Community Based Urgent Care centres with an Integrated care model

Urgent Care is the episodic medical treatment of non-life-threatening illnesses or injury that do not require immediate attention in an Emergency Department (ED), but, nevertheless require medical management within 24 hours to prevent serious deterioration of health (RNZCUC, 2017).

Traditionally, Urgent Care is provided in dedicated Urgent Care Units which have access to on-site radiology and pathology diagnostics, are open longer hours than traditional primary care practices and accept patients on a walk-in basis (Ho et al., 2017; Weinick, Bristol, & DesRoches, 2009).

Successful Urgent Care Units are typically set a distance from hospitals and their associated Emergency Departments (Weinick, Burns et al. 2010).

General Practitioners (GPs), Nurse Practitioners, Urgent Care Physicians (New Zealand) and Family Physicians (USA) provide medical services in Urgent Care Units (Hider, Lay-Yee, & Davis, 2007; Weinick et al., 2009)

Benefits of Urgent Care Units

Improve Access to Care

Patients have indicated that Urgent Care Units improve access to care after-hours and offer a more convenient option to an Emergency Department for those unable to schedule a regular primary care appointment (Coster, Turner, Bradbury, & Cantrell, 2017).

Integrating primary, acute and extended care in a single setting has been shown to enhance the likelihood of patient engagement with primary care practitioners and improve efficiency and outcomes for their local population (Swerissen & Duckett, 2016)

Lower Emergency Department Presentations Rates

Auckland’s average ED presentation rate (184 per 1,000 population) is 40% lower than Australia’s (311 per 1,000 population) which is attributed to the effective provision of Urgent Care in the New Zealand capital (Clearwater, 2014).

American, English and Australian studies have indicated that between10%-43% of patients attending EDs could be handled more appropriately in Urgent Care Units (Thompson, Lasserson, McCann, Thompson, & Heneghan, 2013; Weinick, Burns, & Mehrotra, 2010; Yusuf Nagree et al., 2013).

In Australia, proportionately more of these patients are presenting to ED during normal business hours, reflecting it is not a GP shortage that driving ED presentations but a service availability (Yusuf Nagree et al., 2013).

Lower Cost of Care

Cost of care in Urgent Care Units has been estimated to be $228-$414 per occasion of service less than Emergency Departments (Weinick et al., 2010).

Urgent Care services are not currently established in Australia because:

  • There is limited scope for funding Urgent Care provided under the Medicare Benefits Scheme (MBS) (Department of Health, 2018);
  • Most primary practices do not have appropriate infrastructure to support Urgent Care services (Adie, Graham, & Wallis, 2017);
  • The majority of the medical workforce is not appropriately skilled or has been de-skilled over time and is therefore unwilling or unable to support Urgent Care (Adie et al., 2017).

Why the contribution is important

The development of commuity based urgent care centres with integration to primary care is an evidence based model that has been successfully trialed and developed overseas.

It is time for Australa to now demonstrate this a a sustainable model of care and a longterm solution

by ejones on August 12, 2019 at 12:19PM

Current Rating

3.5
Average score : 3.5
Based on : 4 votes

Comments

  • Posted by mcrice August 12, 2019 at 16:12

    So, what would it take to establish Urgent Care capability in everybody's usual general practice?
    - infrastructure investment (a dedicated space, point-of-care pathology and imaging)
    - staff investment (dedicated personnel, paid by the hour not piecework)
    - recurrent funding for consumables: dressings, casting, disposable etc

    Since Medicare won't be stepping up to this anytime soon; and the savings will be from State budgets, the answer has to be for State health services (like MSHHS and QAS) to develop viable business models.

    I'm aware of settings (not MSHHS) where State-based services have been keen to offer private businesses the "opportunity" to provide services current State-funded - on the basis "we suggest that you bulk-bill". If BB in these cases provided return on investment, it would already be happening. Given that State services are VERY fond indeed of private practice models (I'm looking at YOU the 'named referral' push) I would think they'd be able to develop a viable model quite quickly, if it were possible. I have to conclude that it's not, if Medicare is the funder.

    So what does the State bring to the table for Urgent Care?
  • Posted by kylie August 12, 2019 at 22:10

    I would suggest having it on the hospital grounds ( I believe logan does) so patients don't feel we are turning them away. but by having them not in the ED it would also help train future GP's to be more proactive and stop unnecessary admissions that linger until someone remembers to discharge them. The triage nurse could asses if pt could be referred to the GP urgent care clinic.
  • Posted by cdnurse August 16, 2019 at 13:23

    Look at the Canberra "walk in centre" model of service with Nurse Practitioners and include other clinicians - Medical officers & allied health.
Log in or register to add comments and rate ideas

Idea topics