The National Primary Medical Care Survey (NatMedCa) was undertaken to describe primary health care in New Zealand, including the characteristics of providers and their practices, the patients they see, the problems presented and the management offered. The study covered private general practices (i.e. family doctors), communitygoverned organisations, Accident and Medical (A&M) clinics and Hospital Emergency Departments. It was intended to compare data across practice types as well as overtime.
The study compares general practices and A&M centres. On average, A&M centres had more staff, particularly nursing staff. Nearly all clinics had separate management structures. They were more likely to have policies for written complaints and/or quality management policies than other practices. The distribution of urgency and severity between patients in each practice type was similar. However practitioners spent longer with the patients.Generally A&M clinics are focussed around episodic and reactive care for patients and are not aiming to establish either the continuity of care or enrolment signalled in the Primary Health Care Strategy.The writers noted some limitations with the data. Unlike the GP surveys, data was only collected for one week and there is no summer data. There is no after-hours data from orthodox general practices to allow for comparisons.
Other reports in the NatMedCa series describe private family doctors, Māori, community-governed non-profit and rural general practice provider activities and characteristics, and analyse differences in practice content that have occurred over time or that exist between practice settings.
The characteristics of participating doctors in A&M clinics differed from the wider General Practitioner population. They were younger, more likely to be of Māori or Asian ethnicity, less likely to be female and, on average, had been in practice for just over ten years. On average they saw 90 daytime patients a week, and worked 6.3 half days and saw an average of 13.7 patients per day.
Overall the distribution of A&M clinic contacts showed a marked skew to the younger age groups, and only 17% of visits were for patients 45 years or older. For those in “out of office” hours, that is outside Monday-Friday 8am to 6pm, 31% were for under fives while in “normal” office hours less than a fifth of patients who attended were in this age group.
The Accident Compensation Corporation (ACC) funds a significant number of visits, especially during normal hours.Understandably, given the nature of the practices, few patients had an established relationship with the practitioner they saw. For nearly half of the patients during “normal office hours” and two-thirds of patients during “out of office hours” the recorded visit was their first to the practice.
Most visits were associated with only one “reason for visit” and common reasons for visits were injury/poison related conditions, respiratory and non-specific symptoms. New and short-term problems accounted for 75% of visits.About a fifth of visits resulted in an investigation, and X-Rays were ordered for between one sixth and one fifth of visits depending on the time of day. About a quarter of visits during normal hours resulted in no treatment, and a further one third involved non-pharmacological treatment. A higher number of patients received pharmacological treatment in “out of office hours” and the number of items prescribed in each script was higher.