Presentations to the Bathurst after hours gp clinic
In the first two years of operation (1st December 2012 to 30th November 2014) there were 2125 presentations to the BAHGPC. Of these, 1205 (57%) were female and 920 (43%) were male. During the five month client study period (1st February 2015 to 30th June 2015), there were 827 clinic presentations, of which 62% were female and 38% were male. A total of 219 clients who presented to the clinic during this time frame participated in the client presentation survey. However, 14 were incomplete and not included in the analysis, resulting in a total of 205 surveys; a 25% response rate. The follow-up satisfaction survey was completed by 219 clients, a 26% response rate. During the period 1st December 2014 to 30th June 2015, 452 general practitioner surveys were completed by treating doctors, a response rate of 55%.
Three-quarters of all clients surveyed (76%; 155) deemed their visit to the BAHGPC as essential (Table
1). Sixty per cent (60%; 125) indicated that they would have presented to the ED had the BAHGPC not been operating at the time of their visit, of which 86% (107) classified their visit as essential. A quarter of respondents (27%; 55) indicated they would have waited until the following week to see their own general practitioner rather than present to the ED (Table
1), however 58% (32) of these respondents still deemed their visit as essential. Twenty-eight per cent (28%; 49) of participating clients had a health care card and 44% (75) had private health insurance (Table
1). One-quarter of respondents (25%; 52) reported that they would not use the BAHGPC if they had to pay for the service, i.e. if it was not bulk-billed. Of the clients who said no, only two gave a reason, being:
“Depends on acuity of presentation”; and
“just in case I didn’t have the money at the time”. Of the 75% that would be willing to pay for the service, 56% (87) would be willing to pay the same amount they currently pay their general practitioner, and 39% (60) would be willing to pay a small co-payment (less than $10). There was no significant association between possession of a health care card and willingness to attend the BAHGPC if the client had to pay for the service, i.e., it was not bulk-billed (X
2 1.344,
P = 0.246). However, those with private health insurance were significantly more likely to indicate a willingness to attend the BAHGPC if they had to pay for the service (i.e. if it was not bulk-billed), compared to those who did not have private health insurance (X
2 11.926,
P < 0.001).
Table 1
Client perceptions when presenting at the Bathurst After Hours General Practice Clinic
Main reason for attending the after hours clinic: (n = 205) | | |
Essential visit (had to come) | 155 | 76% |
Convenient | 18 | 9% |
Couldn’t get an appointment with a regular GP | 16 | 8% |
Only to get a script (out of my medication) | 8 | 4% |
Requested by the hospital ED to attend | 1 | 0% |
Requested by the GP to attend | 0 | 0% |
Other | 7 | 3% |
If the after hours clinic was not operational, the client would: (n = 205)a
| | |
Go to the Hospital ED | 125 | 60% |
Wait until next week to see the client’s own GP | 55 | 27% |
Try and consult another GP in town | 22 | 11% |
Visit a pharmacist and try to get medication | 3 | 1% |
Other | 3 | 1% |
If the client had to pay for the clinic, would they use the service: (n = 205)b
| | |
Yes: | 154 | 75% |
If yes, what is the maximum the client would be willing to pay: (n = 154) | | |
The same amount you would pay at your GP | 87 | 56% |
A small co-payment (less than $10) | 60 | 39% |
More than you would pay at your GP | 4 | 3% |
No response/missing data | 3 | 2% |
No | 52 | 25% |
Does the client have a health care card: (n = 175) | | |
Yes | 49 | 28% |
No | 126 | 72% |
Does the client have private health insurance: (n = 170) | | |
Yes | 75 | 44% |
No | 95 | 56% |
From the perspective of the general practitioner, the majority of presentations to the BAHGPC were deemed appropriate (85%; 383) and an additional 2% (7) were considered appropriate
and needed a referral to the local hospital or ED (Table
2). When queried about how essential the presentations to the BAHGPC were on a scale of 0 to 5 (0 being not appropriate and 5 being absolutely essential), 28% of presentations to the BAHGPC were rated by general practitioners as 5 (absolutely essential), 41% as 4, and 17% as 3 (Table
2). A total of 14% of presentations were rated on the lower end of the scale (0, 1 or 2). The most common presentations recorded by general practitioners were for an ear, nose and throat problem (20%), a dermatological problem (17%) or a respiratory problem (17%) (Table
2).
Table 2
General practitioner perceptions of presentations at the Bathurst After Hours General Practice Clinic
Classification of presentations to the Bathurst After Hours GP Clinic: (n = 449) | | |
Consultation was appropriate | 383a
| 85% |
Consultation was appropriate and needed a referral to hospital/ED | 7 | 2% |
Consultation was appropriate and was requested by clients GP during the week | 0 | 0% |
Consultation only for a script | 9 | 2% |
Consultation for an administrative reason | 10 | 2% |
Consultation for drug-seeker | 3 | 1% |
Consultation because it was convenient for the client | 29b
| 7% |
Other | 13 | 4% |
GP perception of appropriateness of presentation: (n = 452) | | |
5 (Absolutely essential) | 125 | 28% |
4 | 186 | 41% |
3 | 77 | 17% |
2 | 33 | 7% |
1 | 17 | 4% |
0 (Not appropriate) | 14 | 3% |
Primary reason for presentation: (n = 452) | | |
Ear, nose and throat | 91 | 20% |
Dermatological | 77 | 17% |
Respiratory | 76 | 17% |
Gastrointestinal | 39 | 9% |
Genito-urinary | 34 | 8% |
Documentation | 20 | 4% |
Neurological | 9 | 2% |
Psychological | 8 | 2% |
Cardiovascular | 3 | 1% |
Other – including dental, injury, immunisation | 95 | 21% |
For the client satisfaction survey, the majority of clients (59%; 129) rated their visit as 10 (very satisfied), and a combined total of 190 (86%) rated their visit as 8, 9 or 10 (Table
3). Seventy-nine per cent (79%; 174) said their health issue was resolved as an outcome of their visit. Of the 45 (21%) issues that were not resolved, within one week of presenting the BAHGPC, 73% (33) saw another GP, 22% (10) went to ED and 9% (4) did not seek additional medical assistance. Ninety-nine per cent (99%; 216) of respondents said that would use the clinic again and 99% (217) would recommend the clinic to someone else (Table
3).
Table 3
Client satisfaction follow-up survey
Client satisfaction with the visit (n = 219) | | |
10 (very satisfied) | 129 | 59% |
9 | 40 | 18% |
8 | 21 | 10% |
7 | 15 | 7% |
6 | 4 | 2% |
5 | 8 | 4% |
4 | 1 | 0% |
3 | 0 | 0% |
2 | 0 | 0% |
1 | 1 | 0% |
0 (very dissatisfied) | | |
Was the clients issue resolved: (n = 219) | | |
Yes | 174 | 79% |
No | 45 | 21% |
Saw another GP within one week of visiting the After Hours clinic (n = 45a)b
| 33 | 73% |
Went to ED within one week of visiting the After Hours clinic (n = 45)a
| 10 | 22% |
Did not anyone else within one week of visiting the After Hours clinic (n = 45) | 4 | 9% |
Would the client use the clinic again: (n = 219) | | |
Yes | 216 | 99% |
No | 3 | 1% |
Would the client recommend the clinic to someone else: (n = 219) | | |
Yes | 217 | 99% |
No | 2 | 1% |
Of the 219 participants that completed the follow-up survey, 162 (74%) provided additional comments about the service when asked. Almost all respondents gave positive comments about the BAHGPC (90%; 147), such as: “Service is very good and it's wonderful to have in town. Also relieves the Emergency Department. Think it's absolutely marvellous”, and “Absolutely excellent service! Nothing worse than having to go to Emergency when “you’re not dying”. Well-needed service in Bathurst”. Only 5 (3%) respondents gave negative comments about the service which were due to: a lack of equipment, a lack of privacy at reception with personal details being relayed to the client, a long waiting time, and being turned away from the service at 6.45 pm (when the clinic closes at 7 pm). An additional two respondents provided a negative comment about the general practitioner on call, but also said that the BAHGPC was a good service. There were 13 (8%) comments that were neither positive nor negative, for example, “Would not use the clinic again because have moved to Sydney”.
Some respondents gave recommendations for improvement which included: the clinic being open for longer hours (12), more advertising about the clinic (2), the clinic being connected to an after hours pharmacy (2), having an extra GP at the clinic to decrease waiting times (1), and more infrastructure and equipment (1).
Presentations to the bathurst base hospital emergency department
Non-urgent and semi-urgent presentations to the Bathurst ED in the two years prior to the BAHGPC opening and in the subsequent two years were compared both in terms of raw numbers and on a population basis (Table
4). There was a significant reduction in non-urgent ED presentations in the two years following the opening of the BAHGPC as compared to the two years prior (418.5 vs 245.5;
P < 0.05). There was no significant reduction in semi-urgent ED presentations in the same period. On a population basis, in the two years prior to the opening of the BAHGPC non-urgent presentations equated to 1.0% of the Bathurst population (Table
4). This dropped significantly in the two years following the opening of the clinic to 0.6% (
P < 0.05). There was no significant difference in semi-urgent ED presentations in this period on a population basis.
Table 4
Emergency Department and After Hours Clinic presentations pre and post commencement of the Clinic
Non-urgent and semi-urgent presentations | | |
Total numbers of people | | |
Non-urgent presentations (Mean ± SD) | 418.5 ± 9.19 | 245.5 ± 27.58* |
Semi-urgent presentations (Mean ± SD) | 3984.5 ± 47.38 | 3931.5 ± 81.32 |
As a percentage of the Bathurst Population** | | |
Non-urgent presentations (Mean ± SD) | 1.0 ± 0.03 | 0.6 ± 0.07* |
Semi-urgent presentations (Mean ± SD) | 9.9 ± 0.05 | 9.5 ± 0.30 |
Presentations by gender | | |
Number (percentage) of non-urgent presentations by gender | | |
Females | 359 (42.9%) | 208 (42.4%) |
Males | 478 (57.1%) | 283 (57.6%) |
Number (percentage) of after hours clinic presentations by gender*** | | |
Females | | 1205 (56.7%) |
Males | | 920 (43.2%) |
Non-urgent ED presentations in the two years prior to the opening of the after hours clinic and the two years subsequent to the opening of the clinic were stratified by gender and compared to the number of visits to the after hours clinic in the first two years of operation (Table
4). More males than females presented to the ED with non-urgent complaints during the first two years of the BAHGPC being in operation. In contrast, more females than males attended the BAHGPC in this same period. This difference in proportions was significantly different (
P < 0.05).