Academic journal article Australian Health Review

Access to Same Day, Next Day and After-Hours Appointments: The Views of Australian General Practitioners

Academic journal article Australian Health Review

Access to Same Day, Next Day and After-Hours Appointments: The Views of Australian General Practitioners

Article excerpt

Introduction

In Australia, general practitioners (GPs) are the first point of contact and coordinate access to much of the rest of the health system. It is therefore essential that general practice is easy to access, and this has been a focus in recent health reforms.1,2 Although there is no evidence that low socioeconomic groups use general practice less,3 inequities in access relative to need have been reported in rural and remote areas and for some population groups (such as indigenous or refugee populations).4-6 There has also been inequities in access to longer consultations and psychological services.7,8 Improving access to primary health- care has been demonstrated to help overcome some of the adverse effects of income inequality on health.9

Workforce shortages and the maldistribution of the medical workforce in general practice have led to increasing concern aboutwaiting times forappointmentswith GPs,especiallyinrural areas.10 There are also increasing problems with access to general practice after-hours, reflecting several factors including changes to the work hours and work practices of GPs and increasing concern about security of practitioners working after-hours.4 Out of hours work has been described as 'the most important stress' in GPs' professional lives.11

The resulting pressure on hospital emergency departments has led to a range of government initiatives to improve access to general practice care after-hours. Accredited general practices havebeenfundedtoprovide after-hourscare as partof thePractice Incentives Program (PIP). In 2008-09, the average PIP payment was $19 700 per full time equivalent (FTE) GP, with incentives for after-hours care comprising 19% of this.12 This was slated to be cut as it is due to be incorporated and funded as part of the new primary care organisations (Medicare Locals).13 However, the PIP funding has been extended until July 2013 following an outcry from the profession. Waiting times and after-hours access are also important standards for general practice accreditation14 and were an early target for improvement by the National Primary Care Collaboratives.15

In a systematic review of the literature, we found only limited research on factors associated with access to general practice in Australia.16 This study examined access to same or next day appointments in general practice and to after-hours general practice care reported by Australian GPs in a large international survey of primary care practitioners.17 The findings were com- pared with the performance in other countries and related to practice and practitioner characteristics and the processes and systems of care used in their practices.

Methods

Data source

The data for this secondary analysis came from the 2009 Inter- national Survey of General Practitioners, coordinated by the Commonwealth Fund.The surveywas conducted in 11 countries: Australia, Canada, France, Germany, Italy, The Netherlands, New Zealand, Norway, Sweden, UK and USA. The methodology has been published previously.18 In Australia, 2025 GPs were randomly drawn from a representative national list of GPs stratified by region (cities, inner regional, outer regional and remote/very remote) for invitation by mail.

Questionnaire

The survey included two questions about how doctors perceived accessibility of their practice:

(1) What proportion of your patients who request a same or next day appointment can get one?

(2) Does your practice have an arrangement where patients can see a doctor or nurse if needed when the practice is closed (after-hours) without going to the hospital emergency room or department?

Information on practitioner and practice characteristics was collected including:-

(1) Staffing: number of doctors (Q28) (less than 5; 5 or more) and non-medical staff (Q29) (less than or equal to 5; more than 5);

(2) Practice location: city or suburban; rural or small towns (Q35);

(3) Hours in practice per week: (under 40; 40 or more) (Q30);

(4) Number of patients seen per week: (under 120; 120 or more) (Q31);

(5) Percentage of work time facing patient: (under 70; 70 or more) (Q32);

(6) Age: (under 50; 50 or more) (Q36); and

(7) Plans to retire: Yes, within 5 years; No (Q36). …

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