Primary health care-based programmes targeting potentially avoidable hospitalisations in vulnerable groups with chronic disease

Reductions in potentially avoidable hospitalisations (PAHs) and emergency department (ED) presentations are important health care policy benchmarks and represent potential for improved health outcomes, efficiency and cost savings. This research aimed to examine the outcomes of interventions targeting reductions in PAHs and/or avoidable ED presentations among people with chronic disease. The main focus was on the role of primary health care and programmes that targeted specific vulnerable populations, including Indigenous Australians, rural and remote residents and those living in socioeconomic disadvantage.

Key findings

Trends in PAH and ED presentation rates

* PAH rates are high, but mostly stable for chronic and acute conditions in the general population, but they have increased for vaccine-preventable conditions
* PAHs are higher in vulnerable populations (Indigenous Australians, rural/remote residents, socioeconomically disadvantaged, elderly)
* Chronic diseases account for more than half of all PAHs, particularly chronic obstructive pulmonary disease
* Despite widespread implementation of chronic disease management programmes, there is no statistically significant reduction in the rates of PAH and ED presentation.

Overview of programmes to reduce PAHs and ED presentations
* Key predictors of PAHs, ED presentations and readmissions include: older age, low socioeconomic status, ethnicity, rurality, comorbidities, mental illness and substance use and being widowed or separated
* Elements of successful programmes are largely context- and condition-specific as PAH rates vary according to different chronic conditions and disease severity; therefore, flexibility in approaches is needed

Primary health care-based interventions that showed significant reductions in rates of PAH and ED presentations included:
* Continuity of GP care (condition-dependent)
* GP management plan with team care arrangement (e.g., diabetes)
* Multidisciplinary team care, with gerontologist and integrated social care for the elderly; and with care coordinators to liaise with GPs, hospital and other services
* Comprehensive, flexible vertical and horizontal integration of primary health care with hospital and community-based services
* Home care for socioeconomically disadvantaged and the elderly
* For Indigenous Australians, evidence was highly variable and condition-specific, often related to multiple disadvantage (remoteness, advanced illness, low socioeconomic status and poor health literacy). Programmes that are culturally appropriate and integrated across sectors are more likely to reduce PAHs
* For rural/remote residents, flexible design and implementation to address problems of access and social isolation are more effective
* Cost of accessing care, multimorbidity and low literacy are key barriers for in low socioeconomic situations
* Flexible, individualised approaches, nurse coordinator involvement and interventions that involve integration across primary health care, acute and community care may influence the rates of PAH.

For more detail see the Summary and the Full report

No comments: