More GP-type patients in rural emergency departments

The research, carried out by the University of Tasmania’s Rural Clinical School (RCS) and the Tasmanian Health Organisation-North West, provided a comparison to similar work looking at EDs in Perth, Western Australia. 

While the number of GP-type patients are two to three times higher in the North West compared to the metropolitan study, these presentations only contribute 7-8% of the department’s total treatment time, and therefore do not cause overcrowding.

The research formed the basis of a paper by RCS research fellows Dr Penny Allen and Colleen Cheek and THO-North West Emergency Specialist Dr Marielle Ruigrok, published in the latest edition of the Medical Journal of Australia

Using the same methodology as the Perth study, the new paper examines retrospective data from THO-NW and determines the number of ED presentations at the North West Regional Hospital and the Mersey Community Hospital that may have been managed by a general practitioner or nurse.

The paper also noted that there are fewer GPs in the North West, which may contribute to less availability and lead to people seeking emergency care.  A policy, such as the recently mooted general practice co-payment, could further increase ED presentations, as the cost of healthcare becomes an increasing concern for families.

Lead researcher Dr Allen said with fewer GPs on the North-West, residents were likely to appropriately self-refer to EDs to access care.

“Increasing the supply of GPs in rural areas remains the cornerstone of reducing general practice-type presentations,” the authors stated.

“The GP to patient ratio in North West Tasmania demonstrates the need to consider a different approach to health care funding and planning to those models which support city health care services.”

The study found that:

  • There were 152,481 emergency department presentations in North West Tasmania during the three-year period from the start of 2011 to the end of 2013.
  • Of these, 35 per cent might have been suitable for GP management.
  • GP-type presentations accounted for 7-8% of total ED workload.
  • The amount of GP-type presentations is two to three times that experienced in Perth, WA.
  • In rural areas, the lack of availability of general practice care, and care at no cost to the patient, are two potential reasons for patients presenting to EDs.

Those patients who were self-referred, who did not arrive by ambulance and had a medical consultation time under one hour, were considered GP-type patients. The study excluded those who left before seeing a doctor or had a longer treatment time.

The authors suggested that other models of providing care, which align with the communities’ needs in less expensive settings than tertiary EDs, require exploration.

University of Tasmania, Australia.