scholarly journals The association between general practitioner regularity of care and ‘high use’ hospitalisation

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Rachael E. Moorin ◽  
David Youens ◽  
David B. Preen ◽  
Cameron M. Wright
Keyword(s):  
General Practitioner ◽  
New South ◽  
Population Attributable Fraction ◽  
Productive Efficiency ◽  
South Wales ◽  
Hypothetical Scenario ◽  
Extended Length ◽  
Sequential Reduction ◽  
Gp Care ◽  
Number Of Individuals

Abstract Background In Australia, as in many high income countries, there has been a movement to improve out-of-hospital care. If primary care improvements can yield appropriately lower hospital use, this would improve productive efficiency. This is especially important among ‘high cost users’, a small group of patients accounting for disproportionately high hospitalisation costs. This study aimed to assess the association between regularity of general practitioner (GP) care and ‘high use’ hospitalisation. Methods This retrospective, cohort study used linked administrative and survey data from the 45 and Up Study, conducted in New South Wales, Australia. The exposure was regularity of GP care between 1 July 2005 and 30 June 2009, categorised by quintile (lowest to highest). Outcomes were ‘high use’ of hospitalisation (defined as ≥3 and ≥ 5 admissions within 12 months), extended length of stay (LOS, ≥30 days), a combined metric (≥3 hospitalisations in a 12 month period where ≥1 hospitalisation was ≥30 days) and 30-day readmission between 1 July 2009 and 31 December 2017. Associations were assessed using multivariable logistic regression. Potential for outcome prevention in a hypothetical scenario where all individuals attain the highest GP regularity was estimated via the population attributable fraction (PAF). Results Of 253,500 eligible participants, 15% had ≥3 and 7% had ≥5 hospitalisations in a 12-month period. Five percent of the cohort had a hospitalisation lasting ≥30 days and 25% had a readmission within 30 days. Compared with lowest regularity, highest regularity was associated with between 6% (p < 0.001) and 11% (p = 0.027) lower odds of ‘high use’. There was a 7–8% reduction in odds for all regularity levels above ‘low’ regularity for LOS ≥30 days. Otherwise, there was no clear sequential reduction in ‘high use’ with increasing regularity. The PAF associated with a move to highest regularity ranged from 0.05 to 0.13. The number of individuals who could have had an outcome prevented was estimated to be between 269 and 2784, depending on outcome. Conclusions High GP regularity is associated with a decreased likelihood of ‘high use’ hospitalisation, though for most outcomes there was not an apparent linear association with regularity.

Use of stereo baited remote underwater video systems to estimate the presence and size of white sharks (Carcharodon carcharias)

2017 ◽  
Vol 68 (7) ◽  
pp. 1391 ◽  
Author(s):  
D. Harasti ◽  
K. A. Lee ◽  
R. Laird ◽  
R. Bradford ◽  
B. Bruce
Keyword(s):  
Relative Abundance ◽  
Fish Assemblages ◽  
New South ◽  
Underwater Video ◽  
Carcharodon Carcharias ◽  
South Wales ◽  
Video Systems ◽  
Near Shore ◽  
Number Of Individuals ◽  
Non Destructive

Stereo baited remote underwater video systems (stereo-BRUVs) are commonly used to assess fish assemblages and, more recently, to record the localised abundance and size of sharks. The present study investigated the occurrence and size of white sharks (Carcharodon carcharias) in the near-shore environment off Bennett’s Beach, part of a known nursery area for the species in central New South Wales, Australia. Six stereo-BRUV units were deployed approximately fortnightly between August and December 2015 for periods of 5h in depths of 7–14m. Stereo-BRUVs successfully recorded 34 separate sightings of 22 individual white sharks. The highest number of individuals detected during a single day survey was eight. All C. carcharias observed on stereo-BRUVs were juveniles ranging in size from 1.50 to 2.46-m total length (mean±s.e., 1.91±0.05m; n=22). The time to first appearance ranged from 15 to 299min (mean±s.e., 148±15min). This study demonstrates that the use of stereo-BRUVs is a viable, non-destructive method to obtain estimates of the size and presence of white sharks, and may be useful in estimating relative abundance in near-shore environments where white sharks are known to frequent.

Spatial variability in the nekton of a canal estate in southern New South Wales, Australia, and its implications for estuarine management

1995 ◽  
Vol 46 (4) ◽  
pp. 715 ◽  
Author(s):  
MP Lincoln Smith ◽  
PMH Hawes ◽  
FJ Duque-Portugal
Keyword(s):  
Spatial Variability ◽  
New South ◽  
New South Wales ◽  
South Wales ◽  
Estuarine Management ◽  
Main Canal ◽  
Number Of Individuals

The nekton of a canal development in NSW, Australia, is described. Two sites each were sampled from the main canal and in end canals. The main canal had more species of fish than did the end canals, but the number of individuals was similar between locations. Abundance of particular species showed three patterns: species that were more abundant in either location, species that varied between locations and sites, and species that did not differ significantly in abundance. There was little evidence that the nekton from the end canals, which are presumably less well flushed, was depauperate compared with the main canal. Surveys of nekton in canal estates should incorporate spatial variability at two or more scales so that the effects of these human developments can be assessed properly.

scholarly journals Stigma as a barrier to diagnosis of lung cancer: patient and general practitioner perspectives

2015 ◽  
Vol 16 (06) ◽  
pp. 618-622 ◽  
Author(s):  
Nicola Scott ◽  
Melanie Crane ◽  
Mayanne Lafontaine ◽  
Holly Seale ◽  
David Currow
Keyword(s):  
Lung Cancer ◽  
General Practitioner ◽  
New South ◽  
Short Report ◽  
Structured Interviews ◽  
Lung Cancer Diagnosis ◽  
South Wales ◽  
Diagnosis Of Lung Cancer ◽  
Delays In Diagnosis ◽  
The Impact

The prognosis for people with lung cancer may be worsened by delays in seeking medical help following the onset of symptoms. Previous research has highlighted that patients’ experiences of stigma and blame may contribute to these delays. This short report focuses on stigma as a barrier to diagnosis of lung cancer, from patient and general practitioner (GP) perspectives. Semi-structured interviews were conducted with people diagnosed with lung cancer (n=20) and with GPs (n=10) in New South Wales, Australia. Participants’ experiences of blame and stigma, GPs preconceptions of lung cancer risk and the impact of anti-smoking messaging were explored. Participants reported experiencing stigma owing to a diagnosis of lung cancer. For some, the anticipation of stigma resulted in delays in seeking diagnosis and hence treatment. The sense of blame associated with a lung cancer diagnosis was also reflected in GP interviews. Successful tobacco control activities have increased societal awareness of lung cancer as smoking related and potentially contributed to the participants’ experiences of stigma. Removing blame associated with smoking is central to reducing delays in diagnosis of lung cancer.

scholarly journals Effect Measure Modification of Multimorbidity On the Association Between Regularity of General Practitioner Contact and Potentially Avoidable Hospitalisations

2020 ◽  
Vol 5 (5) ◽  
Author(s):  
Rachael Moorin
Keyword(s):  
Primary Care ◽  
General Practitioner ◽  
New South ◽  
Population Attributable Fractions ◽  
South Wales ◽  
Frequency Of Contact ◽  
Effect Measure ◽  
Attributable Fractions ◽  
Effect Measure Modification ◽  
The Relationship

IntroductionRegular contact with a general practitioner (GP) has been shown to lower the risk of potentially avoidable hospitalisations (PAHs) independently of continuity of provider and frequency of contact. Multimorbidity affects between 55 and 98% people aged 65+ years and continues to place pressure on healthcare systems globally. However, little is known about its impact on the relationship between continuity of primary care and PAHs. Objectives and ApproachA retrospective, longitudinal cohort study using survey data linked to routinely-collected administrative health data from the 45 and Up Study conducted in New South Wales, Australia was used to investigate the effect measure modification by multimorbidity on the relationship between regularity of GP contact and PAHs. Multimorbidity was assessed using the Rx-Risk comorbidity score, which captures the number of condition groups, assigned based on medicine dispensing records, using a 5-year look-back period. PAHs were: (i) any unplanned hospitalisations, (ii) chronic ambulatory care sensitive conditions (ACSC) hospitalisations or (iii) unplanned ACSC hospitalisations. Multivariable logistic regression and population attributable fractions (PAF) were used to examine effect measure modification by multimorbidity. ResultsHigher GP regularity was significantly associated with a reduction in the probability of each PAH type. This reduction diminished with increasing multimorbidity with the effect measure modification most apparent for chronic ACSC and unplanned chronic ACSC hospitalisations. The PAF of moving to the highest quintile of regularity significantly reduced with increasing multimorbidity. For example, a reduction in the PAF of unplanned ACSC hospitalisations of 31.1% was observed in those with a RX Risk score of >10 (17.8%) compared with those with no multimorbidity (48.9%). Conclusion / ImplicationsWeakening of the relationship between GP visit regularity and PAHs with increasing levels of multimorbidity suggests a need to focus on improving primary care support to prevent PAHs for patients with multimorbidity.

By-catch from Praen trawling in the Hawkesbury River, New South Wales: Species Composition, distribution and Abundance

1990 ◽  
Vol 41 (1) ◽  
pp. 13 ◽  
Author(s):  
CA Gray ◽  
VC McDonall ◽  
DD Reid
Keyword(s):  
Species Composition ◽  
New South ◽  
New South Wales ◽  
Spatial And Temporal Variability ◽  
Composition Distribution ◽  
Number Of Species ◽  
South Wales ◽  
By Catch ◽  
Autumn And Winter ◽  
Number Of Individuals

This study examined spatial and temporal variability in the composition, distribution and relative abundance of by-catch from prawn trawl sampling in the Hawkesbury River, New South Wales. It also determined whether there were differences in the fauna between sections of the river that are open and closed to prawn trawling. By-catch was sampled monthly between March 1986 and February 1988 in three areas along the river that differed in distance from the mouth of the estuary and in salinity. The total incidental catch comprised 75 species of fish, 13 species of crustaceans and 5 species of molluscs: 42 species were commercially and/or recreationally important. Classification and ordination analyses showed that the species composition of the by-catch differed between the area closest to the mouth of the estuary and that furthest upstream, and that this difference was relatively consistent throughout time. The number of species in the by-catch decreased with increasing distance upstream. Annual and seasonal changes in the number of species were similar in all areas along the river: more species were caught in 1987 than in 1986, and in autumn and winter each year. In contrast, the number of individuals caught differed among areas and these differences varied between years. Similarly, seasonal fluctuations in the numbers of individuals caught varied between years, but these variations were similar in all areas. In the area furthest upstream there were no apparent differences in the numbers of species and individuals caught by prawn trawl sampling in sections of the river open or closed to prawn trawling.

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.

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