Below Associate Professor Christopher Carter, Chief Executive Officer, Inner North West Melbourne Medicare Local (INWMML), shares the interesting findings of their recent study into non emergency presentations at hospital emergency departments. The results suggest there is more thinking to be done on how to effectively manage this phenomenon.
Associate Professor Carter writes:
It’s long been noted that people with ‘primary care type’ conditions often seek treatment in a hospital emergency department when they could access care closer to home via their GP. A new analysis now sheds light on the potential reasons behind this behaviour – and the results are surprising.
Primary care type presentations to public hospitals: A local in-hours and after hours population comparison was compiled using 2010 / 2011 data on emergency department attendance at four inner city general hospitals in Melbourne (Royal Melbourne, St Vincent’s, Austin and Northern). This joint initiative between ourselves, our colleagues at Northern Melbourne Medicare Local and Department of Health, North and West Metropolitan region, sought to understand what some of the fundamentals may be in driving emergency department attendance for primary care type conditions such as sprains, skin infections and urinary tract infections.
Here in the INWMML catchment – which incorporates the Local Government Areas of Moreland, Moonee Valley, Yarra and Melbourne – this issue is a very important one. Every day in our catchment 303 people attend an emergency department. More than a third (127 of them) potentially could have been treated by a primary care health service.
The common anecdotal view on the subject has largely assumed that people opting to attend emergency departments rather than visit a GP would be poorer, less educated and have less access to general practices. But this analysis contradicts each of these suppositions.
The most common time of presentations for such conditions at an emergency department was during normal GP opening hours. This contravenes the assumption that people visit emergency departments because their GP is closed.
The report also showed that the people most likely to present to emergency instead of a GP were younger men (aged 20–29 years), and not the elderly as might be supposed.
So, could it be poverty and a lack of access to local GPs driving emergency department visits? After all, hospital attendance is free, while a trip to the GP may result in at least some out of pocket cost to the patient.
Interestingly, this idea was also not supported by the analysis, which showed that hospital attendance was more common among those from higher socioeconomic status and those who live in areas where there are plenty of GPs and an Emergency Department nearby.
This report needs to be understood for the nuanced, complex situation it represents. After all, situations vary enormously around Australia and local factors are at play in the report, given its tight focus on just four hospitals in Melbourne.
However it does raise the possibility that, around Australia, we may need to rethink current strategies to reduce pressure on emergency departments.
Emergency departments are an expensive way to treat primary care type conditions. Primary care – usually general practice – is less expensive to the system and more likely to be close to home, with a doctor who knows the individual patient, has access to their treatment history and can provide holistic, longitudinal care. So obviously, anything that can be done to direct people with primary care type conditions to GPs instead of hospitals will improve care and save the health system money, at a time when the ageing population and increasing cost of care means that the budget is ever more stretched.
A common approach to achieving this has been to create centrally located health clinics that are open late at night and on weekends, where bulk billing is standard. This would be a great strategy if lack of access to GPs and a disadvantaged population who would struggle to pay a consultation fee was driving primary care type conditions into emergency departments.
But the report’s findings call this assumption into question, instead indicating that people’s perceptions and assumptions may be a bigger driver than cost, distance or access to local GP services.
INWMML, like other Medicare Locals around the country, is working hard at a local level to find solutions to improve the patient experience of primary care. Educating and challenging the perceptions of our local residents around GPs and emergency departments is obviously going to be a big part of this work.
What’s needed now is to further tease out the findings of the report and develop strategies to support general practice, hospitals and our community to enable primary care type presentations to be managed appropriately at any time of the day or night.