scholarly journals Association between continuity of provider-adjusted regularity of general practitioner contact and unplanned diabetes-related hospitalisation: a data linkage study in New South Wales, Australia, using the 45 and Up Study cohort

BMJ Open ◽  
2019 ◽  
Vol 9 (6) ◽  
pp. e027158 ◽  
Author(s):  
Rachael E Moorin ◽  
David Youens ◽  
David B Preen ◽  
Mark Harris ◽  
Cameron M Wright
Keyword(s):  
General Practitioner ◽  
New South ◽  
New South Wales ◽  
Self Report ◽  
Lower Probability ◽  
Study Cohort ◽  
Inverse Association ◽  
South Wales ◽  
Related Hospitalisation ◽  
Bed Days

ObjectiveTo assess the association between continuity of provider-adjusted regularity of general practitioner (GP) contact and unplanned diabetes-related hospitalisation or emergency department (ED) presentation.DesignCross-sectional study.SettingIndividual-level linked self-report and administrative health service data from New South Wales, Australia.Participants27 409 survey respondents aged ≥45 years with a prior history of diabetes and at least three GP contacts between 1 July 2009 and 30 June 2015.Main outcome measuresUnplanned diabetes-related hospitalisations or ED presentations, associated costs and bed days.ResultsTwenty-one per cent of respondents had an unplanned diabetes-related hospitalisation or ED presentation. Increasing regularity of GP contact was associated with a lower probability of hospitalisation or ED presentation (19.9% for highest quintile, 23.5% for the lowest quintile). Conditional on having an event, there was a small decrease in the number of hospitalisations or ED presentations for the low (−6%) and moderate regularity quintiles (−8%), a reduction in bed days (ranging from −30 to −44%) and a reduction in average cost of between −23% and −41%, all relative to the lowest quintile. When probability of diabetes-related hospitalisation or ED presentation was included, only the inverse association with cost remained significant (mean of $A3798 to $A6350 less per individual, compared with the lowest regularity quintile). Importantly, continuity of provider did not significantly modify the effect of GP regularity for any outcome.ConclusionsHigher regularity of GP contact—that is more evenly dispersed, not necessarily more frequent care—has the potential to reduce secondary healthcare costs and, conditional on having an event, the time spent in hospital, irrespective of continuity of provider. These findings argue for the advocacy of regular care, as distinct from solely continuity of provider, when designing policy and financial incentives for GP-led primary care.

Comparison of four methods for estimating actual radiotherapy utilisation using the 45 and Up Study cohort in New South Wales, Australia

2019 ◽  
Vol 131 ◽  
pp. 14-20 ◽  
Author(s):  
Mei Ling Yap ◽  
Dianne L. O'Connell ◽  
David Goldsbury ◽  
Marianne Weber ◽  
Michael Barton
Keyword(s):  
New South ◽  
New South Wales ◽  
Study Cohort ◽  
South Wales

scholarly journals Time protective effect of contact with a general practitioner and its association with diabetes-related hospitalisations: a cohort study using the 45 and Up Study data in Australia

BMJ Open ◽  
2020 ◽  
Vol 10 (4) ◽  
pp. e032790
Author(s):  
Ninh Thi Ha ◽  
Mark Harris ◽  
David Preen ◽  
Rachael Moorin
Keyword(s):  
Cohort Study ◽  
General Practitioner ◽  
Protective Effect ◽  
Negative Binomial ◽  
Baseline Period ◽  
Study Data ◽  
Self Report ◽  
Study Cohort ◽  
Related Hospitalisation ◽  
Different Levels

ObjectivesTo evaluate the relationship between the proportion of time under the potentially protective effect of a general practitioner (GP) captured using the Cover Index and diabetes-related hospitalisation and length of stay (LOS).DesignAn observational cohort study over two 3-year time periods (2009/2010–2011/2012 as the baseline and 2012/2013–2014/2015 as the follow-up).SettingLinked self-report and administrative health service data at individual level from the 45 and Up Study in New South Wales, Australia.ParticipantsA total of 21 965 individuals aged 45 years and older identified with diabetes before July 2009 were included in this study.Main outcome measuresDiabetes-related hospitalisation, unplanned diabetes-related hospitalisation and LOS of diabetes-related hospitalisation and unplanned diabetes-related hospitalisation.MethodsThe average annual GP cover index over a 3-year period was calculated using information obtained from Australian Medicare and hospitalisation. The effect of exposure to different levels of the cover on the main outcomes was estimated using negative binomial models weighted for inverse probability of treatment weight to control for observed covariate imbalance at the baseline period.ResultsPerfect GP cover was observed among 53% of people with diabetes in the study cohort. Compared with perfect level of GP cover, having lower levels of GP cover including high (incidence rate ratio (IRR) 2.8, 95% CI 2.6 to 3.0), medium (IRR 3.2, 95% CI 2.7 to 3.8) and low (IRR 3.1, 95% CI 2.0 to 4.9) were significantly associated with higher number of diabetes-related hospitalisation. Similar association was observed between the different levels of GP cover and other outcomes including LOS for diabetes-related hospitalisation, unplanned diabetes-related hospitalisation and LOS for unplanned diabetes-related hospitalisation.ConclusionsMeasuring longitudinal continuity in terms of time under cover of GP care may offer opportunities to optimise the performance of primary healthcare and reduce secondary care costs in the management of diabetes.

scholarly journals Projecting subacute inpatient activity in New South Wales

2009 ◽  
Vol 33 (4) ◽  
pp. 601 ◽  
Author(s):  
Andrew Gibbs ◽  
James E Pearse ◽  
Neill Jones ◽  
Jennifer A Sheehan ◽  
Kathleen T Meleady ◽  
...  
Keyword(s):  
Time Series ◽  
Palliative Care ◽  
Data Quality ◽  
New South ◽  
Local Level ◽  
New South Wales ◽  
Linear Regression Equation ◽  
South Wales ◽  
Bed Days ◽  
Ongoing Monitoring

We describe the development of a method for estimating and modelling future demand for sub- and non-acute inpatient activity across New South Wales, Australia to 2016. A time series linear regression equation was used, which is consistent with projection models found in the literature. Results of the modelling indicated an increase in rehabilitation, palliative care and maintenance episodes and bed-days. Projections for other categories of care are problematic due to smaller levels of activity and data quality issues. This project indicated a need for ongoing monitoring of type-changing by facilities and management of data quality. Local planners will need to consider a range of factors when considering the applicability activity projections at a local level, particularly within the specific age and clinical groupings.

scholarly journals Association between continuity of provider-adjusted regularity of general practitioner (GP) contact and diabetes-related hospitalisation: A data linkage study combining survey and administrative data

2019 ◽  
Vol 4 (3) ◽  
Author(s):  
Rachael Moorin ◽  
David Youens ◽  
David Preen ◽  
Mark Harris ◽  
Cameron Wright
Keyword(s):  
General Practitioner ◽  
Policy Development ◽  
Financial Incentives ◽  
Linear Models ◽  
Negative Binomial ◽  
Lower Probability ◽  
Cross Sectional ◽  
Related Hospitalisation ◽  
Bed Days ◽  
Higher Regularity

Background and rationale We have previously reported decreased rates and costs of diabetes-related hospitalisations with increasing regularity of general practitioner (GP) contact. However previous work has not adjusted for continuity of provider. Thus, despite the relevance for policy development, whether increased regularity is actually a proxy for, or a consequence of, increasing continuity of provider, or is a discrete facet of continuity of care is unknown. Main Aim To assess the association between continuity of provider-adjusted regularity of GP contact and unplanned diabetes-related hospitalisation or emergency department (ED) presentation. Methods/Approach This retrospective, cross-sectional study used linked administrative (from the Centre for Health Record Linkage & the Department of Human Services) and survey data from the baseline 45 and Up Study (2006-09 n=267,153) with a history of diabetes and at least two GP contacts (n=27,409). Multivariable zero-inflated negative binomial and two part generalised linear models were used to asses unplanned diabetes-related hospitalisations or ED presentations, associated costs and cumulative bed days. Results Highest regularity of GP contact was associated with a lower probability (-0.28) of diabetes-related hospitalisation or ED presentations. For those with a previous hospitalisation or ED presentation, higher regularity was associated with a reduction in the number of hospitalisations or ED presentations (6 to 8%); bed days (30 to 44%); and average cost (23 to 41%). Importantly, continuity of provider did not significantly modify the effect of GP regularity for any outcome. Conclusion Higher regularity of GP contact – that is more evenly dispersed, not necessarily more frequent care – has the potential to reduce health care costs and, for those with a previous hospitalisation, the time spent in hospital, irrespective of continuity of provider. These findings argue for the advocacy of regular care, as distinct from solely continuity of provider, when designing policy and financial incentives for GP-led primary care.

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