Kristi Calder, MPH 2009
Abstract
Fundamental changes in the delivery of primary after hours care are occurring internationally. Research into the provision and utilisation of after hours services shows trends towards reduced time commitment among general practitioners and rising demand from patients for primary and emergency department after hours care. Internationally, new models of after hours care have emerged. Debate continues about defining and encouraging appropriate use of after hours services. A number of factors influence a person's decision to seek after hours care including socio-economic status, psychological factors and the perception of a condition and its seriousness. Despite this most research has focused on service utilisation and has been from the perspective of providers, little population research has been completed.
This research aims to assess the way in which people in Christchurch use after hours health care, the barriers they face and how they make their after hours health care decisions. An age stratified random sample of the population was used to select 560 adults from within Christchurch. The questionnaire was completed by 247 of the 560 adults selected (46%). Respondents were asked about their after hours care in the previous twelve months, both for themselves and for those for whom they were responsible. They were also invited to respond to questions on a after hours, health related vignette.
Eighty-seven percent of respondents felt confident that they could access after hours care if required. A small number of adults who required after hours care did not access it. The majority of respondents (62%) accessing services received care from after hours clinics. Statistically significant relationships were shown for the following results. Women use after hours care more than men (both for themselves and for those they are responsible for). Young adults (18-29 years old) faced more barriers to after hours care than adults in the older age groups and were more likely to be influenced by cost in their after hours health care decisions than older people. They were also more likely to be uncertain about which after hours provider to choose. People with a household income of above $70,000 use more after hours care for themselves and others than those with lesser household incomes.
Unlike many previous studies, this research uses a population-based methodology. This allows information to be obtained from people who need after hours care but are not accessing it. A key limitation of the study was the response rate for this research, which may have resulted in a sample too small to show a relationship between some variables when one actually exists. This study complements existing literature on accessing after hours care. Differences in results from other research may be due to methodological differences. Recommendations from this research include considering incorporating primary health services into the emergency department, making changes to the way the phone-based health information service is organised, and public education on after hours services focusing on young men, as well as building on this study by undertaking further population-based research.
Supervisors: Pauline Barnett, Phil Hider