Hospital emergency departments (EDs) in Australia are under increasing demand1 leading to overcrowding in EDs. To manage demand, it may be more efficient (and more effective) for care to be delivered in the most local and least complex health service setting that is also appropriate to the patient. For example, many problems can be dealt with in a general practitioner’s (GP’s) surgery rather than in a hospital, while many more serious injuries and conditions require hospital care.
In order to take steps to encourage the most appropriate use of health care services, it is first necessary to understand to what degree patients who could be treated by a GP are attending hospitals, and in which hospitals there are unusually high rates of patients who could have been managed by a GP.
This report by the National Health Performance Authority (the Authority) focuses on two areas of the health system where an increase in demand for services is perceived to exist – EDs and GPs.
Primary Health Networks (PHNs) were established on 1 July 2015 to increase the efficiency and effectiveness of medical services for patients, particularly those at risk of poor health outcomes. They are also intended to improve coordination of care to ensure patients “receive the right care in the right place at the right time”.2
The information in this report crosses both the primary health care and hospital sectors. It aims to provide information that can be used by local health planners in PHNs and Local Hospital Networks (LHNs) to enhance collaboration, and to instigate or continue meaningful discussions about appropriate health service usage. This should help with planning and delivery of appropriate local health services in each area.
The report is structured in two parts. The first looks at results from advanced statistical analyses of the Australian Bureau of Statistics (ABS) 2013–14 Patient Experience Survey and provides new insights into key factors associated with ED attendances.
The second part of the report presents information on GP and ED attendances for easy comparison so that variation and patterns in the use of these two types of services in local areas can be seen.
Key findings: Factors that affect emergency department attendances
The first part of the report identifies factors associated with ED attendance using responses to the Australian Bureau of Statistics 2013–14 Patient Experience Survey.
The report found that Australians who have a long-term health condition are more likely to visit an ED, and the more conditions people have, the more likely they will visit an ED. Whether someone has a long-term health condition is the strongest driver of ED attendance, stronger than the influence of age, geography and experiences with primary health care the Authority was able to measure.
People with three or more long-term health conditions were almost three times more likely to visit an ED compared to those who reported no long-term health conditions. People with one or two long-term health conditions were 1.5 or two times more likely to visit an ED respectively. These findings were true irrespective of a person’s age, sex, whether they lived in major cities, regional or rural communities or their experiences in accessing primary care.
People who reported delaying or not seeing a GP due to cost in the preceding 12 months were 1.3 times more likely to visit an ED than those who saw a GP when needed, after accounting for other factors such as number of long-term health conditions, geography and age.
Other key drivers of the likelihood that a person visited an ED in the past year were a person’s age and where they lived. After accounting for other factors such as number of long-term health conditions, older people (60 years and over) were less likely to visit an ED compared to younger people (15–24 years). People living in outer regional, remote and very remote regions of Australia were around twice as likely to visit an ED compared to those living in major cities and those who live in inner regional areas were 1.5 times more likely to visit an ED.
More information about these findings can be found in the ‘Key findings: Factors that affect emergency department attendances’ section.
Measures by geography: Use of emergency department and GP services in capital cities
The second part of the report uses maps to show GP and ED attendances side by side for local areas in each capital city across Australia (Measures by geography).
The maps can be used to identify areas for health system improvements and to support population health planning and service integration.
Information on the number of GP and ED attendances is reported at small geographic areas called Statistical Areas Level 3 (SA3s) with PHN boundaries overlaid.
The results have been mapped according to the time of day under two categories:
- In-hours – Monday to Friday on or after 8am and before 8pm, and Saturdays on or after 8am and before 1pm
- After-hours – Monday to Friday before 8am and on or after 8pm; Saturdays before 8am and on or after 1pm; all day on Sundays and public holidays.
For this report, ED attendances are defined as those in which the patient presented to a public hospital ED and was:
- Assigned a triage category of 3 (urgent), 4 (semi-urgent) or 5 (non-urgent)
- Not subsequently admitted to hospital
- Identified by health professionals as being an ‘emergency presentation’ type of visit (as opposed to pre-arranged or return attendances).
Planned ED presentations for diagnostic tests or other treatments are excluded from this report.
It is known that access to after-hours GP services varies across Australia and it is thought that the time of day at which services are required may play a role in a patient’s choice to use a particular health service. Therefore, in this report, in-hours GP attendances and ED attendances are each considered separately from after-hours GP attendances and ED attendances to highlight patterns of service use occurring at particular times of day.
No judgement should be inferred from this report regarding higher or lower rates of GP or ED attendances. The information is best interpreted in the local context, taking into account the health services available and knowledge of the local population and their needs.
1. He J, Hou X-y, Patrick JR and FitzGerald G. Demand for hospital emergency departments: a conceptual understanding. World J Emerg Med 2011;2:253–61.
2. Australian Government Department of Health. Primary Health Networks [Internet]. Canberra: Commonwealth of Australia; 2015 [cited 2016 March 15]. Available from: http://www.health.gov.au/internet/main/publishing.nsf/Content/PHN-BackgroundExternal link, opens in a new window.