For the February 2020 Australia’s Health Panel survey, we asked our panellists about their experience with and opinions on after-hours primary health care. Affordable and accessible after-hours services are an important part of any world-class health care system. Without these services many people, including parents and young families, the elderly including residents in aged care facilities, carers and people with terminal or chronic conditions, would face great difficulty in getting the care they need.
For this survey the AHP platform was augmented with an identical survey distributed via SurveyMonkey, with 85 responses received across the two platforms.
Respondents were from across all states and territories with the highest response rates from New South Wales (35%) and Victoria (24%). Respondents were from across metropolitan, regional and remote areas with 41% coming from major cities, 42% from inner and outer regional areas and 16% from remote and very remote locations.
67% of respondents had accessed after hours primary health care at least once in the previous five years, with the majority (58%) seeing a general practitioner (GP) and significant numbers also accessing nursing (25%) and pharmacy (35%) services.
When asked where those services had been accessed, 20% of respondents had been visited at home by a health professional and 41% had gone to the health professional’s consulting rooms. Other locations of care included hospital clinics, the local pharmacy and online or telephone services.
Respondents were accessing care right across the after-hours period, with 35% accessing care between 6pm-8pm, 43% between 8pm-11pm, 20% in the overnight period (11pm-7am) and 12% in the early morning hours (7am-8am). Respondents also noted the need for services on weekends with some GP practices open for limited hours on weekends, but this is generally an exception rather than the norm.
When asked about their expectations of when they should be able to access after-hours primary health care, most consumers expected care to be available at all times. The 6pm-8pm and 8pm-11pm windows received slightly higher response rates than the overnight and early morning periods, but all were seen as necessary by a majority of respondents. This reflects the fact that consumers are accessing after-hours care for issues that arise unexpectedly and want services to be available whenever they are needed.
Finally, we asked consumers about how easy or difficult they found it to access after-hours primary health care when they needed it. Then responses reflected the variation that exists in access to affordable after-hours primary health care services across different regions. While 24% of respondents said they found it easy to access after-hours services, 18% found it difficult and 25% found it extremely difficult to get care outside of business hours.
From the survey responses, the following themes emerged as key issues:
Availability of Services
The main theme emerging from consumers who found it difficult to access after-hours care was a lack of available services in their local area. Many respondents noted that outside of business hours if they experienced a health issue, they had no other options than to go to the local hospital emergency department.This was particularly the case for people in rural and remote areas, where consumers highlighted the loss of many services over the years and the need for more health care options in rural settings. One respondent highlighted that while in their rural area it was common for services to come and go, including home visiting doctor services. This inconsistency made it hard for consumers to know what services were available and to be able to rely on them in a time of need. A number of respondents highlighted positive experiences with late night or 24-hour pharmacies, where they could get scripts filled and also seek advice about if they needed to go to the hospital for an issue.
Transport and distance
For consumers who lived close to services, access was significantly easier than for those who had to travel a distance to access care. This is predominantly an issue in rural and remote areas where consumers are often required to travel long distances to get to the nearest service. However, this issue was also raised by respondents in metropolitan areas where consumers who are reliant on public transport found it difficult to get to local clinics or walk-in centres after-hours as affordable transport was not available at the time they needed it.
A number of respondents highlighted the difficulty they had finding an after-hours primary health care service that would bulk bill. For some consumers, the high out-of-pocket costs associated with private clinics was a barrier to care and some indicated they would choose to go to the emergency department as they were unable to afford the primary health care option. It is important the services provide information to consumers up front about the cost of accessing care through different services, and in general there is a need for more low or no cost alternatives to the emergency department in many areas.
Where consumers were aware of services that were available in their local area, long wait times were often a barrier to access. Nurse-led walk-in centres were cited by some consumers as a good accessible option with short wait times, though it was noted that they can only deal with a limited level of complexity.
Phone and online services
We received mixed feedback on the benefits and usefulness of telephone helplines and online support services. While a number of respondents highlighted ‘NURSE-ON-CALL’ and ‘healthdirect’ as examples of services they had used and found helpful, others commented that due to the level of complexity they can deal with they were most likely to be referred to the emergency department. Lack of reliable access to mobile and internet connections in rural and remote areas also limit the effectiveness of these kinds of services for people who may benefit the most from them as they offer an alternative to people who are located a long distance from the nearest health service.
Continuity of care
Consumers value the relationship they have with their health care provider and recognise the benefits that come from continuity of care with one health professional. Consumers acknowledged that it is difficult to have choice of provider in an after-hours context and therefore considered these services as a stopgap measure rather than as a regular source of care. Respondents highlighted the need for after-hours services to have clear communication channels with a patient’s regular provider to ensure they received the notes and details of an after-hours consultation. Some respondents noted that this had not occurred even though it was supposed to. Consumers were likely to contact their local GP as a first avenue if they needed care, and felt it was important for all GP clinics to provide information about alternative options for the consumer if they were not providing care at that time. It is understood that many GP clinics already do this, but it was not a universal experience for all consumers.
Awareness of existing services
Some respondents highlighted the need for more publicity of existing services to increase awareness of what is already available. This feedback is likely more reflective of consumers living in major cities where multiple service options exist. Increasing information about local services is important but should not be seen as an alternative to providing additional services where they are lacking.
Overall the survey results suggest that consumers have varying levels of access to and experiences with after-hours primary care services. After-hours services are highly valued by consumers with a strong expectation that there will be services available when they are needed. However, the reality for many consumers, particularly those in rural and remote areas, is that if they experience a health issue outside of business hours their only option is to go to the local hospital emergency department. Some respondents noted that they wanted access to an alternative service in order to take pressure off the hospital and the acute system. Consumers are willing to engage with a range of different health providers and service formats, including after hours clinics, home visiting services and online and phone support. However, respondents noted that if engagement with these services is likely to simply lead to a referral to the hospital then they see that as less useful.
The Consumers Health Forum of Australia would like to thank all panellists for kindly giving their time to participate in this survey. Any questions about this survey and its findings can be directed to firstname.lastname@example.org.