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Thank you for the opportunity to reply to a critique of our recent paper in the Journal by Dr Gray.1Dr Gray believes that the conclusion of our systematic review2 is flawed due to the source studies for the review spanning the length and breadth of New Zealand over almost 50 years. We take the alternative view that as the studies are remarkably consistent regardless of era and location, the conclusion is more robust not less.From our review it was clear that the cost of primary care is a factor for only a small minority of patients presenting to New Zealand's emergency departments (EDs). Subsequent to the completion of our study the Ministry of Health published the results of a survey of current ED use among 12,000 adults and 4000 caregivers of children in 2011/12. The results mirrored our review findings exactly: only "One in 40 adults used an emergency department because of cost".3We agree with Dr Gray that the ED is not a good place to provide primary care. EDs in New Zealand provide acute medical and surgical care, not primary care. The vast majority of patients presenting to EDs in New Zealand are not primary care patients which is why reducing cost barriers to primary care is unlikely to lead to a reduction of acute demand (ED presentations), at least in the short term.Whether improved access to primary care leads to reduced acute demand in the long term is a different question altogether and one deserving of further research.Peter G Jones Emergency Medicine Specialist Adult Emergency Department, Auckland City Hospital Auckland, New Zealand peterj@adhb.govt.nzVanessa Thornton Emergency Medicine Specialist Emergency Department, Middlemore Hospital Auckland, New Zealand

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Acknowledgements

Correspondence

Correspondence Email

Competing Interests

Gray B. Emergency departments cost and primary care [letter]. N Z Med J. 2014;127(1388). http://journal.nzma.org.nz/journal/127-1388/5974/content.pdfJones PG, Thornton V. Does cost drive primary care patients to New Zealands emergency departments? A systematic review. N Z Med J. 2014;126(1387). http://journal.nzma.org.nz/journal/126-1387/5941/content.pdfNew Zealand Ministry of Health. Emergency Department Use 2011/12: Key findings of the New Zealand Health Survey. Wellington: Ministry of Health; 2013.http://www.health.govt.nz/system/files/documents/publications/emergency-department-use-2011-12-sept13.pdf

For the PDF of this article,
contact nzmj@nzma.org.nz

View Article PDF

Thank you for the opportunity to reply to a critique of our recent paper in the Journal by Dr Gray.1Dr Gray believes that the conclusion of our systematic review2 is flawed due to the source studies for the review spanning the length and breadth of New Zealand over almost 50 years. We take the alternative view that as the studies are remarkably consistent regardless of era and location, the conclusion is more robust not less.From our review it was clear that the cost of primary care is a factor for only a small minority of patients presenting to New Zealand's emergency departments (EDs). Subsequent to the completion of our study the Ministry of Health published the results of a survey of current ED use among 12,000 adults and 4000 caregivers of children in 2011/12. The results mirrored our review findings exactly: only "One in 40 adults used an emergency department because of cost".3We agree with Dr Gray that the ED is not a good place to provide primary care. EDs in New Zealand provide acute medical and surgical care, not primary care. The vast majority of patients presenting to EDs in New Zealand are not primary care patients which is why reducing cost barriers to primary care is unlikely to lead to a reduction of acute demand (ED presentations), at least in the short term.Whether improved access to primary care leads to reduced acute demand in the long term is a different question altogether and one deserving of further research.Peter G Jones Emergency Medicine Specialist Adult Emergency Department, Auckland City Hospital Auckland, New Zealand peterj@adhb.govt.nzVanessa Thornton Emergency Medicine Specialist Emergency Department, Middlemore Hospital Auckland, New Zealand

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Acknowledgements

Correspondence

Correspondence Email

Competing Interests

Gray B. Emergency departments cost and primary care [letter]. N Z Med J. 2014;127(1388). http://journal.nzma.org.nz/journal/127-1388/5974/content.pdfJones PG, Thornton V. Does cost drive primary care patients to New Zealands emergency departments? A systematic review. N Z Med J. 2014;126(1387). http://journal.nzma.org.nz/journal/126-1387/5941/content.pdfNew Zealand Ministry of Health. Emergency Department Use 2011/12: Key findings of the New Zealand Health Survey. Wellington: Ministry of Health; 2013.http://www.health.govt.nz/system/files/documents/publications/emergency-department-use-2011-12-sept13.pdf

For the PDF of this article,
contact nzmj@nzma.org.nz

View Article PDF

Thank you for the opportunity to reply to a critique of our recent paper in the Journal by Dr Gray.1Dr Gray believes that the conclusion of our systematic review2 is flawed due to the source studies for the review spanning the length and breadth of New Zealand over almost 50 years. We take the alternative view that as the studies are remarkably consistent regardless of era and location, the conclusion is more robust not less.From our review it was clear that the cost of primary care is a factor for only a small minority of patients presenting to New Zealand's emergency departments (EDs). Subsequent to the completion of our study the Ministry of Health published the results of a survey of current ED use among 12,000 adults and 4000 caregivers of children in 2011/12. The results mirrored our review findings exactly: only "One in 40 adults used an emergency department because of cost".3We agree with Dr Gray that the ED is not a good place to provide primary care. EDs in New Zealand provide acute medical and surgical care, not primary care. The vast majority of patients presenting to EDs in New Zealand are not primary care patients which is why reducing cost barriers to primary care is unlikely to lead to a reduction of acute demand (ED presentations), at least in the short term.Whether improved access to primary care leads to reduced acute demand in the long term is a different question altogether and one deserving of further research.Peter G Jones Emergency Medicine Specialist Adult Emergency Department, Auckland City Hospital Auckland, New Zealand peterj@adhb.govt.nzVanessa Thornton Emergency Medicine Specialist Emergency Department, Middlemore Hospital Auckland, New Zealand

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Acknowledgements

Correspondence

Correspondence Email

Competing Interests

Gray B. Emergency departments cost and primary care [letter]. N Z Med J. 2014;127(1388). http://journal.nzma.org.nz/journal/127-1388/5974/content.pdfJones PG, Thornton V. Does cost drive primary care patients to New Zealands emergency departments? A systematic review. N Z Med J. 2014;126(1387). http://journal.nzma.org.nz/journal/126-1387/5941/content.pdfNew Zealand Ministry of Health. Emergency Department Use 2011/12: Key findings of the New Zealand Health Survey. Wellington: Ministry of Health; 2013.http://www.health.govt.nz/system/files/documents/publications/emergency-department-use-2011-12-sept13.pdf

Contact diana@nzma.org.nz
for the PDF of this article

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