title: Sharing after hours care in a rural New Zealand community--a service utilization survey.
abstract: BACKGROUND
  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
  
  
  
  METHODS
  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.
  
  
  METHODS
  A single geographically defined rural community of 9200 people in the North Island of New Zealand.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Church Street Surgery Opotiki, Opotiki, New Zealand. drjo@opotikigp.co.nz
authors.forename: Joseph
authors.initials: J
authors.lastname: Scott-Jones
authors.forename: Ross
authors.initials: R
authors.lastname: Lawrenson
authors.forename: Nina
authors.initials: N
authors.lastname: Maxwell
mesh_terms: D000328:Adult; D039602:After-Hours Care / Q000458:organization & administration*; D000368:Aged; D003159:Community-Institutional Relations; D003430:Cross-Sectional Studies; D005194:Family Practice / Q000458:organization & administration*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D010043:Outcome and Process Assessment, Health Care; D010818:Practice Patterns, Physicians' / Q000458:organization & administration; D011446:Prospective Studies; D019035:Rural Health Services / Q000706:statistics & numerical data*; D012424:Rural Population / Q000706:statistics & numerical data*