After-hours initiatives review and evaluation
COORDINARE, South Eastern NSW Primary Health Network
Duration: January – August 2016
This project was undertaken to review and evaluate past investments in after-hours primary care by the Illawarra-Shoalhaven Medical Local and the Southern NSW Medicare Local. These investments sought to increase consumer and provider awareness of after-hours primary care services; increase the availability of face-to-face after-hours primary care; improve after-hours care in residential aged care; and improve the provision of after-hours palliative care. The aim of the project was to use the findings to inform future decisions and investments in after-hours primary care by the South Eastern NSW Primary Health Network. Primary Health Networks replaced Medicare Locals in 2015.
What we did
The project involved a review of documentation regarding after-hours primary care in the period 2012-2015, consultation with key stakeholders, a search of some relevant literature and analysis of data on emergency department presentations and after-hours items in the Medicare Benefits Schedule. Analysis of emergency department presentations used a definition of ‘potential primary care’ presentations: patients classified into category 4 or 5 of the Australasian Triage Scale who did not arrive by ambulance and were self-referred. Literature searching identified 56 potentially relevant papers. The full text of each paper was reviewed and relevant papers cited in the final report.
The review of past investments to improve after-hours primary care was limited to the available documentation. Certain aspects of the ‘logic’ underpinning some of these investments made a lot of sense, particularly engagement of pharmacies (to improve knowledge and awareness of available after-hours services) and a health literacy approach to community awareness campaigns. The review highlighted the difficulty implementing meaningful change in residential aged care.
Searching the literature found limited research evidence to guide decisions about improving after-hours primary care. Systematic reviews of the evidence regarding primary care contain almost no reference to after-hours care. Reviews of the literature on after-hours primary care have only been undertaken for very different health systems to Australia. The evidence regarding after-hours care in residential aged care and palliative care is also very limited.