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Crespo-Gonzalez C, Hodgins M, Zurynski Y, Meyers Morris T, Le J, Wheeler K, Khano S, Germano S, Hiscock H, Lingam R. Advancing integrated paediatric care in Australian general practices: Qualitative insights from the SC4C GP-paediatrician model of care. PLoS One 2024; 19:e0302815. [PMID: 38771818 PMCID: PMC11108132 DOI: 10.1371/journal.pone.0302815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 04/14/2024] [Indexed: 05/23/2024] Open
Abstract
The Strengthening Care for Children (SC4C) is a general practitioner (GP)-paediatrician integrated model of care that consists of co-consulting sessions and case discussions in the general practice setting, with email and telephone support provided by paediatricians to GPs during weekdays. This model was implemented in 21 general practices in Australia (11 Victoria and 10 New South Wales). Our study aimed to identify the factors moderating the implementation of SC4C from the perspectives of GPs, general practice personnel, paediatricians and families. We conducted a qualitative study as part of the mixed-methods implementation evaluation of the SC4C trial. We collected data through virtual and in-person focus groups at the general practices and phone, virtual and in-person interviews. Data was analysed using an iterative hybrid inductive-deductive thematic analysis. Twenty-one focus groups and thirty-seven interviews were conducted. Overall, participants found SC4C acceptable and suitable for general practices, with GPs willing to learn and expand their paediatric care role. GPs cited improved confidence and knowledge due to the model. Paediatricians reported an enhanced understanding of the general practice context and the strain under which GPs work. GPs and paediatricians reported that this model allowed them to build trust-based relationships with a common goal of improving care for children. Additionally, they felt some aspects, including the lack of remuneration and the work and effort required to deliver the model, need to be considered for the long-term success of the model. Families expressed their satisfaction with the shared knowledge and quality of care jointly delivered by GPs and paediatricians and highlighted that this model of care provides easy access to specialty services without out-of-pocket costs. Future research should focus on finding strategies to ensure the long-term Implementation of this model of care with a particular focus on the individual stressors in general practices.
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Affiliation(s)
- Carmen Crespo-Gonzalez
- Population Child Health Research Group, University of New South Wales, Sydney, NSW, Australia
| | - Michael Hodgins
- Population Child Health Research Group, University of New South Wales, Sydney, NSW, Australia
| | - Yvonne Zurynski
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Tammy Meyers Morris
- Population Child Health Research Group, University of New South Wales, Sydney, NSW, Australia
- Sydney Local Health District, Sydney, NSW, Australia
| | - Jane Le
- Murdoch Children’s Research Institute, Health Services and Economics Group, Parkville, Victoria, Australia
| | - Karen Wheeler
- Population Child Health Research Group, University of New South Wales, Sydney, NSW, Australia
- Central and Eastern Sydney Primary Health Network, Sydney, NSW, Australia
| | - Sonia Khano
- Murdoch Children’s Research Institute, Health Services and Economics Group, Parkville, Victoria, Australia
| | - Stephanie Germano
- North Western Melbourne Primary Health Network, Parkville, Victoria, Australia
| | - Harriet Hiscock
- Murdoch Children’s Research Institute, Health Services and Economics Group, Parkville, Victoria, Australia
- Professorial Fellow, Department of Paediatrics, The University of Melbourne
| | - Raghu Lingam
- Population Child Health Research Group, University of New South Wales, Sydney, NSW, Australia
- Sydney Children’s Hospitals Network, Sydney, New South Wales, Australia
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Truter P, Flanagan P, Waller R, Richards K, Makate M, Johnstone A, Bongiascia L, Spilsbury K, Cavalheri V, Lin I. Short waits, happy patients and expert care, moving basic musculoskeletal care from the emergency department to a physiotherapist-led diversion pathway. Emerg Med Australas 2024. [PMID: 38622755 DOI: 10.1111/1742-6723.14416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 04/01/2024] [Accepted: 04/02/2024] [Indexed: 04/17/2024]
Abstract
OBJECTIVE Patients with musculoskeletal conditions (MSKCs) are highly prevalent in ED. This project explores the impact of the pilot phase of a 'diversion pathway', which directed patients with MSKCs from the ED waiting room to an outpatient clinic led by advanced-scope physiotherapists. METHODS A prospective intervention study comparing care outcomes between patients in the 'diversion pathway' with usual ED care. The characteristics of patients considered eligible and non-eligible are described. RESULTS Between May and December 2022, 1099 patients were diverted. For diverted patients, mean length of stay (LOS) in ED was reduced by 110 (95% confidence interval [CI]: 99-120) min and 4 h rule compliance improved by 19.3% compared to usual ED care. There were fewer patients who 'did not wait' (DNW) with the diversion pathway. The diverted group was young (median age 22 years and 41% paediatric), mostly low urgency, self-referred and arrived by private transport with minor limb trauma. The diversion pathway triage process appropriately identified 182 patients ineligible for diversion. 96.7% of patients reported satisfaction with care received from the diversion pathway. There was no change in ED representation rates for diverted patients. CONCLUSIONS A new pathway resulted in reduced LOS, reduced DNW, high patient satisfaction and more people being discharged within 4 h for diverted patients compared to usual ED care. The pathway increased ED capacity, improved key ED performance metrics and safely expedited care delivery for patients.
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Affiliation(s)
- Piers Truter
- Physiotherapy Department, Fiona Stanley Hospital, Perth, Western Australia, Australia
- Physiotherapy Department, Rockingham Peel Group, Perth, Western Australia, Australia
- School of Health Sciences and Physiotherapy, University of Notre Dame, Fremantle, Western Australia, Australia
- South Metropolitan Health Service, Perth, Western Australia, Australia
| | - Pippa Flanagan
- Physiotherapy Department, Fiona Stanley Hospital, Perth, Western Australia, Australia
- Physiotherapy Department, Rockingham Peel Group, Perth, Western Australia, Australia
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Robert Waller
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Karen Richards
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
- St John of God Midland Public and Private Hospital, Perth, Western Australia, Australia
| | - Marshall Makate
- Curtin University School of Public Health, Perth, Western Australia, Australia
| | - Anthony Johnstone
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Luke Bongiascia
- Physiotherapy Department, Rockingham Peel Group, Perth, Western Australia, Australia
| | - Katrina Spilsbury
- Institute for Health Research, University of Notre Dame, Fremantle, Western Australia, Australia
| | - Vinicius Cavalheri
- South Metropolitan Health Service, Perth, Western Australia, Australia
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Ivan Lin
- Western Australian Centre for Rural Health, University of Western Australia, Geraldton, Western Australia, Australia
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Truter P, Edgar D, Mountain D, Saggers A, Bulsara C. 'I just need to find out if I had broken something or not.' A qualitative descriptive study into patient decisions to present to an Emergency Department with a simple fracture. Int Emerg Nurs 2024; 73:101420. [PMID: 38408404 DOI: 10.1016/j.ienj.2024.101420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 01/13/2024] [Accepted: 02/01/2024] [Indexed: 02/28/2024]
Abstract
Background To investigate what factors contribute to a working age adult with a simple fracture seeking care in an Australian metropolitan Emergency Department (ED) Methods In this Qualitative Descriptive study, we interviewed ED patients with simple fractures including 5th metacarpal, 5th metatarsal, toe, radial head and clavicle fractures. Results We interviewed 30 patients aged 18-65. Two thirds of participants were aware they might have a minor injury. Many were well informed health consumers and convenience was the most important decision-making factor. Participants focussed on organising imaging, diagnosis and immobilisation. This sequence of care was often perceived as more complex and inefficient in primary care. ED was trusted and preferred to urgent primary care with an unknown doctor. Some patients defaulted to attending ED without considering alternatives due to poor health system knowledge or from escalating anxiety. Conclusions ED is safe, free and equipped to manage simple and complex injuries. Patients would attend primary care if comprehensive fracture management was easily accessible from a trusted clinician. To effectively divert simple fracture presentations from ED, primary care requires collocated imaging, imaging interpretation, orthopaedic expertise, and fracture management resources. Services need to operate 7 days a week and must have accessible 'urgent' appointments.
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Affiliation(s)
- Piers Truter
- School of Health Sciences and Physiotherapy, The University of Notre Dame Australia, Fremantle, WA 6160, Australia; Fiona Stanley Hospital, Emergency Department, Perth, Murdoch, WA 6150, Australia.
| | - Dale Edgar
- Safety and Quality Unit, Armadale Kalamunda Group Health Service, East Metropolitan Health Service, Mt Nasura, WA, Australia; Institute of Health Research, The University of Notre Dame Australia, Fremantle, WA 6160, Australia
| | - David Mountain
- Emergency Department, Sir Charles Gairdner Hospital, Nedlands, WA, Australia; Curtin University Medical School, Bentley, WA, Australia
| | - Annabel Saggers
- School of Health Sciences and Physiotherapy, The University of Notre Dame Australia, Fremantle, WA 6160, Australia
| | - Caroline Bulsara
- Institute of Health Research, The University of Notre Dame Australia, Fremantle, WA 6160, Australia; School of Nursing and Midwifery, The University of Notre Dame, Fremantle, Australia
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Christensen D, Gibberd A, McNamara B, Eades S, Shepherd C, Preen DB, McAullay D, Strobel N. Hospital and emergency department discharge against medical advice in Western Australian Aboriginal children aged 0-4 years from 2002 to 2018: A cohort study. Paediatr Perinat Epidemiol 2023; 37:691-703. [PMID: 37983972 PMCID: PMC10946741 DOI: 10.1111/ppe.13018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 10/15/2023] [Accepted: 10/19/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Discharge against medical advice (DAMA) is a priority issue for the health system. Little is known about the factors associated with DAMA for Aboriginal and/or Torres Strait Islander (Aboriginal) children in Australia. OBJECTIVES Investigate the associations between DAMA for hospital admissions and emergency department (ED) presentations and: (i) child, family and episode of service characteristics and (ii) 30-day readmission/ re-presentation. METHODS We conducted a cohort study of Aboriginal children born in Western Australia (2002-2013) who had ≥1 hospital admissions (n = 16,931) or ED presentations (n = 26,546) within the first 5 years of life. The outcome of interest was hospital and ED DAMA and adjusted odds ratio were derived using multilevel mixed-effects logistic regression. RESULTS In the Hospital Cohort, there were 43,149 hospitalisations for 16,931 children, with 684 hospitalisations (1.6%) recorded as DAMA. In the ED Cohort, there were 232,082 ED presentations in 26,546 children, with 10,918 ED presentations (4.7%) recorded as DAMA. DAMA occurring in hospitals between 2014 and 2018, the adjusted odds decreased by 75% compared to the period between 2002 and 2005. The adjusted odds of ED DAMA increased by 46% over the same period. Hospital admissions in regional and remote hospitals were almost seven times the adjusted odds of DAMA compared with hospital admissions in Perth metropolitan hospitals. The adjusted odds of ED DAMA decreased by 12% for ED presentations in regional and remote hospitals compared to those in Perth metropolitan hospitals. There was no evidence of hospital DAMA being associated with hospital readmission within 30 days and limited evidence of ED DAMA being associated with re-presenting to an ED within 30 days. CONCLUSIONS The study identified several important determinants of DAMA, including admission status, triage status, location and calendar year. These findings could inform targeted measures to decrease DAMA, particularly in regional and remote communities.
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Affiliation(s)
- Daniel Christensen
- Centre for Improving Health Services for Aboriginal and Torres Strait Islander Children and Families (ISAC), Kurongkurl Katitjin, Edith Cowan University, Perth, Western Australia, Australia
| | - Alison Gibberd
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Data Sciences, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Bridgette McNamara
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Barwon South West Public Health Unit, Barwon Health, Geelong, Victoria, Australia
| | - Sandra Eades
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Carrington Shepherd
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
- Ngangk Yira Institute for Change, Murdoch University, Murdoch, Western Australia, Australia
- Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia
| | - David B Preen
- School of Population and Global Health, The University of Western Australia, Crawley, Western Australia, Australia
| | - Daniel McAullay
- Centre for Improving Health Services for Aboriginal and Torres Strait Islander Children and Families (ISAC), Kurongkurl Katitjin, Edith Cowan University, Perth, Western Australia, Australia
| | - Natalie Strobel
- Centre for Improving Health Services for Aboriginal and Torres Strait Islander Children and Families (ISAC), Kurongkurl Katitjin, Edith Cowan University, Perth, Western Australia, Australia
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5
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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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Magnusson C, Ryge H, Scott F, Herlitz J, Axelsson C. Limited need for hospital resources among patients brought to hospital by the emergency medical services. BMC Emerg Med 2021; 21:156. [PMID: 34911447 PMCID: PMC8672622 DOI: 10.1186/s12873-021-00549-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 07/20/2021] [Indexed: 11/14/2022] Open
Abstract
Background In Sweden, the majority of patients who are transported to hospital by the emergency medical services (EMS) are relatively old and the majority suffer from comorbidity. About half these patients are admitted to a hospital ward and will stay in hospital. However, the other half will only make a visit to the emergency department (ED). The burden on the ED is extensive and many elderly patients have to stay for many hours in the ED. Aim To describe the patients who are brought to hospital by the EMS, with particular emphasis on those that were discharged from the ED, and to assess the proportion of these patients who did not require hospital resources, which could mean that they were candidates for primary care (PC). Methods An observational analysis of a cohort of patients who were transported to hospital by the EMS in 2016 in the Municipality of Gothenburg. Results In all, 5,326 patients were transported to hospital by the EMS of which 52% were discharged directly from the ED. These patients included 37% assessed as not requiring hospital resources. The three most common causes of contact with the EMS in this subset were abdominal pain (15%), back pain (8%) and non-specified disease (7%). Of these patients, 77% had contact with a physician in the ED, whereas 6% had contact with a nurse and 17% left the ED without any contact. Twenty-six per cent were given advice on follow-up in PC. Conclusions Among patients who were brought to hospital by the EMS, more than half were discharged directly from the ED. Among these patients, 37% were assessed as not requiring hospital resources. These patients comprised 15% of the overall study cohort and may be candidates for primary care.
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Affiliation(s)
- Carl Magnusson
- Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. .,Department of Prehospital Emergency Care, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Helena Ryge
- Department of Prehospital Emergency Care, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Filip Scott
- Department of Prehospital Emergency Care, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Johan Herlitz
- Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Christer Axelsson
- Department of Prehospital Emergency Care, Sahlgrenska University Hospital, Gothenburg, Sweden.,Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
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Cossar RD, Stewart AC, Wilkinson AL, Dietze P, Ogloff JRP, Aitken C, Butler T, Kinner SA, Curtis M, Walker S, Kirwan A, Stoové M. Emergency department presentations in the first weeks following release from prison among men with a history of injecting drug use in Victoria, Australia: A prospective cohort study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 101:103532. [PMID: 34871944 DOI: 10.1016/j.drugpo.2021.103532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 10/26/2021] [Accepted: 11/11/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Rates of emergency department (ED) use are higher among people released from prison than in the general population. However, little is known about ED presentations specifically among people with a history of injecting drug use (IDU) leaving prison. We measured the incidence of ED presentation in the three months following release from prison, among a cohort of men with histories of IDU, and determined pre-release characteristics associated with presenting to an ED during this period. METHODS We analysed linked survey and administrative data from the Prison and Transition Health (PATH) study (N = 400) using multiple-failure survival analysis. RESULTS Twenty-one percent (n = 81/393) of the cohort presented to an ED at least once within the three months after release from prison. The incidence of ED presentation was highest in the first six days after release. Cox proportional hazards modelling showed that a history of in-patient psychiatric admission and housing instability were associated with increased hazard of an ED presentation, and identifying as Aboriginal and Torres Strait Islander was associated with decreased hazard. CONCLUSIONS In our study, ED presentations following release from prison among people with a history of IDU was linked to acute health risks related to known mental health and social vulnerabilities in this population. Greater collaboration and systems integration between prison and community health and support services is needed to reduce presentations to ED and associated morbidities among people with a history of IDU after release from prison.
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Affiliation(s)
- Reece David Cossar
- Behaviours and Health Risks, Burnet Institute, Melbourne, VIC, Australia; Centre for Forensic Behavioural Science, Swinburne University of Technology and Forensicare, Melbourne, VIC, Australia.
| | - Ashleigh Cara Stewart
- Behaviours and Health Risks, Burnet Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Anna Lee Wilkinson
- Behaviours and Health Risks, Burnet Institute, Melbourne, VIC, Australia; Centre for Forensic Behavioural Science, Swinburne University of Technology and Forensicare, Melbourne, VIC, Australia
| | - Paul Dietze
- Behaviours and Health Risks, Burnet Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; National Drug Research Institute, Curtin University, Perth, Australia
| | - James R P Ogloff
- Centre for Forensic Behavioural Science, Swinburne University of Technology and Forensicare, Melbourne, VIC, Australia
| | - Campbell Aitken
- Behaviours and Health Risks, Burnet Institute, Melbourne, VIC, Australia
| | - Tony Butler
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Stuart A Kinner
- Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Justice Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia; Griffith Criminology Institute, Griffith University, Brisbane, QLD, Australia; Mater Research Institute-UQ, University of Queensland, Brisbane, QLD, Australia
| | - Michael Curtis
- Behaviours and Health Risks, Burnet Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Monash Addiction Research Centre, Monash University, Melbourne, VIC, Australia
| | - Shelley Walker
- Behaviours and Health Risks, Burnet Institute, Melbourne, VIC, Australia
| | - Amy Kirwan
- Behaviours and Health Risks, Burnet Institute, Melbourne, VIC, Australia
| | - Mark Stoové
- Behaviours and Health Risks, Burnet Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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Gray J, Partington A, Karnon J. Access, Use, and Patient-Reported Experiences of Emergency Care During the COVID-19 Pandemic: Population-Based Survey. JMIR Hum Factors 2021; 8:e30878. [PMID: 34494967 PMCID: PMC8428819 DOI: 10.2196/30878] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/01/2021] [Accepted: 08/02/2021] [Indexed: 01/29/2023] Open
Abstract
Background An increase in the number of people presenting to emergency departments (EDs) is contributing to ED overcrowding. In the early stages of the COVID-19 pandemic, there was a significant reduction in the number of ED presentations in Australia, creating an opportunity to learn from patients’ experiences of alternative management options. Objective The aim of this study is to report on the use and experience of health services by Australian adults experiencing a health issue during the COVID-19 pandemic for which they would have presented at an ED prior to the pandemic. Methods An online survey was conducted in May 2020. Reported health issues were categorized using an existing classification system. Data collected included demographics, care pathways, levels of concern at times of health issue and survey completion, and patient-reported experiences with care. Results A total of 1289 eligible respondents completed the survey. Almost 25% (309/1289) of respondents avoided an ED presentation, of which 58% (179/309) used an alternative form of health care and 42% (130/309) self-managed. Respondents making face-to-face or telehealth appointments with their general practitioner (GP) reported high levels of ED avoidance (135/286, 47%) and mostly positive experiences of care provided by GPs. A high proportion of those who self-managed reported high levels of concern at the time of completing the survey (42/130, 32%). Conclusions Telehealth consultations with GPs may be a more promotable alternative to the ED beyond the COVID-19 pandemic, providing easier access to a doctor with access to patients’ medical histories than an appointment for a face-to-face consultation. GP telehealth consultations may also address barriers to accessing health care for those with potentially the greatest need. The reported use and positive experiences with GP telehealth appointments should inform further research on their appropriateness as an alternative to the ED.
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Affiliation(s)
- Jodi Gray
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, Australia
| | - Andrew Partington
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, Australia
| | - Jonathan Karnon
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, Australia
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9
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Duwalage KI, Burkett E, White G, Wong A, Thompson MH. Identifying and quantifying general practice-type emergency department presentations. Emerg Med Australas 2021; 33:1049-1058. [PMID: 34002478 DOI: 10.1111/1742-6723.13800] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/22/2021] [Accepted: 04/25/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This research aims to (i) identify general practice-type (GP-type) presentations to EDs in South-East Queensland, Australia and (ii) compare and quantify the clinical, socio-demographic and time-varying characteristics between GP-type and non-GP-type presentations. METHODS Data were collected from presentations to four EDs in Queensland from 2009 to 2014. A modified version of the Australasian College for Emergency Medicine (ACEM) method for identifying GP-type ED presentations was used. RESULTS The four EDs have different proportions of GP-type presentations, between 7% and 33%. Between 2009 and 2014, the amount of GP-type presentations increased in three EDs, by between 5% and 16%, and decreased by 30% in the other ED. Different holidays, for example, the public holidays over the Christmas to New Year period, impact GP-type presentations. Over 50% of GP-type presentations occurred in those aged 0-34 years, and <1% were aged 85+ years. Injury-related diagnoses made up around 37% of the GP-type presentations, and around 13% did not wait for a diagnosis, averaged over the EDs. GP-type presentations are more likely to present to EDs outside standard general practitioner hours. CONCLUSIONS Existing methods for identifying GP-type presentations have drawbacks, and modified methods are required to better identify these types of presentations. Temporal effects not previously investigated in Australian studies, such as holidays, are significantly associated with GP-type presentations. These findings aid strategic planning and interventions to support review of GP-type presentations, instead, in primary-care facilities, and such interventions may be assistive in some EDs more than others.
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Affiliation(s)
- Kalpani I Duwalage
- School of Mathematical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia.,Centre for Data Science, Queensland University of Technology, Brisbane, Queensland, Australia.,Australian Research Council Centre of Excellence for Mathematical and Statistical Frontiers, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Ellen Burkett
- Emergency Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Healthcare Improvement Unit, Clinical Excellence Queensland, Brisbane, Queensland, Australia
| | - Gentry White
- School of Mathematical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia.,Centre for Data Science, Queensland University of Technology, Brisbane, Queensland, Australia.,Australian Research Council Centre of Excellence for Mathematical and Statistical Frontiers, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Andy Wong
- Emergency Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Mery H Thompson
- School of Mathematical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia.,Centre for Data Science, Queensland University of Technology, Brisbane, Queensland, Australia
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10
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de Moel-Mandel C, Sundararajan V. The impact of practice size and ownership on general practice care in Australia. Med J Aust 2021; 214:408-410.e1. [PMID: 33966270 DOI: 10.5694/mja2.51038] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 03/26/2021] [Accepted: 03/30/2021] [Indexed: 11/17/2022]
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Truter P, Edgar D, Mountain D, Bulsara C. An emergency department optimized protocol for qualitative research to investigate care seeking by patients with non-urgent conditions. Nurs Open 2021; 8:628-635. [PMID: 33570278 PMCID: PMC7877135 DOI: 10.1002/nop2.667] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 09/09/2020] [Accepted: 10/02/2020] [Indexed: 11/11/2022] Open
Abstract
AIM To describe a tailored qualitative research methodology for exploring the complex interaction of factors driving non-urgent care seeking in the emergency department. DESIGN Qualitative descriptive design with a literature informed semi-structured interview and analysis structure. Triangulation with the State-Trait Anxiety Inventory allows expedited exploration of biopsychosocial factors. Consolidated criteria for reporting qualitative research requirements integrated. METHODS With a short 10- to 15-min interview and a low-inference analysis process, this methodology offers a structured way to explore the "go to ED" decision, to understand the patient perspective on their healthcare needs and feed into the development of suitable local services that meet patient healthcare needs. RESULTS This methodology offers a structured way for clinician-researchers to explore the factors that influence patients seeking care in the emergency departments for non-urgent conditions that are specific to their local health service environment. The described methodology is accessible to novice qualitative researchers and includes the semi-structured interview, coding and analysis frameworks.
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Affiliation(s)
- Piers Truter
- School of PhysiotherapyUniversity of Notre Dame AustraliaFremantleWAAustralia
- Emergency DepartmentFiona Stanley HospitalMurdochWAAustralia
- SJOG Midland Public and Private HospitalMidlandWAAustralia
| | - Dale Edgar
- School of PhysiotherapyUniversity of Notre Dame AustraliaFremantleWAAustralia
- Fiona Wood FoundationPerthWAAustralia
| | - David Mountain
- Emergency DepartmentSir Charles Gairdner HospitalNedlandsWAAustralia
- University of Western AustraliaNedlandsWAAustralia
| | - Caroline Bulsara
- School of Nursing and MidwiferyUniversity of Notre Dame AustraliaFremantleWAAustralia
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12
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Kok MR, Tuson M, Yap M, Turlach B, Boruff B, Vickery A, Whyatt D. Impact of the modifiable areal unit problem in assessing determinants of emergency department demand. Emerg Med Australas 2021; 33:794-802. [PMID: 33517585 DOI: 10.1111/1742-6723.13727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 12/22/2020] [Accepted: 01/01/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To examine the impact of the modifiable areal unit problem (MAUP) in an investigation of factors associated with ED demand in Perth, Western Australia, in 2016. Furthermore, to advocate a means of avoiding this impact. METHODS ED presentations were classified as: urgent medical, non-urgent medical, urgent trauma or non-urgent trauma. In each group, sex-stratified, age-adjusted multivariate associations with socio-economic status and distance to the nearest ED and general practitioner (GP) were estimated. Modelling was undertaken using different sets of spatial units: Australian Bureau of Statistics (ABS) Statistical Areas Level 1 (SA1s) and numerous aggregate-level zonations of SA1s (ABS SA2s and others). RESULTS Estimates obtained using the different units often varied widely: for seven (30%) of 24 strata defined by combinations of sex, ED type and covariate, the smallest and largest effect sizes differed in terms of direction; further, for 11 (65%) of the remaining 17 strata, the largest effect size was at least twice as high as the smallest. This demonstrates the MAUP's impact and that analyses based on a single set of spatial units are unreliable. To resolve the observed variation, we highlight the SA1-level estimates. CONCLUSIONS When formulating interventions targeting reduced ED utilisation, policy planners should be guided by evidence based on analysis of appropriate spatial units. This ideal is undermined by the widespread lack of acknowledgement of the MAUP in studies examining drivers of ED demand using spatially aggregated data. To avoid the MAUP, only estimates obtained through examining a minimal geographic unit should be relied upon.
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Affiliation(s)
- Mei Ruu Kok
- Division of General Practice, Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Matthew Tuson
- Division of General Practice, Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia.,Department of Mathematics and Statistics, Faculty of Engineering and Mathematical Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Matthew Yap
- Division of General Practice, Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Berwin Turlach
- Department of Mathematics and Statistics, Faculty of Engineering and Mathematical Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Bryan Boruff
- Department of Geography, Faculty of Arts, Business, Law and Education, The University of Western Australia, Perth, Western Australia, Australia.,UWA School of Agriculture and Environment, Faculty of Science, The University of Western Australia, Perth, Western Australia, Australia
| | - Alistair Vickery
- Division of General Practice, Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - David Whyatt
- Division of General Practice, Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
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13
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Pak A, Gannon B. Do access, quality and cost of general practice affect emergency department use? Health Policy 2021; 125:504-511. [PMID: 33546911 DOI: 10.1016/j.healthpol.2021.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 01/17/2021] [Accepted: 01/20/2021] [Indexed: 11/28/2022]
Abstract
Limited access, poor experience, and high out-of-pocket (OOP) costs of primary care services may lead to avoidable emergency department (ED) presentations. But, the evidence has been limited with most of the studies using surveys conducted in EDs. Using detailed health survey data of Australian women linked to multiple administrative datasets, we extend the literature by estimating the effects of access, costs, and experience of general practice (GP) services on the probability of ED attendance while accounting for a large set of health and socioeconomic covariates. Our findings suggest that improvements in access to primary care services can significantly reduce the demand for low acuity ED presentations. We also show that the impact of increased accessibility of GP services is expected to be the highest for socioeconomic vulnerable populations and patients whose access is the poorest. This evidence can be useful for the design of targeted policies aimed at improving access to doctors in particular areas that are socioeconomically disadvantaged and where medical skill shortages are significant. However, policies aimed at reduction in primary care OOP costs or improvement in the perception of GP quality are less likely to be effective in reducing the number of non-urgent ED presentations.
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Affiliation(s)
- Anton Pak
- James Cook University, Australian Institute of Tropical Health and Medicine, Australia; The University of Queensland, School of Economics, Australia.
| | - Brenda Gannon
- The University of Queensland, School of Economics, Australia; The University of Queensland, Centre for the Business and Economics of Health, Australia.
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14
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Andrew NE, Kilkenny MF, Sundararajan V, Kim J, Faux SG, Thrift AG, Johnston T, Grimley R, Gattellari M, Katzenellenbogen JM, Dewey HM, Lannin NA, Anderson CS, Cadilhac DA. Hospital Presentations in Long-Term Survivors of Stroke: Causes and Associated Factors in a Linked Data Study. Stroke 2020; 51:3673-3680. [PMID: 33028173 DOI: 10.1161/strokeaha.120.030656] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE A comprehensive understanding of the long-term impact of stroke assists in health care planning. We aimed to determine changes in rates, causes, and associated factors for hospital presentations among long-term survivors of stroke. METHODS Person-level data from the AuSCR (Australian Stroke Clinical Registry) during 2009 to 2013 were linked with state-based health department emergency department and hospital admission data. The study cohort included adults with first-ever stroke who survived the first 6 months after discharge from hospital. Annualized rates of hospital presentations (nonadmitted emergency department or admission)/person/year were calculated for 1 to 12 months prior, and 7 to 12 months (inclusive) after hospitalization. Multilevel, negative binomial regression was used to identify associated factors after adjustment for prestroke hospital presentations and stratification for perceived impairment status. Perceived impairments to health were defined according to the subscales and visual analog health status scores on the 5-Dimension European Quality of Life Scale. RESULTS There were 7183 adults with acute stroke, 7-month survivors (median age 72 years; 56% male; 81% ischemic, and 42% with impairment at 90-180 days) from 39 hospitals included in this landmark analysis. Annualized presentations/person increased from 0.88 (95% CI, 0.86-0.91) to 1.25 (95% CI, 1.22-1.29) between the prestroke and poststroke periods, with greater rate increases in those with than without perceived impairment (55% versus 26%). Higher presentation rates were most strongly associated with older age (≥85 versus 65 years, incidence rate ratio, 1.52 [95% CI, 1.27-1.82]) and greater comorbidity score (incidence rate ratio, 1.06 [95% CI, 1.02-1.10]), whereas reduced rates were associated with greater social advantage (incidence rate ratio, 0.71 [95% CI, 0.60-0.84]). Poststroke hospital presentations (7-12 months) were most frequently related to recurrent cardiovascular and cerebrovascular events and sequelae of stroke. CONCLUSIONS A large increase in annualized hospital presentation rates after stroke indicates the potential for improved community management and support for this vulnerable patient group.
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Affiliation(s)
- Nadine E Andrew
- Department of Medicine, Peninsula Clinical School, Central Clinical School (N.E.A.), Monash University, VIC, Australia.,Stroke & Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health (N.E.A., M.F.K., J.K., A.G.T., R.G., D.A.C.), Monash University, VIC, Australia
| | - Monique F Kilkenny
- Stroke & Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health (N.E.A., M.F.K., J.K., A.G.T., R.G., D.A.C.), Monash University, VIC, Australia.,Florey Institute of Neuroscience and Mental Health, VIC, Australia (M.F.K., J.K., D.A.C.)
| | - Vijaya Sundararajan
- Department of Public Health, School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, VIC, Australia (V.S.)
| | - Joosup Kim
- Stroke & Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health (N.E.A., M.F.K., J.K., A.G.T., R.G., D.A.C.), Monash University, VIC, Australia.,Florey Institute of Neuroscience and Mental Health, VIC, Australia (M.F.K., J.K., D.A.C.)
| | - Steven G Faux
- St Vincent's Hospital, NSW, Australia (S.G.F.).,University of New South Wales, NSW, Australia (S.G.F.)
| | - Amanda G Thrift
- Stroke & Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health (N.E.A., M.F.K., J.K., A.G.T., R.G., D.A.C.), Monash University, VIC, Australia
| | - Trisha Johnston
- Health Statistics Branch, Queensland Department of Health, QLD, Australia (T.J.)
| | - Rohan Grimley
- Stroke & Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health (N.E.A., M.F.K., J.K., A.G.T., R.G., D.A.C.), Monash University, VIC, Australia.,School of Medicine, Griffith University, QLD, Australia (R.G.)
| | - Melina Gattellari
- Department of Neurology, Royal Prince Alfred Hospital, NSW, Australia (M.G.)
| | | | - Helen M Dewey
- Eastern Health Clinical School, Monash University, VIC, Australia (H.M.D.)
| | - Natasha A Lannin
- Department of Neuroscience, Central Clinical School (N.A.L.), Monash University, VIC, Australia
| | - Craig S Anderson
- Royal Prince Alfred Hospital, NSW, Australia (C.S.A.).,The George Institute for Global Health, NSW, Australia (C.S.A.).,Neurology Department, Royal Prince Alfred Hospital, Sydney Health Partners, NSW, Australia (C.S.A.).,The George Institute for Global Health at Peking University Health Science Center China (C.S.A.)
| | - Dominique A Cadilhac
- Stroke & Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health (N.E.A., M.F.K., J.K., A.G.T., R.G., D.A.C.), Monash University, VIC, Australia.,Florey Institute of Neuroscience and Mental Health, VIC, Australia (M.F.K., J.K., D.A.C.)
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15
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Toloo G(S, Bahl N, Lim D, FitzGerald G, Wraith D, Chu K, Kinnear FB, Aitken P, Morel D. General practitioner‐type patients in emergency departments in metro North Brisbane, Queensland: A multisite study. Emerg Med Australas 2019; 32:481-488. [DOI: 10.1111/1742-6723.13447] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 11/20/2019] [Accepted: 11/21/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Ghasem (Sam) Toloo
- Institute of Health and Biomedical InnovationQueensland University of Technology Brisbane Queensland Australia
- School of Public Health and Social WorkQueensland University of Technology Brisbane Queensland Australia
| | - Nimisha Bahl
- School of Public Health and Social WorkQueensland University of Technology Brisbane Queensland Australia
| | - David Lim
- School of Science and HealthWestern Sydney University Sydney New South Wales Australia
| | - Gerry FitzGerald
- School of Public Health and Social WorkQueensland University of Technology Brisbane Queensland Australia
| | - Darren Wraith
- Institute of Health and Biomedical InnovationQueensland University of Technology Brisbane Queensland Australia
| | - Kevin Chu
- Department of Emergency MedicineRoyal Brisbane and Women's Hospital Brisbane Queensland Australia
| | - Frances B Kinnear
- Emergency and Children's ServicesThe Prince Charles Hospital Brisbane Queensland Australia
| | - Peter Aitken
- Health Disaster Management UnitQueensland Health Brisbane Queensland Australia
| | - Douglas Morel
- Emergency DepartmentRedcliffe Hospital Redcliffe Queensland Australia
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