Exploring the associative relationship between general practice engagement and hospitalisation in older carers to potentially reduce hospital burden
Anthony Azer A * , Margo Barr A , George Azer B and Ben Harris-Roxas CA
B
C
Abstract
Caregiving is an essential yet often overlooked component of health care. Although carers play a pivotal role in reducing healthcare costs and improving patient outcomes, they are also prone to psychological and physical burdens that can lead to their own hospitalisation. This study aimed to explore the relationship between the frequency of interactions with general practitioners and hospitalisation rates among caregivers aged ≥45 years in New South Wales, Australia.
This cohort study retrospectively identified participants from the Sax Institute’s 45 and Up Study in New South Wales, linked with national datasets. The cohort comprised 26,004 individuals aged ≥45 years who were caregivers. The primary outcome was hospitalisation within a 7-year period, and the intervention was whether the patient was a high or low general practice (GP) user, ascertained by determining if the average number of annual GP visits was above or below 11, respectively. Data analysis included descriptive statistics and Poisson regression models.
The study found a statistically significant association between high GP use and reduced rates of hospitalisation among caregivers. Caregivers with frequent GP interactions had a relative risk of hospitalisation of 0.514 (95% CI: 0.479–0.550) compared with their counterparts who infrequently used GP services. This association remained significant, even after adjusting for various demographic and health-related factors with an adjusted relative risk of 0.619 (95% CI: 0.554–0.690).
The findings underscore the potential of primary care interventions in reducing hospitalisations among caregivers, in turn providing economic and societal benefits. They also highlight the need for future research to understand the specific aspects of GP interactions that contribute to this protective effect.
Keywords: aged, caregiver burden, caregivers, general practice, health burden, hospitalisation, middle aged, preventative medicine.
Reference
Adelman RD, Tmanova LL, Delgado D, Dion S, Lachs MS (2014) Caregiver burden: a clinical review. JAMA 311(10), 1052-1060.
| Crossref | Google Scholar | PubMed |
Arno PS, Levine C, Memmott MM (1999) The economic value of informal caregiving. Health Affairs 18(2), 182-188.
| Crossref | Google Scholar | PubMed |
Australian Bureau of Statistics (2018) Disability, ageing and carers, Australia: summary of findings. (ABS Website) Available at https://www.abs.gov.au/statistics/health/disability/disability-ageing-and-carers-australia-summary-findings/latest-release
Australian Institute of Health and Welfare (2023) Older Australians. AIHW, Canberra. Available at https://www.aihw.gov.au/reports/older-people/older-australians [accessed 20 March 2023]
Banks E, Redman S, Jorm L, Armstrong B, Bauman A, Beard J, Beral V, Byles J, Corbett S, Cumming R, Harris M, Sitas F, Smith W, Taylor L, Wutzke S, Lujic S (2008) Cohort profile: the 45 and up study. International Journal of Epidemiology 37(5), 941-947.
| Crossref | Google Scholar | PubMed |
Barbosa A, Figueiredo D, Sousa L, Demain S (2011) Coping with the caregiving role: differences between primary and secondary caregivers of dependent elderly people. Aging & Mental Health 15(4), 490-499.
| Crossref | Google Scholar | PubMed |
Bastawrous M (2013) Caregiver burden—a critical discussion. International Journal of Nursing Studies 50(3), 431-441.
| Crossref | Google Scholar | PubMed |
Bauer JM, Sousa-Poza A (2015) Impacts of informal caregiving on caregiver employment, health, and family. Journal of Population Ageing 8, 113-145.
| Crossref | Google Scholar |
Bazemore A, Petterson S, Peterson LE, Bruno R, Chung Y, Phillips RL, Jr (2018) Higher primary care physician continuity is associated with lower costs and hospitalizations. The Annals of Family Medicine 16(6), 492-497.
| Crossref | Google Scholar | PubMed |
Bevans M, Sternberg EM (2012) Caregiving burden, stress, and health effects among family caregivers of adult cancer patients. JAMA 307(4), 398-403.
| Crossref | Google Scholar | PubMed |
Bittman M, Hill T, Thomson C (2007) The impact of caring on informal carers’ employment, income and earnings: a longitudinal approach. Australian Journal of Social Issues 42(2), 255-272.
| Crossref | Google Scholar |
Bleicher K, Summerhayes R, Baynes S, Swarbrick M, Navin Cristina T, Luc H, Dawson G, Cowle A, Dolja-Gore X, McNamara M (2023) Cohort profile update: the 45 and up study. International Journal of Epidemiology 52(1), e92-e101.
| Crossref | Google Scholar | PubMed |
Carduff E, Jarvis A, Highet G, Finucane A, Kendall M, Harrison N, Greenacre J, Murray SA (2016) Piloting a new approach in primary care to identify, assess and support carers of people with terminal illnesses: a feasibility study. BMC Family Practice 17, 18.
| Crossref | Google Scholar |
CHeReL (2023) Centre for health record linkage (CHeReL). Available at https://www.cherel.org.au/
Chi N-C, Demiris G (2015) A systematic review of telehealth tools and interventions to support family caregivers. Journal of Telemedicine and Telecare 21(1), 37-44.
| Crossref | Google Scholar | PubMed |
Clark RG, Barr M (2018) A blended link approach to relative risk regression. Statistical Methods in Medical Research 27(11), 3325-3339.
| Crossref | Google Scholar | PubMed |
Cohen CA, Colantonio A, Vernich L (2002) Positive aspects of caregiving: rounding out the caregiver experience. International Journal of Geriatric Psychiatry 17(2), 184-188.
| Crossref | Google Scholar | PubMed |
Corey K, McCurry M, Sethares K, Bourbonniere M, Hirschman K, Meghani S (2018) Predictors of psychological distress and sleep quality in former family caregivers of people with dementia. Innovation in Aging 2(1), 851-852.
| Crossref | Google Scholar |
Cronin M, McGilloway S (2023) Supporting family carers in Ireland: the role of the general practitioner. Irish Journal of Medical Science (1971-) 192(2), 951-961.
| Crossref | Google Scholar |
Cummins RA (2010) Subjective wellbeing, homeostatically protected mood and depression: a synthesis. Journal of Happiness Studies 11, 1-17.
| Crossref | Google Scholar |
Department of Health and Aged Care (2023) Keeping australians out of hospital initiative. Australian Government. Available at https://www.health.gov.au/our-work/keeping-australians-out-of-hospital-initiative [accessed 20 March 2023]
Edwards B, Zmijewski N, Gray M, Kingston M (2008) The nature and impact of caring for family members with a disability in Australia. Australian Institute of Family Studies. https://aifs.gov.au/sites/default/files/publication-documents/rr16_0.pdf
Einarsdóttir K, Preen DB, Emery JD, Kelman C, Holman CDJ (2010) Regular primary care lowers hospitalisation risk and mortality in seniors with chronic respiratory diseases. Journal of General Internal Medicine 25, 766-773.
| Crossref | Google Scholar | PubMed |
Etters L, Goodall D, Harrison BE (2008) Caregiver burden among dementia patient caregivers: a review of the literature. Journal of the American Academy of Nurse Practitioners 20(8), 423-428.
| Crossref | Google Scholar | PubMed |
Farmer RE, Kounali D, Walker AS, Savović J, Richards A, May MT, Ford D (2018) Application of causal inference methods in the analyses of randomised controlled trials: a systematic review. Trials 19, 23.
| Crossref | Google Scholar | PubMed |
George ES, Kecmanovic M, Meade T, Kolt GS (2020) Psychological distress among carers and the moderating effects of social support. BMC Psychiatry 20, 154.
| Crossref | Google Scholar | PubMed |
Gordon J, Britt H, Miller GC, Henderson J, Scott A, Harrison C (2022) General practice statistics in Australia: pushing a round peg into a square hole. International Journal of Environmental Research and Public Health 19(4), 1912.
| Google Scholar |
Haley WE, Roth DL, Sheehan OC, Rhodes JD, Huang J, Blinka MD, Howard VJ (2020) Effects of transitions to family caregiving on well-being: a longitudinal population-based study. Journal of the American Geriatrics Society 68(12), 2839-2846.
| Crossref | Google Scholar | PubMed |
Hansen AH, Halvorsen PA, Aaraas IJ, Førde OH (2013) Continuity of GP care is related to reduced specialist healthcare use: a cross-sectional survey. British Journal of General Practice 63(612), e482-e489.
| Crossref | Google Scholar |
Hariton E, Locascio JJ (2018) Randomised controlled trials – the gold standard for effectiveness research: study design: randomised controlled trials. BJOG: An International Journal of Obstetrics & Gynaecology 125(13), 1716.
| Crossref | Google Scholar | PubMed |
Harris-Roxas B, Kabir A, Kearns R, Webster G, Woodland L, Barr M (2023) Characteristics and Health Service Use of a Longitudinal Cohort of Carers Aged over 45 in Central and Eastern Sydney, Australia. Health & Social Care in the Community 2023, 5032583.
| Crossref | Google Scholar |
Hill P, Thomson C, Cass B (2011) The costs of caring and the living standards of carers. Department of Families, Housing, Community Services and Indigenous Affairs. Available at https://library.bsl.org.au/jspui/bitstream/1/2608/1/The%20costs%20of%20caring%20and%20the%20living%20standards%20of%20carers.pdf [accessed 20 March 2023]
Hoffmann RL, Mitchell AM (1998) Caregiver burden: historical development. Nursing Forum 33(4), 5-11.
| Crossref | Google Scholar | PubMed |
Hussain R, Wark S, Dillon G, Ryan P (2016) Self-reported physical and mental health of Australian carers: a cross-sectional study. BMJ Open 6(9), e011417.
| Crossref | Google Scholar | PubMed |
Jiwa M, Gerrish K, Gibson A, Scott H (2002) Preventing avoidable hospital admission of older people. British Journal of Community Nursing 7(8), 426-431.
| Crossref | Google Scholar | PubMed |
Kenny P, King MT, Hall J (2014) The physical functioning and mental health of informal carers: evidence of care-giving impacts from an Australian population-based cohort. Health & Social Care in the Community 22, 646-659.
| Crossref | Google Scholar | PubMed |
Langa KM (2009) S3-01-05: Informal caregiving for older adults with dementia: economic and health implications. Alzheimer’s & Dementia 5, P119.
| Google Scholar |
Mitchell SE, Laurens V, Weigel GM, Hirschman KB, Scott AM, Nguyen HQ, Howard JM, Laird L, Levine C, Davis TC, Gass B, Shaid E, Li J, Williams MV, Jack BW (2018) Care transitions from patient and caregiver perspectives. The Annals of Family Medicine 16(3), 225-231.
| Crossref | Google Scholar | PubMed |
Mohanty I, Niyonsenga T (2019) A longitudinal analysis of mental and general health status of informal carers in Australia. BMC Public Health 19, 1436.
| Crossref | Google Scholar |
Peters M, Rand S, Fitzpatrick R (2020) Enhancing primary care support for informal carers: A scoping study with professional stakeholders. Health and Social Care in the Community 28, 642-650.
| Crossref | Google Scholar | PubMed |
Pristavec T (2019) The burden and benefits of caregiving: a latent class analysis. The Gerontologist 59(6), 1078-1091.
| Crossref | Google Scholar | PubMed |
Productivity Commission (2011) Caring for older Australians. Australian Government Productivity Commission, Canberra. Available at https://www.pc.gov.au/inquiries/completed/aged-care/report/aged-care-volume1.pdf
Raina P, O’Donnell M, Schwellnus H, Rosenbaum P, King G, Brehaut J, Russell D, Swinton M, King S, Wong M, Walter SD, Wood E (2004) Caregiving process and caregiver burden: conceptual models to guide research and practice. BMC Pediatrics 4, 1.
| Crossref | Google Scholar | PubMed |
Rodakowski J, Rocco PB, Ortiz M, Folb B, Schulz R, Morton SC, Leathers SC, Hu L, James AE (2017) Caregiver integration during discharge planning for older adults to reduce resource use: a metaanalysis. Journal of the American Geriatrics Society 65, 1748-1755.
| Crossref | Google Scholar | PubMed |
Sankey CB, McAvay G, Siner JM, Barsky CL, Chaudhry SI (2016) “Deterioration to door time”: an exploratory analysis of delays in escalation of care for hospitalized patients. Journal of General Internal Medicine 31, 895-900.
| Crossref | Google Scholar | PubMed |
Sawicki OA, Mueller A, Klaaßen-Mielke R, Glushan A, Gerlach FM, Beyer M, Wensing M, Karimova K (2021) Strong and sustainable primary healthcare is associated with a lower risk of hospitalization in high risk patients. Scientific Reports 11, 4349.
| Crossref | Google Scholar | PubMed |
Schulz R, Beach SR (1999) Caregiving as a risk factor for mortality: the caregiver health effects study. JAMA 282(23), 2215-2219.
| Crossref | Google Scholar | PubMed |
Schulz R, Sherwood PR (2008) Physical and mental health effects of family caregiving. Journal of Social Work Education 44(sup3), 105-113.
| Crossref | Google Scholar |
Shahid R, Shoker M, Chu LM, Frehlick R, Ward H, Pahwa P (2022) Impact of low health literacy on patients’ health outcomes: a multicenter cohort study. BMC Health Services Research 22, 1148.
| Crossref | Google Scholar | PubMed |
Sherman DW (2019) A review of the complex role of family caregivers as health team members and second-order patients. Healthcare 7(2), 63.
| Crossref | Google Scholar | PubMed |
Sisk RJ (2000) Caregiver burden and health promotion. International Journal of Nursing Studies 37(1), 37-43.
| Crossref | Google Scholar | PubMed |
Stacey AF, Gill TK, Price K, Taylor AW (2018) Differences in risk factors and chronic conditions between informal (family) carers and non-carers using a population-based cross-sectional survey in South Australia. BMJ Open 8(7), e020173.
| Crossref | Google Scholar | PubMed |
Steverson M (2022) Ageing and Health. Available at https://www.who.int/news-room/fact-sheets/detail/ageing-and-health [accessed 20 March 2023]
The Office of the Ryoal Commission (2019) Carers of older australians (background paper 6). Available at https://agedcare.royalcommission.gov.au/sites/default/files/2019-12/background-paper-6.pdf
Thomson C, Broady T, Hamilton M, Jops P, Katz I (2014–2019) Review of the NSW Carers Strategy. UNSW Social Policy Research Centre. Available at https://dcj.nsw.gov.au/documents/community-inclusion/carers/nsw-carers-strategy/sprc-report-of-the-review-of-the-nsw-carers-strategy-2014-2019.pdf
Wangler J, Jansky M (2021) Support, needs and expectations of family caregivers regarding general practitioners – results from an online survey. BMC Family Practice 22, 47.
| Crossref | Google Scholar | PubMed |
Weissman JS, Stern R, Fielding SL, Epstein AM (1991) Delayed access to health care: risk factors, reasons, and consequences. Annals of Internal Medicine 114(4), 325-331.
| Crossref | Google Scholar | PubMed |
Welberry H, Barr ML, Comino EJ, Harris-Roxas BF, Harris E, Harris MF (2019) Increasing use of general practice management and team care arrangements over time in New South Wales, Australia. Australian Journal of Primary Health 25(2), 168-175.
| Crossref | Google Scholar | PubMed |
Yang S, Zhou M, Liao J, Ding X, Hu N, Kuang L (2022) Association between primary care utilization and emergency room or hospital inpatient services utilization among the middle-aged and elderly in a self-referral system: evidence from the china health and retirement longitudinal study 2011–2018. International Journal of Environmental Research and Public Health 19(19), 12979.
| Crossref | Google Scholar |