Initiative increases access to medical care for under 6s

After-hours initiative increases access to medical care for under 6s - report

Reducing the cost of subsidised co-payments appears to have led to an increase in the number of children under 6 using after-hours accident and medical clinics, according to a government-commissioned report released today.

The report, written by lead researcher Dr Tim Tenbensel from the University of Auckland, evaluates initiatives designed to reduce barriers to accessing after-hours and urgent medical care in the Auckland region. These initiatives, sponsored by the Greater Auckland Integrated Health Network, include the Accident and Medical (A&M) intervention, which introduced subsidised co-payments and increased opening hours to 11 participating A&M clinics across Auckland.

This research was funded by the Health Research Council of New Zealand in partnership with the Ministry of Health. It was commissioned under the government’s Better, Sooner, More Convenient Primary Health Care initiative, which aims to deliver a more personalised primary health care system that provides services closer to home and makes Kiwis healthier.

For those patients that were eligible for subsidised co-payments*, the report’s researchers estimated that use of the participating A&M clinics was 13 per cent higher than expected (8600 patients) over the course of the initiative’s second year (September 2012 – August 2013). The number of patients aged over 65 using A&M clinics was higher than predicted (although still low); however, the biggest indication of a positive effect was for children under 6 years.

“We are confident that increases in the use of accident and medical clinics, particularly for under-6s, can be attributed to the A&M intervention. This is based on economic analysis of the data, which shows that reducing co-payments to zero had a strong influence on the use of A&M clinics by under-6s in low income neighbourhoods,” says Dr Tenbensel.

These results corresponded with an estimated 10 per cent (7000 patients) drop in the number of eligible patients presenting to hospital emergency departments. However, Dr Tenbensel stresses that this decrease cannot necessarily be attributed to the A&M intervention because of other confounding factors.

The report also evaluated two other initiatives: an after-hours telephone triage service offered by HomeCare Medical Limited (HML), where patients can call their GP after hours, and the St John Transport (SJT) Initiative, which aims to reduce the number of patients St John Ambulance services transports to emergency departments who can be safely managed in the community.

Awareness of the HML service was found to be low, with only 10 per cent of surveyed patients aware that their family doctor provided an after-hours telephone service.

Over the first 24 months of the SJT Initiative (December 2011 to November 2013), 2967 patients were diverted by ambulance to an Auckland A&M clinic. In 88 per cent of these transfers, patients were successfully managed in primary care, while 10 per cent were referred on to hospital.

The report concluded that the SJT Initiative had made a “small difference” to patients’ use of A&M clinics and hospital emergency departments. Surveys of ambulance patients showed that those who were transferred to A&M clinics were satisfied with their care as long as they were seen by a doctor or nurse on arrival.

Dr Tenbensel says while it is too early to expect these initiatives to show positive results, the report does indicate the key issues to address if these services are to play a positive role.

“The value in all the initiatives lies more in the processes by which they came about – as a consequence of constructive engagement between Auckland region health organisations – and less in the capacity of these instruments to quickly solve endemic, structural health system problems,” says Dr Tenbensel.

To download a copy of the full report, go to https://cdn.auckland.ac.nz/assets/fmhs/reports/BSMC-HRC-12-940-FINAL-REPORT-16-May-2014.pdf

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