Practitioners, patients, and their visits: a description of accident and medical (A&M) clinics in New Zealand, 2001/2.

Abstract

Aims The National Primary Medical Care survey was undertaken to describe primary health care in New Zealand, including the characteristics of accident and medical (A&M) clinic providers, their practices, the patients they see, the problems presented, and the management offered. Methods Data were collected from a 50% random sample of all A&M clinics in New Zealand as part of the National Primary Medical Care survey carried out in 2001/2. Results Data were obtained from 12 A&M clinics throughout New Zealand between usual hours (Monday–Friday 8am–6pm) and at other times. A&M clinics were staffed by an average of 2.7 full-time equivalent (FTE) A&M practitioners . Most clinics operated as a limited liability company. The majority of A&M practitioners were male and aged between 35–44 years. On average, A&M doctors had been in practice for over 10 years and had been in the sampled practice for only 2.9 years. More than a third of doctors had not trained in New Zealand. The doctors worked, on average, 6.3 half days and saw nearly 90 patients per week. The findings suggest that young patients and a diverse ethnic range attend A&M practices. Community Services Card holders were not usual patients. Few patients had an ongoing relationship with the practices. Most visits related to a single, new, and short-term problem that was often an injury or a respiratory illness. About a fifth of visits were associated with an order for an investigation or an X-ray, fewer investigations were arranged outside usual hours. About half the visits resulted in a prescription but more visits outside normal hours received pharmacological treatment and the number of items was higher. The most frequently prescribed items were antibiotics and analgesics. Follow-up was arranged for between a third to a half of visits, depending on the time of day. Referrals were often made to non-medical destinations. While patient and visit characteristics were generally similar regardless of whether the visit occurred during usual working hours or at other times, some differences were apparent in the type of problems that were presented out of hours and their management. Conclusions The main impression is that the medical A&M clinics provide episodic treatment for relatively young patients mainly related to a new, short-term problem, particularly an injury or a respiratory illness. This picture is consistent with previous research and the role of similar clinics overseas. Further work is needed to compare A&M clinics with established general practice in relation to the services that are provided as well as the acceptability and quality of these services.