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Unmet need for referred services as measured by general practice
Resource type
Authors/contributors
- McGeoch, Graham (Author)
- Holland, Kieran (Author)
- Kerdemelidis, Melissa (Author)
- Elliot, Nikki (Author)
- Shand, Brett (Author)
- Fink, Catherine (Author)
- Dixon, Anne (Author)
- Gullery, Carolyn (Author)
Title
Unmet need for referred services as measured by general practice
Abstract
INTRODUCTION Unmet needs are a key indicator of the success of a health system. Clinicians and funders in Christchurch, Canterbury, New Zealand were concerned that unmet health need was hidden. AIM The aim of this survey was to estimate the proportion of patients attending general practice who were unable to access clinically indicated referred services. METHODS The survey used a novel method to estimate unserviced health needs. General practitioners (GPs, n = 54) asked their patients (n = 2135) during a consultation about any health needs requiring a referred service. If both agreed that a service was potentially beneficial and not available, this was documented on an e-referral system for review. The outcomes of actual referrals were also reviewed. RESULTS The patient group was broadly representative of the Canterbury population, but over-sampled female and middle-aged people and under-sampled Māori. Data adjusted to regional demographics showed that 3.6% of patients had a GP-confirmed unserviced health need. Elective orthopaedic surgery, general surgery and mental health were areas of greatest need. Unserviced health needs were significantly (P ≤ 0.05) associated with greater deprivation, middle-age, and receiving high health-use subsidies. DISCUSSION To our knowledge, this is the first survey of GP and patient agreement on unserviced referred health needs. Measuring unserviced health needs in this way is directly relevant to service planning because the gaps identified reflect clinically indicated services that patients want and need. The survey method is an improvement on declined referral rates as a measure of need. Key factors in the method were using a patient-initiated GP consultation and an e-referral system to collect data.
Publication
Journal of Primary Health Care
Date
Dec 2017
Volume
9
Issue
4
Pages
269-278
Journal Abbr
J Prim Health Care
DOI
PMID
29530138
ISSN
1172-6156
Language
en
Library Catalog
PubMed
Notes
Study topic: Estimating the proportion of general practice patients in Canterbury, New Zealand, who had clinically indicated but unavailable referred health service needs.
Study type: Cross-sectional survey with follow-up and referral review
Key findings
- After adjusting for regional demographics, 3.6% of patients attending general practice had a clinically indicated referred service need that was not met.
- This unmet need equates to approximately 19,000 people in Canterbury who were unable to access services they needed.
- The most common areas of unmet need were elective orthopaedic surgery, general surgery, and mental health services.
- Patients in the highest deprivation quintile had a 7.8% rate of unmet need, indicating a strong link between socioeconomic status and access to care.
- Patients with a High Use Health Card had a 17.7% rate of unmet need, and those enrolled in Care Plus had a 10% rate, showing that those with higher health needs were disproportionately affected.
- The study introduced a novel method for identifying unmet need based on GP–patient agreement during routine consultations, supported by an electronic referral system.
- Relevance to HealthPathways: The study was embedded in the broader Canterbury Initiative, which included HealthPathways. It demonstrates how general practice data—including referral constraints—can inform service planning and better align with pathway development.
Citation
McGeoch, G., Holland, K., Kerdemelidis, M., Elliot, N., Shand, B., Fink, C., Dixon, A., & Gullery, C. (2017). Unmet need for referred services as measured by general practice. Journal of Primary Health Care, 9(4), 269–278. https://doi.org/10.1071/HC17044
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