Abstract
Growth in emergency department (ED) attendance and acute medical admissions has been managed to very low rates for 18 years in Canterbury, New Zealand, using a combination of community and hospital avoidance strategies. This paper describes the specific strategies that supported management of acutely unwell patients in the community as part of a programme to integrate health services. Community-based acute care was established by a culture of close collaboration and trust between all sectors of the health system, with general practice closely involved in the design and management of the services, and support provided by hospital specialists, coordination and diagnostic units, and competent informatics. Introduction of the community-based services was aided by a clinical guidance website and an education programme for general practice teams and allied health professionals. Attendance at EDs and acute medical admission rates have been held at low growth and, in some cases, shorter lengths of hospital stay. This trend was especially evident in elderly patients and those with ambulatory care sensitive or chronic disorders. A system of community-based care and education has resulted in sustained gains for the Canterbury health system and freed-up hospital resources. This outcome has engendered a sense of empowerment for general practice teams and their patients.
Highlights
Growth in emergency department (ED) attendance and acute medical admissions has been managed to very low rates for 18 years in Canterbury, New Zealand, using a combination of community and hospital avoidance strategies
This system was introduced with the purpose of reducing acute ED attendances, paediatric admissions, and adult medical admissions to hospitals by increasing access to community-based services provided by extended general practice teams
The foundation required to develop these services was established by health care reforms that occurred in New Zealand in the mid 1990s, one of which was the formation of independent practitioner associations (IPAs) by groups of general practices
Summary
Increases in attendance at Emergency Departments (EDs) and acute admissions impact adversely on the quality of care, delay elective surgical procedures, and expose patients unnecessarily to the risks of hospital admission (New Zealand Health Technology Assessment, 1998; Purdy and Huntley, 2013). This paper provides an overview of the development and impact of an Acute Demand Management Service (ADMS) in the Canterbury region of New Zealand This system was introduced with the purpose of reducing acute ED attendances, paediatric admissions, and adult medical admissions to hospitals by increasing access to community-based services provided by extended general practice teams. It was recognised that the range of skills of general practice teams were being under-utilised and that the issue of acute medical admission growth could be alleviated, in part, from a primary care base Drawing together these themes, the ADMS was developed to increase the availability of care for acutely unwell people in their own homes (Timmins and Ham, 2013; Charles, 2013; Gullery and Hamilton, 2015; Pegasus Health, 2017). The following sections describe the impact of the ADMS and discuss the principles and strategies used to develop the programme
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