General practitioner follow-up after hospitalisation in Central and Eastern Sydney, Australia: access and impact on health services
Margo Linn Barr
A E , Heidi Welberry A , John Hall B , Elizabeth J. Comino A , Elizabeth Harris A , Ben F. Harris-Roxas A , Tony Jackson C , Debra Donnelly D and Mark Fort Harris A
+ Author Affiliations
- Author Affiliations
A Centre for Primary Health Care and Equity, Faculty of Medicine, Level 3, AGSM Building, UNSW, Sydney, NSW 2052, Australia. Email: h.welberry@unsw.edu.au; e.comino@unsw.edu.au; e.harris@unsw.edu.au; b.harris-roxas@unsw.edu.au; m.f.harris@unsw.edu.au
B Faculty of Medicine, Wallace Wurth Building, 18 High Street, UNSW, Sydney, NSW 2052, Australia. Email: john.hall@unsw.edu.au
C South Eastern Sydney Local Health District, NSW Health, District Executive Unit, Locked Mail Bag 21, Tarren Point, NSW 2229, Australia. Email: tony.jackson@health.nsw.gov.au
D Sydney Local Health District, NSW Health, Level 11, KGV Building, Missenden Road, Camperdown, NSW 2050, Australia. Email: debra.donnelly@health.nsw.gov.au
E Corresponding author. Email: margo.barr@unsw.edu.au
Australian Health Review 45(2) 247-254 https://doi.org/10.1071/AH19285
Submitted: 12 December 2019 Accepted: 2 June 2020 Published: 22 October 2020
Journal Compilation © AHHA 2021 Open Access CC BY-NC-ND
Abstract
Objectives General practitioner (GP) follow-up after a hospital admission is an important indicator of integrated care. We examined the characteristics of patients who saw a GP within 2 weeks of hospital discharge in the Central and Eastern Sydney (CES) region, Australia, and the relationship between GP follow-up and subsequent hospitalisation.
Methods This data linkage study used a cohort of 10 240 people from the 45 and Up Study who resided in CES and experienced an overnight hospitalisation in the 5 years following recruitment (2007–14). Characteristics of participants who saw a GP within 2 weeks of discharge were compared with those who did not using generalised linear models. Time to subsequent hospitalisation was compared for the two groups using Cox proportional hazards regression models stratified by prior frequency of GP use.
Results Within 2 weeks of discharge, 64.3% participants saw a GP. Seeing a GP within 2 weeks of discharge was associated with lower rates of rehospitalisation for infrequent GP users (i.e. <8 visits in year before the index hospitalisation; hazard ratio (HR) 0.83; 95% confidence interval (CI) 0.70–0.97) but not frequent GP users (i.e. ≥8 plus visits; HR 1.02; 95% CI 0.90–1.17).
Conclusion The effect of seeing a GP on subsequent hospitalisation was protective but differed depending on patient care needs.
What is known about the topic? There is general consensus among healthcare providers that primary care is a significant source of ongoing health care provision.
What does this paper add? This study explored the relationship between GP follow-up after an uncomplicated hospitalisation and its effect on rehospitalisation.
What are the implications for practitioners? Discharge planning and the transfer of care from hospital to GP through discharge arrangements have substantial benefits for both patients and the health system.
References
[1] Braithwaite J, Hibbert P, Blakely B, Plumb J, Hannaford N, Long JC, Marks D. Health system frameworks and performance indicators in eight countries: a comparative international analysis. SAGE Open Med 2017; 5 2050312116686516| Health system frameworks and performance indicators in eight countries: a comparative international analysis.Crossref | GoogleScholarGoogle Scholar | 28228948PubMed |
[2] Australian Commission on Safety and Quality in Health Care (ACSQHC). National safety and quality health service standards. 2nd edn. Sydney: ACSQHC; 2017.
[3] Australian Medical Association. General practice/hospitals transfer of care arrangements. 2013; Available at: https://ama.com.au/system/tdf/documents/AMA_position_statement_general_practice_and_hospitals_transfer_of_care_arrangements_final.pdf?file=1&type=node&id=40603 [verified 1 September 2018].
[4] NSW Ministry of Health. Policy directive. Care coordination: planning from admission to transfer of care in NSW public hospitals. PD2011_015; 2011. Available at: https://www1.health.nsw.gov.au/pds/ActivePDSDocuments/PD2011_015.pdf [verified 22 September 2020].
[5] Howlett JG, McKelvie RS, Costigan J, Ducharme A, Estrella-Holder E, Ezekowitz JA, Giannetti N, Haddad H, Heckman GA, Herd AM, Isaac D, Kouz S, Leblanc K, Liu P, Mann E, Moe GW, O’Meara E, Rajda M, Siu S, Stolee P, Swiggum E, Zeiroth S. The 2010 Canadian Cardiovascular Society guidelines for the diagnosis and management of heart failure update: heart failure in ethnic minority populations, heart failure and pregnancy, disease management, and quality improvement/assurance programs. Can J Cardiol 2010; 26 185–202.
| The 2010 Canadian Cardiovascular Society guidelines for the diagnosis and management of heart failure update: heart failure in ethnic minority populations, heart failure and pregnancy, disease management, and quality improvement/assurance programs.Crossref | GoogleScholarGoogle Scholar | 20386768PubMed |
[6] Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WH, Tsai EJ, Wilkoff BL. ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2013; 128 e240–327.
| ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.Crossref | GoogleScholarGoogle Scholar | 23741058PubMed |
[7] Tran CTT, Lee DS, Flintoft VF, Higginson L, Grant FC, Tu JV, Cox J, Holder D, Jackevicius C, Pilote L, Tanser P, Thompson C, Tsoi E, Warnica W, Wielgosz A, Canadian Cardiovascular Outcomes Research Team/Canadian Cardiovascular Society Acute Myocardial Infarction Quality Indicator Panel CCORT/CCS quality indicators for acute myocardial infarction care. Can J Cardiol 2003; 19 38–45.
[8] National Heart Foundation of Australia, Cardiac Society of Australia and New Zealand. Guidelines for the prevention, detection and management of chronic heart failure in Australia. 2011; Available at: https://www.csanz.edu.au/documents/guidelines/clinical_practice/2011_HF_CSANZ_Chronic_Heart_Failure.pdf [verified 25 September 2018].
[9] Cohen MD, Hilligoss PB. The published literature on handoffs in hospitals: deficiencies identified in an extensive review. Qual Saf Health Care 2010; 19 493–7.
| The published literature on handoffs in hospitals: deficiencies identified in an extensive review.Crossref | GoogleScholarGoogle Scholar | 20378628PubMed |
[10] Vedsted P, Christensen MB. Frequent attenders in general practice care: a literature review with special reference to methodological considerations. Public Health 2005; 119 118–37.
| Frequent attenders in general practice care: a literature review with special reference to methodological considerations.Crossref | GoogleScholarGoogle Scholar | 15694959PubMed |
[11] Byrne M, Murphy AW, Plunkett PK, McGee HM, Murray A, Bury G. Frequent attenders to an emergency department: a study of primary health care use, medical profile, and psychosocial characteristics. Ann Emerg Med 2003; 41 309–18.
| Frequent attenders to an emergency department: a study of primary health care use, medical profile, and psychosocial characteristics.Crossref | GoogleScholarGoogle Scholar | 12605196PubMed |
[12] Scott IA. Preventing the rebound: improving care transition in hospital discharge processes. Aust Health Rev 2010; 34 445–51.
| Preventing the rebound: improving care transition in hospital discharge processes.Crossref | GoogleScholarGoogle Scholar | 21108906PubMed |
[13] Hansen LO, Young RS, Hinami K, Leung A, Williams MV. Interventions to reduce 30-day rehospitalization: a systematic review. Ann Intern Med 2011; 155 520–8.
| Interventions to reduce 30-day rehospitalization: a systematic review.Crossref | GoogleScholarGoogle Scholar | 22007045PubMed |
[14] Jackson C, Shahsahebi M, Wedlake T, DuBard CA. Timeliness of outpatient follow-up: an evidence-based approach for planning after hospital discharge. Ann Fam Med 2015; 13 115–22.
| Timeliness of outpatient follow-up: an evidence-based approach for planning after hospital discharge.Crossref | GoogleScholarGoogle Scholar | 25755032PubMed |
[15] Shen E, Koyama SY, Huynh DN, Watson HL, Mittman B, Kanter MH, Nguyen HQ. Association of a dedicated post-hospital discharge follow-up visit and 30-day re-admission risk in a Medicare Advantage population. JAMA Intern Med. 2017; 177 132–5.
| Association of a dedicated post-hospital discharge follow-up visit and 30-day re-admission risk in a Medicare Advantage population.Crossref | GoogleScholarGoogle Scholar | 27893040PubMed |
[16] Comino EJ, Harris E, Page J, McDonald J, Harris MF. The 45 and Up Study: a tool for local population health and health service planning to improve integration of healthcare. Public Health Res Pract 2016; 26 e2631629
| The 45 and Up Study: a tool for local population health and health service planning to improve integration of healthcare.Crossref | GoogleScholarGoogle Scholar | 27421341PubMed |
[17] 45 and Up Study Collaborators Cohort profile: the 45 and Up Study. Int J Epidemiol 2008; 37 941–7.
| Cohort profile: the 45 and Up Study.Crossref | GoogleScholarGoogle Scholar | 17881411PubMed |
[18] NSW Ministry of Health. Centre for Health Record Linkage. Data Dictionaries: NSW Admitted Patient Data Collection 2018; Available at: https://www.cherel.org.au/data-dictionaries#section1 / [verified 1 September 2018].
[19] Australian Government Department of Human Services. Medicare Benefits Schedule book, Publications number: 11720. 2017; Available at: http://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/CF1350417910EAE6CA25817D0015AF5B/$File/201709-MBS.pdf [verified 1 September 2018].
[20] Griffin BA, Ridgeway G, Morral AR, Burgette LF, Martin C, Almirall D, Ramchand R, Jaycox LH, McCaffrey DF. Toolkit for Weighting and Analysis of Nonequivalent Groups (TWANG) Website. Santa Monica, CA: RAND Corporation, 2014. Available at: http://www.rand.org/statistics/twang
[21] R Core Team. (2019). R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. URL Available at: https://www.R-project.org/.
[22] Funk MJ, Westreich D, Wiesen C, Stürmer T, Brookhart MA, Davidian M. Doubly robust estimation of causal effects. Am J Epidemiol 2011; 173 761–7.
| Doubly robust estimation of causal effects.Crossref | GoogleScholarGoogle Scholar | 21385832PubMed |
[23] National Centre for Classification in Health (NCCH). The international statistical classification of diseases and related health problems, 10th Revision, Australian modification (ICD-10-AM). Australian Coding Standards. Sydney: NCCH; 2006.
[24] Roughead EE, Kalisch LM, Ramsay EN, Ryan P, Gilbert AL. Continuity of care: when do patients visit community healthcare providers after leaving hospital? Intern Med J 2011; 41 662–7.
| Continuity of care: when do patients visit community healthcare providers after leaving hospital?Crossref | GoogleScholarGoogle Scholar | 19849749PubMed |
[25] Watson B, Tam CW, Pellizzon B, Ban L, Doan H. General practitioner follow-up in older patients after an emergency department admission. Aust Fam Physician 2017; 46 521–6.
| 28697297PubMed |
[26] Qureshi R, Asha SE, Zahra M, Howell S. Factors associated with failure to follow up with a general practitioner after discharge from the emergency department. Emerg Med Australas 2012; 24 604–9.
| Factors associated with failure to follow up with a general practitioner after discharge from the emergency department.Crossref | GoogleScholarGoogle Scholar | 23216720PubMed |
[27] Silverstein MD, Qin H, Mercer SQ, Fong J, Haydar Z. Risk factors for 30-day hospital re-admission in patients ≥65 years of age. Proc Bayl Univ Med Cent 2008; 21 363–72.
| Risk factors for 30-day hospital re-admission in patients ≥65 years of age.Crossref | GoogleScholarGoogle Scholar | 18982076PubMed |
[28] Considine J, Fox K, Plunkett D, Mecner M, O’Reilly M, Darzins P. Factors associated with unplanned re-admissions in a major Australian health service. Aust Health Rev 2019; 43 1–9.
| Factors associated with unplanned re-admissions in a major Australian health service.Crossref | GoogleScholarGoogle Scholar | 29092726PubMed |
[29] Field TS, Ogarek J, Garber L, Reed G, Gurwitz JH. Association of early post-discharge follow-up by a primary care physician and 30-day rehospitalization among older adults. J Gen Intern Med 2015; 30 565–71.
| Association of early post-discharge follow-up by a primary care physician and 30-day rehospitalization among older adults.Crossref | GoogleScholarGoogle Scholar | 25451987PubMed |
[30] Tooth L, Hockey R, Byles J, Dobson A. Weighted multimorbidity indexes predicted mortality, health service use, and health-related quality of life in older women. J Clin Epidemiol 2008; 61 151–9.
| Weighted multimorbidity indexes predicted mortality, health service use, and health-related quality of life in older women.Crossref | GoogleScholarGoogle Scholar | 18177788PubMed |
[31] Cresswell A, Hart M, Suchanek O, Young T, Leaver L, Hibbs H.. Mind the gap: improving discharge communication between secondary and primary care. BMJ Quality Improvement Reports 2015; 4 u207936.w3197
| Mind the gap: improving discharge communication between secondary and primary care.Crossref | GoogleScholarGoogle Scholar | 26734391PubMed |
[32] Schwarz CM, Hoffmann M, Schwarz P, Kamolz L-P, Brunner G, Sendlhofer G. A systematic literature review and narrative synthesis on the risks of medical discharge letters for patients’ safety. BMC Health Serv Res 2019; 19 158
| A systematic literature review and narrative synthesis on the risks of medical discharge letters for patients’ safety.Crossref | GoogleScholarGoogle Scholar | 30866908PubMed |
[33] Mealing NM, Banks E, Jorm LR, Steel DG, Clements MS, Rogers KD. Investigation of relative risk estimates from studies of the same population with contrasting response rates and designs. BMC Med Res Methodol 2010; 10 26
| Investigation of relative risk estimates from studies of the same population with contrasting response rates and designs.Crossref | GoogleScholarGoogle Scholar | 20356408PubMed |
[34] Wellson L (au.), Sweet M (ed.) An important overview of the pros, cons and questions about My Health Record. Croakey 6 June, 2018. Available at https://croakey.org/an-important-overview-of-the-pros-cons-and-questions-about-my-health-record/ [verified 18 February 2019].
