After-hours GP clinics can reduce non-urgent presentations to hospital EDs

Establishing after-hours general practice clinics in areas with limited existing after-hours GP access can be associated with a substantial reduction in low-urgency presentations to hospital emergency departments, according to research published in the Medical Journal of Australia.

Statistician David Buckley and his co-authors at the Greater Southern Area Health Service in Wagga Wagga, NSW, conducted a retrospective time series analysis of data for all patients presenting to the emergency department (ED) at Wagga Wagga Base Hospital between January 1998 and October 2008.

After adjusting for long-term trends and weekly and annual cycles, they found the opening of a non-bulk-billing, after-hours clinic in March 2003 was associated with a daily reduction of 7.04 patients in ED presentations triaged as potentially serious or less urgent. This represented an 8.2 per cent reduction in total presentations.

“Before the clinic opened, after-hours general practice services in Wagga Wagga were extremely limited and the GP to patient ratio relatively low … Areas with low availability of after-hours general practice and few alternatives to the ED will likely see a larger response from the opening of an after-hours clinic,” Mr Buckley said. 

However, the study also found that the opening of the after-hours clinic was associated with an increase in the number of patients presenting to the ED with conditions triaged as immediately, imminently or potentially life-threatening. These presentations rose by 1.36 patients a day, which represented 1.6 per cent of total presentations.

In an accompanying editorial, Associate Prof Drew Richardson, from the Australian National University Medical School, said the study should be “the last nail in the coffin” of the myth that the root cause of overcrowding in hospital EDs is a lack of primary care services.

“Based on published Wagga Wagga Base Hospital data and accepted casemix measures, this reduction “access block” patients … who are inappropriately occupying ED space and staff time.”

The Medical Journal of Australia is a publication of the Australian Medical Association.