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Problem Statement

Demand for urgent, non-emergency care in primary care, the community and within Middlemore Hospital continues to increase. This trend is reflected across New Zealand and has a significant impact on CM Health’s resources.

Previous research indicates that up to one-third of people seeking urgent care services within an Emergency Department could be appropriately treated within another service, for example at their general practice or at an after-hours accident and medical clinic.

There are also an increasing number of people who are admitted to hospital with conditions that could have been avoided if they had been able to access timely primary care. The reasons for this are complex and multivariate. They include the accessibility and proximity of primary care, convenience, affordability, patient knowledge, learnt behaviour, patient preferences and confidence in the service.

What are we trying to achieve?

We are trying to improve access to urgent care within the community (both within hours and after hours), and reduce avoidable Emergency Department presentations and hospital admissions. This is particularly targeted at groups who experience barriers to accessing primary care, such as Maaori, Pacific people, and those with low incomes or high health needs.

What have we done?

From 1 July 2018, we have provided free or subsidised after-hours care at eight accident and medical clinics across the district for:

  • children under 14
  • those living in quintile 5 areas
  • Community Services Card and High User Health Card holders
  • older adults aged over 65.

During this time, over 3500 clinically appropriate people have chosen to leave the Emergency Department and attend a local accident and medical clinic for non-emergency treatment, as a result of using our Emergency Q digital information tool.

We have also increased use of Primary Options for Acute Care services by Maaori and Pacific people.

Where to from here?

We will continue to improve access to and use of after-hours urgent care, particularly for Maaori, Pacific and quintile 5 people.

We will increase use of the Emergency Q digital information tool, by extending it to children and a wider number of clinics.

We will also review the current acute demand management services provided in primary care and the community from an equity perspective; considering, in particular, the objectives and logic model that underpin the current services and investment.

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