Evaluation of A&M, HML Telephone Triage, and St John Transport Initiatives: Evaluation Research commissioned under the ‘Researching the Better, Sooner, More Convenient Primary Health Care initiative’

Abstract

Two initiatives sponsored by the Greater Auckland Integrated Health Network (GAIHN) aim to reduce barriers of access to after-hours and urgent medical care in the community. One of these initiatives, the After-Hours (AH) Initiative was developed and implemented by the Auckland Region After-hours Network (ARAHN). ARAHN consists of 11 Accident and Medical (A&M) centres, 3 District Health Boards (DHBs), and 7 Primary Health Organisations (PHOs). These ARAHN organisations collectively fund two interventions in the Auckland region that were introduced on 5 September 2011. The first of these is the Accident and Medical (A&M) intervention. This covers: • Subsidisation of patient co-payments for medical visits to 11 A&M medical clinics across the Auckland region for eligible patients (under 6s, 65 and over, holders of Community Services and/or High User Health Cards; residents of low-income areas). • Extension of opening hours of some of these participating A&Ms to 10pm. The second ARAHN-sponsored intervention is the HML telephone triage (HML TT) intervention. This initiative involved the expansion of access to an after-hours telephone triage service offered by HomeCare Medical Limited (HML), a company owned by Auckland’s largest PHO, ProCare. A closely related initiative developed under the GAIHN business plan aims to reduce the number of patients transported to hospital emergency departments (EDs) by St John Ambulance services who can be safely managed in the community. Under the St John Transport (SJT) initiative, which commenced in December 2011, the co-payment for all patients attending specific A&M clinics (the 11in the ARAHN network plus 4 others) is met by POAC (Primary Options for Acute Care), an organisation funded by DHBs. This document reports on the evaluation research of these initiatives led by the University of Auckland. The research was funded by the Health Research Council, in partnership with the Ministry of Health, under the dedicated stream of funding for evaluation of local initiatives that are consistent with the government’s Better, Sooner, More Convenient (BSMC) policy framework for primary health care. The After-Hours and St John Transport initiatives align with the original BSMC objectives, which include: • The provision of a wider range of health services in primary care settings more responsive to community needs • Reducing acute demand on publicly-funded hospital services This evaluation also builds on a previous evaluation of the After-Hours initiative that was commissioned and funded by ARAHN, and which was published in April 2013 (Tenbensel et al 2013). Our report focuses on the implementation and impacts of the two initiatives. The report addresses five overarching evaluation questions: 1. How effective is each initiative in meeting its primary objectives? 2. How effective are the processes of implementation? 3. What are the key factors that determine effectiveness of each initiative? 4. What other intended and unintended outcomes of the initiatives are there for funders, providers, patients and other stakeholders? 5. How can the initiatives be adapted and improved to be more effective and cost-effective in achieving primary objectives, while minimising adverse consequences? The first four questions are addressed in turn for the A&M intervention, the HML TT intervention and the SJT initiative. The fifth question is addressed in the conclusion of this executive summary, and more fully in the conclusion of Section 1 of this report. Our research team adopted a mixed-methods approach to address these evaluation research questions. This approach combines utilisation analysis, economic modelling, analysis of patient surveys, and interpretation of qualitative data from patients, frontline staff and key informants. We gathered a large range of service utilisation data to build a picture answer the question ‘what changed?’ Other sources of data allowed us to answer how and why the desired changes did or did not eventuate.