Sharing after hours care in a rural New Zealand community--a service utilization survey.

INTRODUCTION As the rural general practice workforce in New Zealand changes, after hours services are under pressure to change. This is an international problem. This article reports on an initiative in a rural New Zealand community to meet the need for after hours care. First contact for patients is with a community nursing team operating from the local health centre, complemented by on-call advice from GPs and GP clinics twice daily at weekends. OBJECTIVE To report on the demand for after hours services generated by a geographically defined community in New Zealand. METHODS DESIGN A prospective cross-sectional survey of after hours utilization over a one month period using questionnaires was completed by the full range of healthcare professionals providing care. SETTING A single geographically defined rural community of 9200 people in the North Island of New Zealand. PARTICIPANTS Rural GPs, community nurses and the ambulance service. RESULTS Only 90/204 patient contacts were seen by the GPs with the remainder being managed by the nurses or ambulance staff. Nurses referred more patients to the base hospital but overall 87% of contacts handled by the doctors and nurses were managed locally. Estimated out of hours contact rate was 320/1000 persons/year (including telephone consultations). For direct face-to-face contact the rate was 245/1000 per year: for Maori the rate was 425/1000 per year while for non-Maori the rate was 151/1000 per year. Ambulance services provided an urgent call service at the rate of 29/1000 persons per year. CONCLUSION A collaborative service providing after hours care to a rural community is described and utilization rates assessed. The model of first on-call nurse with GP back up provides a sustainable service and reduces the burden on rural doctors without reducing patient access.