Why patients attend after-hours medical services: a cross-sectional survey of patients across the Australian Capital Territory.

BACKGROUND: Almost half of Australian after-hours emergency department (ED) presentations are rated as 'non-urgent' by clinicians and are suggested to be managed by community-based services, such as general practice (GP). This paper reports patient reasons for presenting for medical care after hours, and reasons for selection of specific services across a health system. METHODS: A cross-sectional survey was conducted across the Australian Capital Territory. Patients voluntarily completed questionnaires in waiting rooms during the after-hours periods of one weekday and one weekend in 2019 at 28/51 extended hours GPs, 3/3 medical deputising services (MDS), 3/3 nurse-led walk-in-clinics (WICs), and 2/2 public emergency departments (EDs). RESULTS: Of 3371 presentations, 1992 patients completed a survey, with 58% from GPs (n =1149), 16% from WIC (n =317), 10% from MDS (n =193), and 17% from EDs (n =333). Most patients presented with self-rated new issues (n =987, 49.5%) and were uncertain of the urgency of their issues (n =723, 36.7%). Common reasons for presenting to WIC, MDS, and EDs included the problem occurring after hours, and patients concern about the issue. Common reasons for presenting to GP were related to personal preference for after-hours care. CONCLUSIONS: Patients present to after-hours medical services for both perceived need and convenience. Most patients appear to be self-selecting after-hours services appropriately aligned with advertised services; except for GP patients who were attending after hours for care that is often non-urgent and could be seen in usual working hours. This study should be replicated to account for local health systems, and coronavirus disease 2019 (COVID-19)-related changes to health care.

After-hours presentations to community-based primary care in the Australian Capital Territory.

This study describes patient characteristics and presentations to community-based primary care medical services in the after-hours period. A cross-sectional survey completed by practitioners was voluntarily conducted over one weeknight and weekend in 2019 at 31 of 51 extended hours general practices (GP), three of three medical deputising services and three of three nurse-led walk-in clinics (WICs). Of 3371 community-based after-hours presentations, 934 consultation records were obtained (overall response: 28%). Emergency departments reported 524 triage code 4 and 5 patients within the study period. Problems managed in community-based after-hours services were most often rated as non-urgent (n = 482; 51.6%) and new (n = 606; 64.9%). The most common community-based after-hours presentations were diagnostic or disease related (e.g. infections or injury; n = 667; 59.5%). The most common body systems impacted were respiratory (n = 329; 29.6%), skin (n = 164; 16.4%) and general/unspecified (e.g. fever; n = 164; 16.4%). Community-based after-hours services reported different types of presentations, with medical deputising services reporting more urgent presentations, GPs reporting more procedural presentations and walk-in clinics reporting more skin-related issues (e.g. wound care). Community-based after-hours medical services contribute significantly to after-hours medical care in the ACT. Patients are self-selecting community-based after-hours medical services appropriately based on problems managed by practitioners.

Faith-based cognitive behavioral therapy: easing depression in the elderly with cognitive decline.

Minimizing depression in residential aged care facilities is a formidable challenge but doing so may improve quality of life and protect against dementia. A pilot project with residents with cognitive decline and concurrent depression tested the suitability of a faith-based cognitive behavioral therapy (CBT) intervention in reducing participant levels of depression, offering promising results.

A case against generalisation of mental health occupational therapy in Australia.

BACKGROUND/AIM: In 2009, the World Federation of Occupational Therapists International Advisory Group on Mental Health conducted a global survey that yielded data on mental health occupational therapy practice. The Australian dataset reflected aspects of the current situation of the Australian mental health occupational therapy workforce. Of particular interest were resource availability, workforce recruitment and retention, and perception of the future of mental health occupational therapy. METHODOLOGY: Using a cross-sectional survey design, quantitative and qualitative data were gathered electronically over a one-month period. Manual analysis indicated themes common to mental health occupational therapists across a framework of professional areas. RESULTS: Findings suggested that role blurring negatively affected workforce retention. Workforce recruitment and retention were complicated by resource shortages. Some Federal Government initiatives were perceived as only partially beneficial to the profession. CONCLUSIONS: Survey respondents believed that mental health occupational therapy was a potential growth area particularly where occupational therapy specific skills were retained.

A response to patient-initiated aggression in general practice: Australian professional medical organisations face a challenge.

Little is known about the incidence, prevalence, and impact of patient-initiated aggression against general practice staff in Australia or how medically related professional organisations respond to this. The few available Australian studies suggest that up to about two-thirds of Australian GPs experience patient-initiated aggression within a 12-month period. This paper reports on relevant professional stakeholder organisations' perceptions of and response to aggression perpetrated against their members working in Australian general practices. Thirteen organisations each nominated a representative to undertake a one-off semi-structured interview. Respondents informed the study findings from organisational, practice level, and Divisions of General Practice perspectives. While all professional organisations were cognisant of the presence of violence and aggression in Australian general practice, very few offered proactive measures in the management of difficult or aggressive patients, or practical support to their members. Organisations with fewer members involved in general practice were overall more supportive and proactive with regard to education, training, and publications than were organisations with a greater proportion of their membership involved in general practice settings. Respondents believed the current socio-political climate provided opportunity for a greater organisational response, but there was uncertainty regarding the appropriate response in view of a lack of evidence base.