Health professional and patient perspectives of factors associated with potentially avoidable hospitalisations in a rural Australian setting: a qualitative study

Background Potentially avoidable hospitalisations are a proxy measure of effective primary care at a population level. Hospitalisations for the chronic health conditions of diabetes, congestive cardiac failure and chronic obstructive pulmonary disease account for half of the potentially avoidable hospitalisations for chronic diseases. These hospitalisations are higher in rural areas and socioeconomically disadvantaged areas. Scarce qualitative research has focussed on the identification of factors associated with potentially avoidable hospitalisation from the perspectives of health professionals or patients. This study sought to identify factors associated with potentially avoidable hospitalisations in a rural context from the perspectives of patients and health professionals. Methods Patients with chronic obstructive pulmonary disease, congestive cardiac failure or type 2 diabetes, admitted to a rural hospital in Australia, and health professionals involved in the care of patients with these conditions, were invited to participate in interviews between September and October 2019. Conversations were recorded, transcribed verbatim and analysed using thematic analysis. Results Nine patients and 16 health professionals participated in semi-structured interviews. Five themes were identified (representing factors associated with potentially avoidable hospitalisation); namely General Practitioner involvement, individual patient factors, the influence of the rural locality, medication awareness and health service access. Within these themes, inter-related subthemes emerged including sub-optimal disease management plans, barriers to accessing general practice, poor mental health, patients living alone, healthcare costs, sub-optimal communication and poor connectivity between patients and beneficial services. Conclusion Factors associated with potentially avoidable hospitalisation in this rural area were complex and inter-related. These factors encompassed health service access and disease management, as well as socioeconomic disadvantage. Results suggest that improved indicators of access to effective health services, including primary care, are necessary to address potentially avoidable hospitalisation.