Potentially preventable hospitalisations: are they a useful marker of access to and experience of care in general practice among people with type 2 diabetes?
Jo-Anne Manski-Nankervis A C , John Furler A , Ralph Audehm A B , Irene Blackberry A and Doris Young A
+ Author Affiliations
- Author Affiliations
A General Practice and Primary Health Care Academic Centre, The University of Melbourne, 200 Berkeley Street, Carlton, Vic. 3053, Australia.
B Dianella Community Health, 35 Johnstone Street, Broadmeadows, Vic. 3047, Australia.
C Corresponding author. Email: jomn@unimelb.edu.au
Australian Journal of Primary Health 21(2) 214-220 https://doi.org/10.1071/PY13112
Submitted: 9 August 2013 Accepted: 13 January 2014 Published: 4 February 2014
Abstract
The aim of the present study was to explore access to and experience of care in general practice among patients admitted to hospital with a type 2 diabetes mellitus-related potentially preventable hospitalisation (PPH). Forty-eight patients admitted to two public hospitals in the north and west of Melbourne completed a survey and 13 patients were interviewed. Patients generally had long-standing diabetes with multimorbidity and were relatively socioeconomically disadvantaged. Nearly two-thirds reported more than one hospital admission in the prior 12 months, and 74% of respondents were able to access their preferred general practitioner (GP) on either the same or next day. Emotional support, time and continuity of care with their GP were important to patients, but they recognised many patient barriers to optimal care, including self-management and social and economic factors. Patients that accessed specialist care perceived that GPs had limited role in their disease management. Although the patients in this study experienced good access to care, they also identified several factors that were arguably outside the scope of general practice management, indicating that their admissions to hospital may not have been avoidable.
Additional keywords: continuity of care, health professional roles, multimorbidity.
References
All-Party Parliamentary Group for Diabetes (2006) Diabetes and the disadvantaged: reducing health inequalities in the UK. (Diabetes UK: London) Available at http://www.diabetes.org.uk/Documents/Reports/Diabetes_disadvantaged_Nov2006.pdf [Verified 24 January 2014]Ansari Z (2007) The concept and usefulness of ambulatory care sensitive conditions as indicators of quality and access to primary health care. Australian Journal of Primary Health 13, 91–110.
| The concept and usefulness of ambulatory care sensitive conditions as indicators of quality and access to primary health care.Crossref | GoogleScholarGoogle Scholar |
Australian Bureau of Statistics (2013) Census of population and housing: socio-economic indexes for areas (SEIFA), Australia, 2011. (Australian Bureau of Statistics: Canberra) Available at http://www.abs.gov.au/ausstats/abs@.nsf/DetailsPage/2033.0.55.0012011?OpenDocument [Verified 7 July 2013]
Australian Institute of Health and Welfare (2010) Australian hospital statistics 2008–09. Health services series no. 34. Catalogue no. HSE 84. (Australian Institute of Health and Welfare: Canberra) Available at http://www.aihw.gov.au/publications/hse/84/11173.pdf [Verified 5 February 2012]
Australian Institute of Health and Welfare (2011) National healthcare agreement: PI 22-selected potentially preventable hospitalisations. (Australian Institute of Health and Welfare: Canberra) Available at http://meteor.aihw.gov.au/content/index.phtml/itemId/421649 [Verified 27 November 2013]
Australian Institute of Health and Welfare (2013) Australian hospital statistics 2011–12. Health services series no. 50. Catalogue no. HSE 134. (Australian Institute of Health and Welfare: Canberra)
Benbassat J, Taragin M (2000) Hospital readmissions as a measure of quality of health care: advantages and limitations. Archives of Internal Medicine 160, 1074–1081.
| Hospital readmissions as a measure of quality of health care: advantages and limitations.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3c3kvVClsw%3D%3D&md5=4f8a1eaf33b5cabd45a73a651a0ad3f0CAS | 10789599PubMed |
Broom DH (2003) Familiarity breeds neglect? Unanticipated benefits of discontinuous primary care. Family Practice 20, 503–507.
| Familiarity breeds neglect? Unanticipated benefits of discontinuous primary care.Crossref | GoogleScholarGoogle Scholar | 14507788PubMed |
Cabana MD, Jee SH (2004) Does continuity of care improve patient outcomes? The Journal of Family Practice 53, 974–980.
Cambridge Centre for Health Services Research (2011) Manual for General Practice Assessment Questionnaire GPAQ V3. Available at http://www.gpaq.info/GPAQV3manual.pdf [Verified 11 June 2012]
Gonzalez JS, Peyrot M, McCarl LA, Collins EM, Serpa L, Mimiaga MJ, Safren SA (2008) Depression and diabetes treatment nonadherence: a meta-analysis. Diabetes Care 31, 2398–2403.
| Depression and diabetes treatment nonadherence: a meta-analysis.Crossref | GoogleScholarGoogle Scholar | 19033420PubMed |
Haggerty JL, Roberge D, Freeman GK, Beaulieu C (2013) Experienced continuity of care when patients see multiple clinicians: a qualitative metasummary. Annals of Family Medicine 11, 262–271.
| Experienced continuity of care when patients see multiple clinicians: a qualitative metasummary.Crossref | GoogleScholarGoogle Scholar | 23690327PubMed |
Hjortdahl P, Laerum E (1992) Continuity of care in general practice: effect on patient satisfaction. BMJ 304, 1287–1290.
| Continuity of care in general practice: effect on patient satisfaction.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK383pvVWhtQ%3D%3D&md5=085af1c7b2dbfdca7015d5a469f68a19CAS | 1606434PubMed |
James GD, Baker P, Badrick E, Mathur R, Hull S, Robson J (2012) Ethnic and social disparity in glycaemic control in type 2 diabetes; cohort study in general practice 2004–9. Journal of the Royal Society of Medicine 105, 300–308.
Johnson RB, Onwuegbuzie AJ, Turner LA (2007) Toward a definition of mixed methods research. Journal of Mixed Methods Research 1, 112–133.
| Toward a definition of mixed methods research.Crossref | GoogleScholarGoogle Scholar |
Muenchberger HEK (2008) Determinants of avoidable hospitalization in chronic disease: development of a predictor matrix. (Centre for National Research on Disability and Rehabilitation, Griffith Institute of Health and Medical Research, Griffith University: Meadowbrook, Qld)
Page A, Ambrose S, Glover J, Hetzel D (2007) Atlas of avoidable hospitalisations in Australia: ambulatory care-sensitive conditions. (Public Health Information Development Unit, University of Adelaide: Adelaide)
Plibersek T (2012) GP12: leading primary care. Royal Australian College of General Practitioners Conference. Available at http://www.health.gov.au/internet/ministers/publishing.nsf/Content/sp-yr12-tp-tpsp251012.htm [Verified 1 June 2013]
Potiriadis M, Chondros P, Gilchrist G, Hegarty K, Blashki G, Gunn JM (2008) How do Australian patients rate their general practitioner? A descriptive study using the General Practice Assessment Questionnaire. The Medical Journal of Australia 189, 215–219.
Primary Health Care Research and Information Service (2011) Division mapping tool: map of Australian divisions of general practice activities. Available at http://www.phcris.org.au/products/asd/mapping/?dataset=5#capitals [Verified 25 May 2013]
Sanmartin C, Khan S, Longitudinal Health and Administrative Data research team (2011) Hospitalizations for ambulatory care sensitive conditions (ACSC): the factors that matter. Health Research Working Paper Series. (Health Analysis Division, Statistics Canada: Ottawa)
Struijs JN, Baan CA, Schellevis FG, Westert GP, van den Bos GAM (2006) Comorbidity in patients with diabetes mellitus: impact on medical health care utilization. BMC Health Services Research 6, 84
| Comorbidity in patients with diabetes mellitus: impact on medical health care utilization.Crossref | GoogleScholarGoogle Scholar | 16820048PubMed |
Walsh ME, Katz MA, Sechrest L (2002) Unpacking cultural factors in adaptation to type 2 diabetes mellitus. Medical Care 40, I129–I139.
Weinberger M, Oddone EZ, Henderson WG (1996) Does increased access to primary care reduce hospital admission? Veterans Affairs Cooperative Study Group on Primary Care and Hospital Readmission. The New England Journal of Medicine 334, 1441–1447.
| Does increased access to primary care reduce hospital admission? Veterans Affairs Cooperative Study Group on Primary Care and Hospital Readmission.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK283hvVyhuw%3D%3D&md5=4c98fc3d65e616017d7cbf5688123b26CAS | 8618584PubMed |
World Health Organization (2010) International statistical classification of diseases and related health problems, 10th revision. Available at http://www.who.int/classifications/icd/ICD10Volume2_en_2010.pdf?ua=1 [Verified 24 January 2014]
Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica 67, 361–370.
| The hospital anxiety and depression scale.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaL3s3nvFWjug%3D%3D&md5=217a9377d2da74268863964749ad567dCAS | 6880820PubMed |
