Zhao, Yuejen; Wright, Jo; Guthridge, Steven; Lawton, Paul

Author(s)

Zhao, Yuejen

Wright, Jo

Guthridge, Steven

Lawton, Paul

Publication Date

2013-11-06

Abstract

Primary health care (PHC) is widely regarded as essential for preventing and treating ill health. However, the evidence on whether improved PHC reduces hospitalisations has been mixed. This study examines the relationship between PHC and hospital inpatient care in a population with high health need, high rates of hospitalisation and relatively poor PHC access.The cross-sectional study used linked individual level PHC visit and hospitalisation data for 52 739 Indigenous residents from 54 remote communities in the Northern Territory of Australia between 1 July 2007 and 30 June 2011. The association between PHC visits and hospitalisations was modelled using simple and spline quadratic regression for key demographics and disease groups including potentially avoidable hospitalisations.At the aggregate level, the average annual number of PHC visits per person had a U-shaped association with hospitalisations. For all conditions combined, there was an inverse association between PHC visits and hospitalisations for people with less than four clinic visits per year, but a positive association for those visiting the clinic four times or more. For patients with diabetes, ischaemic heart disease or renal disease, the minimum level of hospitalisation was found when there was 20-30 PHC visits a year, and for children with otitis media and dental conditions, 5-8 visits a year.The results of this study demonstrate a U-shape relationship between PHC visits and hospitalisations. Under the conditions of remote Indigenous Australians, there may be an optimal level of PHC at which hospitalisations are at a minimum. The authors propose that the effectiveness of a health system may hinge on a refined balance, rather than a straight-line relationship between primary health care and tertiary care.

Affiliation

Department of Health, PO Box 40596, Casaurina, NT 0811, Australia. yuejen.zhao@nt.gov.au.

Citation

BMC Health Serv Res . 2013 Nov 6:13:466. doi: 10.1186/1472-6963-13-466.

ISSN

1472-6963

OrcId

Pubmed ID

https://pubmed.ncbi.nlm.nih.gov/24195746/?otool=iaurydwlib

Link

https://hdl.handle.net/10137/13486

Subject

MESH subject

Adolescent

Adult

Age Factors

Child

Child, Preschool

Cross-Sectional Studies

Female

Hospitalization

Humans

Infant

Infant, Newborn

Male

Middle Aged

Native Hawaiian or Other Pacific Islander

Northern Territory

Office Visits

Primary Health Care

Regression Analysis

Rural Population

Young Adult

Title

The relationship between number of primary health care visits and hospitalisations: evidence from linked clinic and hospital data for remote Indigenous Australians.

Type of document

Journal Article

Entity Type

Publication

Author(s)	Zhao, Yuejen Wright, Jo Guthridge, Steven Lawton, Paul
Publication Date	2013-11-06
Abstract	Primary health care (PHC) is widely regarded as essential for preventing and treating ill health. However, the evidence on whether improved PHC reduces hospitalisations has been mixed. This study examines the relationship between PHC and hospital inpatient care in a population with high health need, high rates of hospitalisation and relatively poor PHC access.The cross-sectional study used linked individual level PHC visit and hospitalisation data for 52 739 Indigenous residents from 54 remote communities in the Northern Territory of Australia between 1 July 2007 and 30 June 2011. The association between PHC visits and hospitalisations was modelled using simple and spline quadratic regression for key demographics and disease groups including potentially avoidable hospitalisations.At the aggregate level, the average annual number of PHC visits per person had a U-shaped association with hospitalisations. For all conditions combined, there was an inverse association between PHC visits and hospitalisations for people with less than four clinic visits per year, but a positive association for those visiting the clinic four times or more. For patients with diabetes, ischaemic heart disease or renal disease, the minimum level of hospitalisation was found when there was 20-30 PHC visits a year, and for children with otitis media and dental conditions, 5-8 visits a year.The results of this study demonstrate a U-shape relationship between PHC visits and hospitalisations. Under the conditions of remote Indigenous Australians, there may be an optimal level of PHC at which hospitalisations are at a minimum. The authors propose that the effectiveness of a health system may hinge on a refined balance, rather than a straight-line relationship between primary health care and tertiary care.
Affiliation	Department of Health, PO Box 40596, Casaurina, NT 0811, Australia. yuejen.zhao@nt.gov.au.
Citation	BMC Health Serv Res . 2013 Nov 6:13:466. doi: 10.1186/1472-6963-13-466.
ISSN	1472-6963
OrcId
Pubmed ID	https://pubmed.ncbi.nlm.nih.gov/24195746/?otool=iaurydwlib
Link	https://hdl.handle.net/10137/13486
Subject
MESH subject	Adolescent Adult Age Factors Child Child, Preschool Cross-Sectional Studies Female Hospitalization Humans Infant Infant, Newborn Male Middle Aged Native Hawaiian or Other Pacific Islander Northern Territory Office Visits Primary Health Care Regression Analysis Rural Population Young Adult
Title	The relationship between number of primary health care visits and hospitalisations: evidence from linked clinic and hospital data for remote Indigenous Australians.
Type of document	Journal Article
Entity Type	Publication

The relationship between number of primary health care visits and hospitalisations: evidence from linked clinic and hospital data for remote Indigenous Australians.

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