Access to same day, next day and after-hours appointments: the views of Australian general practitioners

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doi:10.1071/AH11080

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Access to same day, next day and after-hours appointments: the views of Australian general practitioners

Mark F. Harris ^A ^D, Patrick G. Powell Davies ^A, Mahnaz Fanaian ^A, Nicholas A. Zwar ^B and Siaw-Teng Liaw ^B ^C

^A Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW 2052, Australia. Email: g.powell-davies@unsw.edu.au, m.fanaian@unsw.edu.au
^B School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW 2052, Australia. Email: n.zwar@unsw.edu.au
^C Department of General Practice, Fairfield Hospital, Sydney, NSW 2165, Australia. Email: siaw@unsw.edu.au
^D Corresponding author. Email: m.f.harris@unsw.edu.au

Australian Health Review 36(3) 325-330 http://dx.doi.org/10.1071/AH11080
Submitted: 27 August 2011 Accepted: 12 February 2012 Published: 27 July 2012





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Abstract

Objective. To evaluate factors associated with the availability of same or next day appointments and after-hours access reported by Australian general practitioners (GPs).

Methods. Secondary analysis of a survey of primary care practitioners conducted by the Commonwealth Fund in 2009 in 11 countries. Analysis of factors likely to be associated with reported availability of same or next day appointments and after-hours access.

Findings. Of 1016 Australian GPs, 78.8% reported that most patients in their practice had access to an appointment on the same or next day and 50% that their practice had arrangements for after-hours access. Access to same or next day care was better in practices where practitioners reported larger numbers of patients seen per GP per week and reviewed their performance against annual targets, but worse in rural areas and practices routinely reviewing outcomes data. Arrangements for after-hours care were more common among GPs who were planning to retire in the next 5 years; worked in practices with high electronic functioning information systems; and received and reviewed clinical outcome data and incentives for performance.

Conclusions. Improving after-hours access requires a comprehensive approach which includes incentives, improvements to information management and organised systems of care with review of data on clinical outcomes.

What is known about the topic? Access to general practice is an important priority for the health system and the subject of several reforms and initiatives over the past decade in Australia. Access to same or next day appointments and after-hours has been an increasing concern related to workforce availability, and limited access to general practice is one factor influencing the demand on hospitals, especially their emergency departments.

What does this paper add? This paper reports on secondary analysis of a survey of over 1000 general practitioners in Australia. Responses to questions about access to same or next day appointments or after-hours arrangements were analysed for associations with practitioner and practice characteristics and their processes and systems of care. Access to same day appointments is particularly challenging in rural general practice but is more likely to be reported by GPs working in larger practices. Incentives, quality improvement and better information management may be important strategies to improve after-hours access.

What are the implications for practitioners? Strategies to improve access to appointments and to after-hours care need to be considered as part of a comprehensive approach which includes financial incentives, strengthening information systems and quality improvement activities.

Additional keywords: general practice, information technology, multidisciplinary, rural, workload.

References

[1] Department of Health and Ageing. Building a 21st century primary health care system: Australia’s first national primary health care strategy. Canberra: Commonwealth of Australia; 2010.

[2] Department of Health and Ageing. National health reform: performance and accountability framework. Canberra: Commonwealth of Australia; 2011.

[3] Pegram R, Daniel J, Harris M, Humphries J, Kalucy L, MacIsaac P, et al. General practice in Australia 2004. Canberra: Department of Health and Ageing; 2005.

[4] Britt H, Miller GC, Charles J, Henderson J, Bayram C, Valenti L, et al. General practice activity in Australia 1990–2000 to 2008–09: 10 year data tables. Canberra: Australian Institute of Health and Welfare; 2009.

[5] Harris MF, Furler J, Valenti L, Harris E, Britt H. Matching care to need in general practice: a secondary analysis of BEACH data. Aust J Primary Health 2004; 10: 151–5.
| CrossRef |

[6] Harris MF, Zwar N. Refugee health. Aust Fam Physician 2005; 34: 825–9.

[7] Furler JS. HE, Chondros P, Powell Davies PG, Harris MF, Young DYL. The inverse care law revisited: impact of disadvantaged location on accessing longer GP consultation times. Med J Aust 2002; 177: 80–3.
| PubMed |

[8] Pirkis J, Harris M, Hall W, Ftanou M. Evaluation of the Better Access to Psychiatrists, Psychologists and General Practitioners through the Medicare Benefits Schedule Initiative. Melbourne: Centre for Health Policy Programs and Economics, University of Melbourne; 2011.

[9] Shi LMB, Starfield J, Wulu J,, Regan J, Politzer R. The relationship between primary care, income inequality and morality in the United States 1980–1995. J Am Board Fam Pract 2003; 16: 412–22.
| CrossRef |

[10] Australian Consumers Health Forum. Response to the Royal Australian College of General Practitioners (RACGP) review of standards for general practice. 2nd ed. Canberra: Australian Consumers Health Forum; 2004.

[11] Dale J, Shipman C, Lacock L, Davies M. Creating a shared vision of out of hours care: using rapid appraisal methods to create an interagency, community oriented, approach to service development. BMJ 1996; 312: 1206–10.
| CrossRef | CAS | PubMed |

[12] The Auditor-General. Performance audit: Practice Incentives Program. Canberra: Australian Government; 2010.

[13] Department of Health and Ageing (DoHA). National health and hospital reform fact sheet: establishment of Medicare Locals and better access to after hours care. Canberra: DoHA; 2011. Available at http://www.yourhealth.gov.au/internet/yourhealth/publishing.nsf/Content/factsheet-gp-01 [verified 16 July 2011].

[14] Royal Australian College of General Practitioners (RACGP). RACGP standards for general practices. Melbourne: RACGP; 2011. Available at http://www.racgp.org.au/standards [verified 25 June 2012].

[15] Australian Primary Care Collaboratives. Adelaide: Improvement Foundation; 2011. Available at http://www.apcc.org.au/ [verified 25 June 2012].

[16] Comino E, Harris MF, Haas M, Furler J, Powell Davies G, Raymont A, et al. Optimising access to best practice primary health care: a systematic review. Canberra: Australian Primary Health Care Institute; 2010.

[17] Commonwealth Fund. 2009 international survey of primary care doctors. New York: Commonwealth Fund; 2010.

[18] Schoen C, Osborn R, Doty MM, Squires D, Peugh J, Applebaum S. A survey of primary care physicians in eleven countries 2009: perspectives on care, costs and experiences. Health Aff 2009; 28: w1171–83.
| CrossRef |

[19] Schoen C, Osborn R, Trang P, et al Taking the pulse of health care systems: experiences of patients with health problems in six countries. Health Aff 2005; 10: 1377.

[20] Rural Doctors Association of Australia. Rural doctors welcome government rollout of additional rural training places. Canberra: Rural Doctors Association of Australia; 2011.

[21] Department of Health and Ageing. Report on the audit of health workforce in rural and regional Australia. Canberra: Commonwealth of Australia; 2008.

[22] Australian Institute of Health and Welfare. Health and community services labour force series. Canberra: Australian Institute of Health and Welfare; 2001.

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