-care’. This is a challenging issue to consider because patients may face difficulties when deciding the best action to take, and different staff may make different judgements about what constitutes a legitimate reason for service use.
Objectives
To identify the drivers of ‘clinically unnecessary’ use of emergency ambulances, emergency departments and same-day general practitioner appointments from patient and population perspectives.
Design
This was a sequential mixed-methods study with three components: a realist review; qualitative interviews (n = 48) and focus groups (n = 3) with patients considered ‘clinically unnecessary’ users of these services, focusing on parents of young children, young adults and people in areas of social deprivation; and a population survey (n = 2906) to explore attitudes towards seeking care for unexpected, non-life-threatening health problems and to identify the characteristics of someone with a tendency for ‘clinically unnecessary’ help-seeking.
Results
From the results of the three study components, we found that multiple, interacting drivers influenced individuals’ decision-making. Drivers could be grouped into symptom related, patient related and health service related. Symptom-related drivers were anxiety or need for reassurance, which were caused by uncertainty about the meaning or seriousness of symptoms; concern about the impact of symptoms on daily activities/functioning; and a need for immediate relief of intolerable symptoms, particularly pain. Patient-related drivers were reduced coping capacity as a result of illness, stress or limited resources; fear of consequences when responsible for another person’s health, particularly a child; and the influence of social networks. Health service-related drivers were perceptions or previous experiences of services, particularly the attractions of emergency departments; a lack of timely access to an appropriate general practitioner appointment; and compliance with health service staff’s advice.
Limitations
Difficulty recruiting patients who had used the ambulance service to the interviews and focus groups meant that we were not able to add as much as we had anticipated to the limited evidence base regarding this service.
Conclusions
Patients use emergency ambulances, emergency departments and same-day general practitioner appointments when they may not need the level of clinical care provided by these services for a multitude of inter-related reasons that sometimes differ by population subgroup. Some of these reasons relate to health services, in terms of difficulty accessing general practice leading to use of emergency departments, and to population-learnt behaviour concerning the positive attributes of emergency departments, rather than to patient characteristics. Social circumstances, such as complex and stressful lives, influence help-seeking for all three services. Demand may be ‘clinically unnecessary’ but completely understandable when service accessibility and patients’ social circumstances are considered.
Future work
There is a need to evaluate interventions, including changing service configuration, strengthening general practice and addressing the stressors that have an impact on people’s coping capacity. Different subgroups may require different interventions.
Study registration
This study is registered as PROSPERO CRD42017056273.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 15. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Alicia O’Cathain
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Emma Knowles
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Jaqui Long
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Janice Connell
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | | | - Rebecca Simpson
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Joanne Coster
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | | | | | - Elizabeth Croot
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Jon M Dickson
- Academic Unit of Primary Medical Care, University of Sheffield, Sheffield, UK
| | - Steve Goodacre
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Enid Hirst
- Sheffield Emergency Care Forum, Sheffield, UK
| | - Richard Jacques
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | | | | | - Janette Turner
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
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5
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Ho JH, Dubash R, Kozlovski J. The busyness of medicine. Emerg Med Australas 2019; 31:1101-1103. [PMID: 31769206 DOI: 10.1111/1742-6723.13428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 10/31/2019] [Indexed: 11/29/2022]
Affiliation(s)
- James H Ho
- Emergency Department, Cabrini Health, Melbourne, Victoria, Australia
| | - Roxanne Dubash
- Emergency Department, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Jennifer Kozlovski
- Emergency and Trauma Centre, Alfred Hospital, Melbourne, Victoria, Australia
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6
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Dufton PH, Drosdowsky A, Gerdtz MF, Krishnasamy M. Socio-demographic and disease related characteristics associated with unplanned emergency department visits by cancer patients: a retrospective cohort study. BMC Health Serv Res 2019; 19:647. [PMID: 31492185 PMCID: PMC6731557 DOI: 10.1186/s12913-019-4509-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 09/03/2019] [Indexed: 01/31/2023] Open
Abstract
Background Emergency department (ED) presentations made by patients having cancer treatment are associated with worth outcomes. This study aimed to explore the socio-demographic and disease related characteristics associated with ED presentation, frequent ED presentations, and place of discharge for cancer patients receiving systemic cancer therapies in the ambulatory setting. Methods This was a single site, retrospective observational cohort design. Hospital data for patients treated in the Day Oncology Unit of a large public tertiary hospital in Melbourne, Australia between December 2014 and November 2017 were extracted from clinical databases and retrospectively matched to ED attendance records. Andersen’s Behavioral Model of Health Service Utilisation provided the conceptual framework for exploring associations between socio-demographic and disease characteristics and ED use. Results A total of 2638 individuals were treated in the Day Oncology Unit over the study dates. Of these, 1182 (45%) made an unplanned ED presentation within 28 days of receiving systemic cancer therapy. One hundred and twenty-two (12%) patients attended the ED on two or more occasions within 28 days; while 112 (10%) patients attended the ED four or more times (within 28 days of receiving systemic cancer therapy) within any given 12 month period. Being born outside of Australia was independently related to making an unplanned ED presentation within 28 days of receiving anti-cancer therapy (p < .01) as was being diagnosed with head and neck (p = .03), upper gastrointestinal (p < .001), colorectal (p < .001), lung (p < .001), skin (p < .001) or breast cancer (p = .01). Conclusions This study identified a subgroup of cancer patients for whom an ED presentation is more likely. Better understanding of socio-demographic and disease related characteristics associated with the risk of an ED presentation may help inform targeted follow up of patients, to mitigate potentially avoidable ED presentation and optimize outcomes of care.
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Affiliation(s)
- Polly H Dufton
- Department of Nursing & Centre for Cancer Research, The University of Melbourne, Parkville, VIC, Australia. .,The Olivia Newton John Cancer, Wellness and Research Centre, Heidelberg, VIC, Australia.
| | - Allison Drosdowsky
- Department of Cancer Experiences Research, Sir Peter McCallum Cancer Centre, Parkville, VIC, Australia
| | - Marie F Gerdtz
- Department of Nursing & Centre for Cancer Research, The University of Melbourne, Parkville, VIC, Australia
| | - Mei Krishnasamy
- Department of Nursing & Centre for Cancer Research, The University of Melbourne, Parkville, VIC, Australia.,The Olivia Newton John Cancer, Wellness and Research Centre, Heidelberg, VIC, Australia.,Victorian Comprehensive Cancer Centre, Parkville, VIC, Australia
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7
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Forero R, Nahidi S, de Costa J, Fatovich D, FitzGerald G, Toloo S, McCarthy S, Mountain D, Gibson N, Mohsin M, Man WN. Perceptions and experiences of emergency department staff during the implementation of the four-hour rule/national emergency access target policy in Australia: a qualitative social dynamic perspective. BMC Health Serv Res 2019; 19:82. [PMID: 30700302 PMCID: PMC6354365 DOI: 10.1186/s12913-019-3877-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 01/04/2019] [Indexed: 11/25/2022] Open
Abstract
Background The Four-Hour Rule or National Emergency Access Target policy (4HR/NEAT) was implemented by Australian State and Federal Governments between 2009 and 2014 to address increased demand, overcrowding and access block (boarding) in Emergency Departments (EDs). This qualitative study aimed to assess the impact of 4HR/NEAT on ED staff attitudes and perceptions. This article is part of a series of manuscripts reporting the results of this project. Methods The methodology has been published in this journal. As discussed in the methods paper, we interviewed 119 participants from 16 EDs across New South Wales (NSW), Queensland (QLD), Western Australia (WA) and the Australian Capital Territory (ACT), in 2015–2016. Interviews were recorded, transcribed, imported to NVivo 11 and analysed using content and thematic analysis. Results Three key themes emerged: Stress and morale, Intergroup dynamics, and Interaction with patients. These provided insight into the psycho-social dimensions and organisational structure of EDs at the individual, peer-to-peer, inter-departmental, and staff-patient levels. Conclusion Findings provide information on the social interactions associated with the introduction of the 4HR/NEAT policy and the intended and unintended consequences of its implementation across Australia. These themes allowed us to develop several hypotheses about the driving forces behind the social impact of this policy on ED staff and will allow for development of interventions that are rooted in the rich context of the staff’s experiences.
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Affiliation(s)
- Roberto Forero
- Simpson Centre for Health Services Research, South Western Sydney Clinical School, University of NSW, Liverpool BC, NSW, 1871, Australia. .,Ingham Institute for Applied Medical Research, Liverpool Hospital, Liverpool, NSW, Australia.
| | - Shizar Nahidi
- Simpson Centre for Health Services Research, South Western Sydney Clinical School, University of NSW, Liverpool BC, NSW, 1871, Australia.,Ingham Institute for Applied Medical Research, Liverpool Hospital, Liverpool, NSW, Australia
| | - Josephine de Costa
- Simpson Centre for Health Services Research, South Western Sydney Clinical School, University of NSW, Liverpool BC, NSW, 1871, Australia.,Ingham Institute for Applied Medical Research, Liverpool Hospital, Liverpool, NSW, Australia
| | - Daniel Fatovich
- Department of Emergency Medicine, Royal Perth Hospital, Perth, WA, Australia.,Discipline of Emergency Medicine, University of Western Australia, Crawley, WA, Australia
| | - Gerry FitzGerald
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
| | - Sam Toloo
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
| | - Sally McCarthy
- Emergency Department, Prince of Wales Hospital , Randwick, NSW, Australia.,Prince of Wales Clinical School, University of NSW, Kensington, NSW, Australia
| | - David Mountain
- Department of Emergency Medicine, Sir Charles Gairdner Hospital, Crawley, WA, Australia.,Discipline of Emergency Medicine, University of Western Australia, Crawley, WA, Australia
| | - Nick Gibson
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA, Australia
| | - Mohammed Mohsin
- Psychiatry Research and Teaching UNit, Liverpool Hospital, NSW Health, Liverpool, NSW, Australia.,School of Psychiatry, Faculty of Medicine, University of NSW, Sydney, NSW, Australia
| | - Wing Nicola Man
- Simpson Centre for Health Services Research, South Western Sydney Clinical School, University of NSW, Liverpool BC, NSW, 1871, Australia.,Ingham Institute for Applied Medical Research, Liverpool Hospital, Liverpool, NSW, Australia
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8
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Banham D, Karnon J, Densley K, Lynch JW. How much emergency department use by vulnerable populations is potentially preventable?: A period prevalence study of linked public hospital data in South Australia. BMJ Open 2019; 9:e022845. [PMID: 30782688 PMCID: PMC6340627 DOI: 10.1136/bmjopen-2018-022845] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 12/11/2018] [Accepted: 12/13/2018] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To quantify emergency department (ED) presentations by individuals within vulnerable populations compared with other adults and the extent to which these are potentially preventable. DESIGN Period prevalence study from 2005-2006 to 2010-2011. SETTING Person-linked, ED administrative records for public hospitals in South Australia. PARTICIPANTS Adults aged 20 or more in South Australia's metropolitan area presenting to ED and categorised as Refugee and Asylum Seeker Countries of birth (RASC); Aboriginal; those aged 75 years or more; or All others. MAIN OUTCOME MEASURES Unadjusted rates of ambulatory care sensitive condition (ACSC), general practitioner (GP)-type presentations and associated direct ED costs among mutually exclusive groups of individuals. RESULTS Disparity between RASC and All others was greatest for GP-type presentations (423.7 and 240.1 persons per 1000 population, respectively) with excess costs of $A106 573 (95% CI $A98 775 to $A114 371) per 1000 population. Aboriginal had highest acute ACSC presenter rates (125.8 against 51.6 per 1000 population) with twice the risk of multiple presentations and $A108 701 (95% CI $A374 to $A123 029) per 1000 excess costs. Those aged 75 or more had highest chronic ACSC presenter rates (119.7vs21.1 per 1000), threefold risk of further presentations (incidence rate ratio 3.20, 95% CI 3.14 to 3.26) and excess cost of $A385 (95% CI $A178 160 to $A184 609) per 1000 population. CONCLUSIONS Vulnerable groups had excess ED presentations for a range of issues potentially better addressed through primary and community healthcare. The observed differences suggest inequities in the uptake of effective primary and community care and represent a source of excess cost to the public hospital system.
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Affiliation(s)
- David Banham
- School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Division of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Jonathan Karnon
- School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Kirsten Densley
- Flinders Medical Centre, Southern Adelaide Local Health Network, Bedford Park, South Australia, Australia
| | - John W Lynch
- School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
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9
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O'Loughlin M, Harriss L, Thompson F, McDermott R, Mills J. Exploring factors that influence adult presentation to an emergency department in regional Queensland: A linked, cross-sectional, patient perspective study. Emerg Med Australas 2018; 31:67-75. [DOI: 10.1111/1742-6723.13094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 03/28/2018] [Accepted: 04/04/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Mary O'Loughlin
- Australian Institute of Tropical Health and Medicine, Centre for Chronic Disease Prevention, College of Public Health, Medical and Veterinary Sciences; James Cook University; Cairns Queensland Australia
| | - Linton Harriss
- Australian Institute of Tropical Health and Medicine, Centre for Chronic Disease Prevention, College of Public Health, Medical and Veterinary Sciences; James Cook University; Cairns Queensland Australia
| | - Fintan Thompson
- Australian Institute of Tropical Health and Medicine, Centre for Chronic Disease Prevention, College of Public Health, Medical and Veterinary Sciences; James Cook University; Cairns Queensland Australia
| | - Robyn McDermott
- Australian Institute of Tropical Health and Medicine, Centre for Chronic Disease Prevention, College of Public Health, Medical and Veterinary Sciences; James Cook University; Cairns Queensland Australia
- School of Health Sciences; University of South Australia; Adelaide South Australia Australia
| | - Jane Mills
- College of Health; Massey University; Wellington New Zealand
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10
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He J, Hou XY, Toloo GS, FitzGerald G. Patients' choice between public and private hospital emergency departments: a cross-sectional survey. Emerg Med Australas 2017; 29:635-642. [PMID: 28929641 DOI: 10.1111/1742-6723.12841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 05/28/2017] [Accepted: 06/27/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aim of this study was to understand what factors influence patients' choice between public and private hospital ED and the relative weight of those factors among adult patients with private health insurance in Australia. METHODS A survey of 280 patients was conducted in four public and private hospitals' EDs in Brisbane between May and August 2015. The survey included information about respondent's demographics, nature of illness, decision-making, attitudes and choice. Independent t-test and Pearson's χ²-test were used to identify binary associations, and logistic regression was used to determine what factors influence patients' choice. RESULTS Patients who agreed that 'long waiting time is a barrier to access public hospital ED' were twice as likely to choose private hospitals (odds ratio [OR] 2.172, P = 0.001). Alternatively patients who did not consider that 'there were long waiting times in public hospital ED' were less likely to access private hospitals (OR 0.200, P = 0.003). More public hospital patients (70.7%) than private hospital patients (56.4%) (P = 0.015) agreed that 'out-of-pocket payment is a barrier to accessing private hospital ED'. Patients attending private hospitals rated the quality of service higher than those attending public hospitals (OR 1.26, P = 0.001). CONCLUSION Longer waiting times in public EDs is the principal issue considered by patients choosing private EDs and the out-of-pocket payment for accessing private EDs is the principal issue considered by public ED patients. The study suggests that addressing the out-of-pocket payments will attract more patients with private health insurance to access private EDs.
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Affiliation(s)
- Jun He
- School of Public Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Xiang-Yu Hou
- School of Public Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Ghasem Sam Toloo
- School of Public Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Gerry FitzGerald
- School of Public Health, Queensland University of Technology, Brisbane, Queensland, Australia
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11
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Health Care Services in IBD: Factors Associated with Service Utilization and Preferences for Service Options for Routine and Urgent Care. Inflamm Bowel Dis 2017; 23:1461-1469. [PMID: 28816754 DOI: 10.1097/mib.0000000000001215] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND We aimed to explore factors associated with health service utilization and preference for services, including alternatives to attending the emergency department (ED) when experiencing mild to moderate or severe symptoms. METHODS A total of 1143 persons (46% response rate) aged 18 to 65 years in the population-based University of Manitoba IBD Research Registry participated in the survey. RESULTS Although 61% had a gastroenterologist, when experiencing active symptoms, only 29% felt they could call their gastroenterologist for an urgent appointment, and 42% could call their gastroenterologist for telephone advice. Nine percent of the respondents visited the ED in the previous year. If having severe symptoms, 48% said that they would attend the ED. Visits to the ED were related to higher bowel symptom severity and high health anxiety. When experiencing severe symptoms, women, persons with Crohn's disease and those with high health anxiety, indicated that they would be more likely to use the ED. Considering services which could be available in the future respondents indicated that if acutely symptomatic they would be very likely or likely to use the following services: phone contact with inflammatory bowel disease nurse (77%), phone contact with a gastroenterologist (75%), and going to a walk-in gastroenterology clinic (71%). CONCLUSIONS Persons with inflammatory bowel disease are receptive to options other than the ED when experiencing inflammatory bowel disease symptoms; however, attending the ED remains a prominent choice. Improved access to specialized care may improve timeliness of care and reduce ED attendance. Future research should include the impact of health anxiety on health care utilization.
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12
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Stephens AS, Broome RA. Patterns of low acuity patient presentations to emergency departments in New South Wales, Australia. Emerg Med Australas 2017; 29:283-290. [PMID: 28320067 DOI: 10.1111/1742-6723.12767] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 01/03/2017] [Accepted: 01/16/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To explore the patterns of low acuity patient (LAP) presentations to EDs in New South Wales (NSW), Australia. METHODS Retrospective study of NSW public hospital ED presentations between January 2013 and December 2014 that were registered in the NSW Emergency Department Data Collection (n = 409 035). LAPs were defined according to the Australian Institute of Health and Welfare (AIHW), Sprivulis and multiple ACEM methods. Multivariable logistic regression was used to assess the adjusted odds of LAP ED presentation by a suite of sociodemographic factors. RESULTS The percentage of LAPs varied considerably by definition, being as high as 54.7% (inner regional areas) and as low as 3.2% (major cities) using revised ACEM methods modified to contain unlimited consultation times or consultation times of 15 min or less, respectively. For each method, higher proportions of LAPs were observed in inner regional and remote/very remote areas relative to major cities. LAP ED presentations, based on ACEM definition with 1 h or 15 min consultation times, were greater in younger patients, increased during out of business hours and weekends, and decreased with increasing general practitioner (GP) density. CONCLUSION The percentage of LAPs varied substantially by definition, and further work is required to validate the methods, particularly around the appropriateness of length of consultation time with ACEM, between different hospitals and remoteness areas. Age was strongly associated with low acuity, with substantial effects also observed for GP density, and attendances during out of hours and weekends.
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Affiliation(s)
- Alexandre S Stephens
- Public Health Observatory, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Richard A Broome
- Public Health Observatory, Sydney Local Health District, Sydney, New South Wales, Australia
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13
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Scuffham PA, Moretto N, Krinks R, Burton P, Whitty JA, Wilson A, Fitzgerald G, Littlejohns P, Kendall E. Engaging the public in healthcare decision-making: results from a Citizens' Jury on emergency care services. Emerg Med J 2016; 33:782-788. [PMID: 27323789 DOI: 10.1136/emermed-2015-205663] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 05/09/2016] [Accepted: 05/30/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND Policies addressing ED crowding have failed to incorporate the public's perspectives; engaging the public in such policies is needed. OBJECTIVE This study aimed at determining the public's recommendations related to alternative models of care intended to reduce crowding, optimising access to and provision of emergency care. METHODS A Citizens' Jury was convened in Queensland, Australia, to consider priority setting and resource allocation to address ED crowding. Twenty-two jurors were recruited from the electoral roll, who were interested and available to attend the jury from 15 to 17 June 2012. Juror feedback was collected via a survey immediately following the end of the jury. RESULTS The jury considered that all patients attending the ED should be assessed with a minority of cases diverted for assistance elsewhere. Jurors strongly supported enabling ambulance staff to treat patients in their homes without transporting them to the ED, and allowing non-medical staff to treat some patients without seeing a doctor. Jurors supported (in principle) patient choice over aspects of their treatment (when, where and type of health professional) with some support for patients paying towards treatment but unanimous opposition for patients paying to be prioritised. Most of the jurors were satisfied with their experience of the Citizens' Jury process, but some jurors perceived the time allocated for deliberations as insufficient. CONCLUSIONS These findings suggest that the general public may be open to flexible models of emergency care. The jury provided clear recommendations for direct public input to guide health policy to tackle ED crowding.
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Affiliation(s)
- P A Scuffham
- Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Meadowbrook, Queensland, Australia
| | - N Moretto
- Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Meadowbrook, Queensland, Australia
| | - R Krinks
- Centre of National Research on Disability and Rehabilitation, Menzies Health Institute Queensland, Griffith University, Meadowbrook, Queensland, Australia
| | - P Burton
- Urban Research Program, Griffith School of Environment, Griffith University, Southport, Queensland, Australia
| | - J A Whitty
- Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Meadowbrook, Queensland, Australia.,School of Pharmacy, Faculty of Health and Behavioural Sciences, University of Queensland, St Lucia, Queensland, Australia
| | - A Wilson
- Menzies Centre for Health Policy, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - G Fitzgerald
- School of Public Health, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - P Littlejohns
- Division of Health and Social Care Research, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - E Kendall
- Centre of National Research on Disability and Rehabilitation, Menzies Health Institute Queensland, Griffith University, Meadowbrook, Queensland, Australia
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14
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Dinh MM, Berendsen Russell S, Bein KJ, Chalkley DR, Muscatello D, Paoloni R, Ivers R. Statewide retrospective study of low acuity emergency presentations in New South Wales, Australia: who, what, where and why? BMJ Open 2016; 6:e010964. [PMID: 27165649 PMCID: PMC4874101 DOI: 10.1136/bmjopen-2015-010964] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE The present study aims to use a statewide population-based registry to assess the prevalence of low acuity emergency department (ED) presentations, describe the trend in presentation rates and to determine whether they were associated with various presentation characteristics such as the type of hospital as well as clinical and demographic variables. DESIGN AND SETTING This was a retrospective analysis of a population-based registry of ED presentations in New South Wales (NSW). Generalised estimating equations with log links were used to determine factors associated with low acuity presentations to account for repeat presentations and the possibility of clustering of outcomes. PARTICIPANTS Patients were included in this analysis if they presented to an ED between January 2010 and December 2014. The outcomes of interest were low acuity presentation, defined as those who self-presented (were not transported by ambulance), were assigned a triage category of 4 or 5 (semiurgent or non-urgent) and discharged back to usual residence from ED. RESULTS There were 10.7 million ED presentations analysed. Of these, 45% were classified as a low acuity presentation. There was no discernible increase in the rate of low acuity presentations across NSW between 2010 and 2014. The strongest predictors of low acuity ED presentation were age <40 years of age (OR 1.77); injury or musculoskeletal administrative and non-urgent procedures (OR 2.96); ear, nose and throat, eye or oral (OR 5.53); skin or allergy-type presenting problems (OR 2.84). CONCLUSIONS Low acuity ED presentations comprise almost half of all ED presentations. Alternative emergency models of care may help meet the needs of these patients.
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Affiliation(s)
- Michael M Dinh
- Royal Prince Alfred Hospital, New South Wales, Australia
- The University of Sydney, Discipline of Emergency Medicine, New South Wales, Australia
| | - Saartje Berendsen Russell
- Royal Prince Alfred Hospital, New South Wales, Australia
- The University of Sydney, School of Nursing, New South Wales, Australia
| | - Kendall J Bein
- Royal Prince Alfred Hospital, New South Wales, Australia
| | | | - David Muscatello
- University of New South Wales, School of Public Health and Community Medicine, New South Wales, Australia
| | - Richard Paoloni
- The University of Sydney, Discipline of Emergency Medicine, New South Wales, Australia
| | - Rebecca Ivers
- Injury Division, The George Institute for Global Health, The University of Sydney, New South Wales, Australia
- Flinders University, School of Nursing and Midwifery, South Australia, Australia
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15
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Dinh MM, Berendsen Russell S, Bein KJ, Chalkley D, Muscatello D, Paoloni R, Ivers R. Understanding drivers of Demand for Emergency Service Trends in Years 2010-2014 in New South Wales: An initial overview of the DESTINY project. Emerg Med Australas 2016; 28:179-86. [DOI: 10.1111/1742-6723.12542] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 11/16/2015] [Accepted: 12/08/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Michael M Dinh
- Royal Prince Alfred Hospital; Sydney New South Wales Australia
- Discipline of Emergency Medicine; The University of Sydney; Sydney New South Wales Australia
| | - Saartje Berendsen Russell
- Royal Prince Alfred Hospital; Sydney New South Wales Australia
- School of Nursing; The University of Sydney; Sydney New South Wales Australia
| | - Kendall J Bein
- Royal Prince Alfred Hospital; Sydney New South Wales Australia
| | - Dane Chalkley
- Royal Prince Alfred Hospital; Sydney New South Wales Australia
| | - David Muscatello
- School of Public Health and Community Medicine; University of New South Wales; Sydney New South Wales Australia
| | - Richard Paoloni
- Discipline of Emergency Medicine; The University of Sydney; Sydney New South Wales Australia
| | - Rebecca Ivers
- The George Institute for Global Health; The University of Sydney; Sydney New South Wales Australia
- School of Nursing and Midwifery; Flinders University; Adelaide South Australia Australia
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16
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He J, Toloo GS, Hou XY, FitzGerald G. Qualitative study of patients' choice between public and private hospital emergency departments. Emerg Med Australas 2016; 28:159-63. [DOI: 10.1111/1742-6723.12530] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 11/09/2015] [Accepted: 11/23/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Jun He
- School of Public Health and Social Work; Queensland University of Technology; Brisbane Queensland Australia
| | - Ghasem-Sam Toloo
- School of Public Health and Social Work; Queensland University of Technology; Brisbane Queensland Australia
| | - Xiang-Yu Hou
- School of Public Health and Social Work; Queensland University of Technology; Brisbane Queensland Australia
| | - Gerry FitzGerald
- School of Public Health and Social Work; Queensland University of Technology; Brisbane Queensland Australia
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17
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Rosie C. Is Australasia producing too many emergency physicians? Yes. Emerg Med Australas 2015; 27:599-600. [PMID: 26559040 DOI: 10.1111/1742-6723.12508] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Cameron Rosie
- Adult Emergency Department, Auckland City Hospital, Auckland, New Zealand
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