Low-acuity emergency department presentation characteristics and their association with Medicare-subsidised general practitioner services across New South Wales: A data linkage study

Objectives: Identify clinical and demographic characteristics of low-acuity presentations (LAPs) to the ED and analyse correlations between population rates of LAPs to ED and rates of Medicare-subsidised general practitioner (GP) services across statistical areas.

Methods: Retrospective data linkage study using state-wide ED data and publicly available data on GP services per population by statistical area. We performed multilevel logistic regression to determine predictors of LAP at an individual level after adjusting for remoteness categories and performed correlations between rates of LAP and GP services per population across statistical areas in New South Wales, Australia. The primary outcome was the rate of LAPs to ED, LAPs being defined as patients who self-presented to ED, assigned an Australasian Triage Score of 4 or 5 and subsequently discharged from ED.

Results: There were 2.9 million ED presentations in 2021, of which 39.9% presentations were classified as LAP. LAPs were associated with younger age, routine care, eyes, ear, nose and throat and musculoskeletal presentations. The rate of LAPs was higher in non-metropolitan areas. Additionally, 85% of LAPs were seen and discharged from ED within 4 h. There was an inverse correlation between the rate of Medicare-subsidised GP services and the rate of total ED or LAPs in non-metropolitan areas (ρ = -0.47, ρ = -056 and P = 0.012, P = 0.001, respectively). In metropolitan areas, correlations were either positive for all ED presentations (ρ = +0.41, P = 0.007) or not significant for LAPs (ρ = +0.18, P = 0.57).

Conclusions: A relationship between LAPs to ED and Medicare-subsidised GP episodes of care exists for non-metropolitan but not metropolitan areas.