Abstract

BackgroundThe Australian government sponsored trials aimed at addressing problems in after hours primary medical care service use in five different parts of the country with different after hours care problems. The study's objective was to determine in four of the five trials where telephone triage was the sole innovation, if there was a reduction in emergency GP after hours service utilization (GP first call-out) as measured in Medicare Benefits Schedule claim data. Monthly MBS claim data in both the pre-trial and trial periods was monitored over a 3-year period in each trial area as well as in a national sample outside the trial areas (National comparator). Poisson regression analysis was used in analysis.ResultsThere was significant reduction in first call out MBS claims in three of the four study areas where stand-alone call centre services existed. These were the Statewide Call Centre in both its Metropolitan and Non-metropolitan areas in which it operated – Relative Risk (RR) = 0.87 (95% Confidence interval: 0.86 – 0.88) and 0.60 (95% CI: 0.54 – 0.68) respectively. There was also a reduction in the Regional Call Centre in the non-Metropolitan area in which it operated (RR = 0.46 (95% CI: 0.35 – 0.61) though a small increase in its Metropolitan area (RR = 1.11 (95% CI: 1.06 – 1.17). For the two telephone triage services embedded in existing organisations, there was also a significant reduction for the Deputising Service – RR = 0.62 (95% CI: 0.61 – 0.64) but no change in the Local Triage centre area.ConclusionThe four telephone triage services were associated with reduced GP MBS claims for first callout after hours care in most study areas. It is possible that other factors could be responsible for some of this reduction, for example, MBS submitted claims for after hours GP services being reclassified from 'after hours' to 'in hours'. The goals of stand-alone call centres which are aimed principally at meeting population needs rather than managing demand may be being met only in part.

Highlights

  • The Australian government sponsored trials aimed at addressing problems in after hours primary medical care service use in five different parts of the country with different after hours care problems

  • This paper reports further on the national evaluation of the After Hours Primary Medical Care Trials (AHPMCTs) which were a recent initiative of the Australian Government

  • This study presents Medicare Benefits Schedule (MBS) data from Medicare Australia bearing in mind that this data too had limitations

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Summary

Introduction

The Australian government sponsored trials aimed at addressing problems in after hours primary medical care service use in five different parts of the country with different after hours care problems. This paper reports further on the national evaluation of the After Hours Primary Medical Care Trials (AHPMCTs) which were a recent initiative of the Australian Government. The goals of these trials were to improve the quality of service delivery as well as consumer acceptability, consumer access (including affordability) and equity, appropriateness of service mix, provider satisfaction with regard to their impact on service mix as well as service use more generally [1]. Telephone triage and advice services have an important place in the development of after hours care in other countries. In some areas of England and Wales, NHS Direct is commissioned by local Primary Care Trusts (PCTs) to provide the gateway for out-of-hours access to GP's surgeries and clinics. [3]

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