Primary health care service utilisation before and after entry into long-term care in Australia

Gillian E Caughey; Miia Rahja; Luke Collier; Tracy Air; Kailash Thapaliya; Maria Crotty; Helena Williams; Gillian Harvey; Janet K Sluggett; Tiffany K Gill; Jyoti Kadkha; David Roder; Andrew R Kellie; Steve Wesselingh; Maria C Inacio; ROSA Primary Care Research Collaborators

doi:10.1016/j.archger.2023.105210

Primary health care service utilisation before and after entry into long-term care in Australia

Arch Gerontol Geriatr. 2024 Feb:117:105210. doi: 10.1016/j.archger.2023.105210. Epub 2023 Sep 24.

Authors

Affiliations

¹ The Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, SA, Australia; UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia; Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia. Electronic address: gillian.caughey@sahmri.com.
² The Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, SA, Australia; Flinders Health and Medical Research Institute, Division of Rehabilitation, Aged and Palliative Care, Flinders Drive, Bedford Park, SA, Australia.
³ The Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, SA, Australia.
⁴ The Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, SA, Australia; UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia.
⁵ Flinders Health and Medical Research Institute, Division of Rehabilitation, Aged and Palliative Care, Flinders Drive, Bedford Park, SA, Australia; College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia; Southern Adelaide Local Health Network, SA Health, Adelaide, SA, Australia.
⁶ Silver Chain Group Limited, Adelaide, SA, Australia.
⁷ College of Nursing and Health Science, Flinders University, Adelaide, SA, Australia.
⁸ The Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, SA, Australia; UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia; Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC, Australia.
⁹ UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia; Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia.
¹⁰ The Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, SA, Australia; College of Nursing and Health Science, Flinders University, Adelaide, SA, Australia.
¹¹ UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia.
¹² East Adelaide Healthcare, Newton, SA, Australia.

PMID: 37812974
DOI: 10.1016/j.archger.2023.105210

Abstract

Objectives: To examine utilisation of primary health care services (subsidised by the Australian Government, Medicare Benefits Schedule, MBS) before and after entry into long-term care (LTC) in Australia.

Methods: A retrospective cohort study of older people (aged ≥65 years) who entered LTC in Australia between 2012 and 2016 using the Historical Cohort of the Registry of Senior Australians. MBS-subsidised general attendances (general practitioner (GP), medical and nurse practitioners), health assessment and management plans, allied health, mental health services and selected specialist attendances accessed in 91-day periods 12 months before and after LTC entry were examined. Adjusted relative changes in utilisation 0-3 months before and after LTC entry were estimated using risk ratios (RR) calculated using Generalised Estimating Equation Poisson models.

Results: 235,217 residents were included in the study with a median age of 84 years (interquartile range 79-89) and 61.1% female. In the first 3 months following LTC entry, GP / medical practitioner attendances increased from 86.6% to 95.6% (aRR 1.10 95%CI 1.10-1.11), GP / medical practitioner urgent after hours (from 12.3% to 21.1%; aRR 1.72, 95%CI 1.70-1.74) and after-hours attendances (from 18.5% to 33.8%; aRR 1.83, 95%CI 1.81-1.84) increased almost two-fold. Pain, palliative and geriatric specialist medicine attendances were low in the 3 months prior (<3%) and decreased further following LTC admission.

Conclusion: There is an opportunity to improve the utilisation of primary health care services following LTC entry to ensure that residents' increasingly complex care needs are adequately met.

Keywords: Health service utilisation; Long-term care; Primary care.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aged, 80 and over
Australia
Female
Humans
Long-Term Care*
Male
National Health Programs*
Primary Health Care
Retrospective Studies