Australian Health Review Australian Health Review Society
Journal of the Australian Healthcare & Hospitals Association
RESEARCH ARTICLE

Health service use in the older person with complex health needs

Mark Bartlett A D , Joanna Wang A , Liz Hay B and Glen Pang C
+ Author Affiliations
- Author Affiliations

A Sax Institute. PO Box K617 Haymarket NSW 1240. Email: Joanna.Wang@saxinstitute.org.au

B NSW Ministry of Health. Locked Mail Bag 961, North Sydney NSW 2059. Email: Liz.Hay@health.nsw.gov.au

C NSW Agency for Clinical Innovation. PO Box 699, Chatswood NSW 205. Email: glen.pang@aci.health.nsw.gov.au

D Corresponding author. Email: mark.bartlett@saxinstitute.org.au

Australian Health Review - https://doi.org/10.1071/AH16286
Submitted: 16 December 2016  Accepted: 14 August 2017   Published online: 28 September 2017

Abstract

Objective Effective health care for older people with complex health needs requires a diverse range of healthcare professionals working together. The Building Partnerships Framework of the New South Wales Agency for Clinical Innovation seeks to promote collaboration and integration among service providers. The aim of the present study was to inform implementation and evaluation of the Framework.

Methods Data from the 45 and Up Study was linked with deaths and service data from hospitalisations and the Medicare Benefits Schedule (MBS). Participants with a hospitalisation for conditions representing ‘geriatric syndrome’ were allocated to a complex needs group; the remainder were allocated to a comparison group. Hospital admissions and MBS services use were modelled using log-linear Poisson regression.

Results Multivariate analysis showed that the rate of hospitalisation in the 2 years following index admission for the complex needs group was 18% (95% confidence interval (CI) 1.12–1.24) greater than the comparison group and specialist physician attendance was 13% (95% CI 1.06 – 1.21) greater. The rate of general practitioner (GP) attendances was 2% (95% CI 0.97–1.07) greater in the complex needs group, but this was not statistically significant.

Discussion The greater rates of hospitalisation and specialist service use, the absence of a similar finding for GP services and the prominence of the role of primary care in service integration literature, policy and strategy underscore the importance of careful planning, consultation and inclusiveness in the development and implementation of integrated care policy.

What is known about the topic? Older people with complex health needs are significant consumers of primary and secondary health services and benefit from well-planned and coordinated care.

What does this paper add? The findings presented here indicate that although hospitals and specialist physicians provide a significantly greater volume of services to people with complex health needs, GPs do not. Within the limitations of the present study, these findings can contribute to integrated care policy and strategy development and implementation.

What are the implications for practitioners? Given the prominence of primary care in service integration literature, policy and strategy and the findings of the present study with regard to the relative level of GP involvement in the management of people with complex needs, careful policy implementation will be required to ensure GPs are able to contribute significantly to coordinated cooperation between health services.

Additional keywords: geriatric syndrome; integrated care; primary care.


References

[1]  Bodenheimer TS, Berry-Millett R. Care management of patients with complex care needs. Research Synthesis Report No. 19. Princeton, NJ: Robert Wood Johnson Foundation; 2009.

[2]  Agency for Clinical Innovation. Strategic Framework for Integrated care of the older person with complex health needs. Draft for consultation. 2013. Available at: https://www.aci.health.nsw.gov.au/__data/assets/pdf_file/0005/204377/ACI_draft_framework_for_integrated_care_of_the_older_person_with_complex_health_needs.pdf [verified 21 August 2017].

[3]  Agency for Clinical Innovation. Building partnerships: a framework for integrating care for older people with complex health needs. 2014. Available at: https://www.aci.health.nsw.gov.au/__data/assets/pdf_file/0003/249483/Building_Partnerships_Framework.pdf [verified 21 August 2017].

[4]  Inouye SK, Studenski S, Tinetti M, Kuchel G. Geriatric syndromes: clinical, research and policy implications of a core geriatric concept. J Am Geriatr Soc 2007; 55 780–91.
Geriatric syndromes: clinical, research and policy implications of a core geriatric concept.CrossRef |

[5]  Australian Institute of Health and Welfare (AIHW). Australian hospital statistics 2011–12. Canberra: AIHW; 2013.

[6]  Australian Institute of Health and Welfare (AIHW). Australia’s hospitals 2010–11 at a glance. Canberra: AIHW; 2012.

[7]  Australian Institute of Health and Welfare (AIHW). Dementia in Australia. Canberra: AIHW; 2012. Available at: http://www.aihw.gov.au/publication-detail/?id=10737422958 [verified 5 September 2017].

[8]  Australian Institute of Health and Welfare (AIHW). Dementia care in hospitals: costs and strategies. Canberra: AIHW; 2013.

[9]  Australian Institute of Health and Welfare (AIHW), Bradley C. Trends in hospitalisations due to falls by older people, Australia 1999–00 to 2010–11. Canberra: AIHW; 2013. Available at: http://www.aihw.gov.au/publication-detail/?id=60129543594 [verified 5 September 2017].

[10]  Australian Institute of Health and Welfare. Falls in older people. 2016. Available at: http://www.aihw.gov.au/injury/falls/ [verified 30 August 2017].

[11]  45 and Up Study Collaborators Banks E, Redman S, Jorm L, Armstrong B, Bauman A, Beard J, Beral V, Byles J, Corbett S, Cumming R, Harris M, Sitas F, Smith W, Taylor L, Wutzke S, Lujic S. Cohort profile: the 45 and Up Study. Int J Epidemiol 2008; 37 941–7.
Cohort profile: the 45 and Up Study.CrossRef |

[12]  Hickam DH, Weiss W, Guise J, Buckley D, Motu’apuaka M, Graham E, Wasson N, Saha S. Outpatient case management for adults with medical illness and complex care needs [Internet]. Comparative Effectiveness Reviews, No. 99. Rockville, MD: Agency for Healthcare Research and Quality; 2013. Available at: https://www.ncbi.nlm.nih.gov/books/NBK116491/ [verified 21 August 2017].

[13]  South Australian Department of Health Statewide Service Strategy Division. Health service framework for older people 2009–2016: improving health and wellbeing together. 2009. Available at: http://www.sahealth.sa.gov.au/wps/wcm/connect/cd478e804278955d8b07ab182b8 de443/hsframeworkolderpeople09-16- clincal networks-sahealth-0905.pdf?MOD=AJPERES&CACHEID=cd478e804278955d8b07ab 182b8de443 [verified 21 August 2017].

[14]  National Health Performance Authority. Hospital performance: length of stay in public hospitals in 2011–12. 2013. Available at: http://www.myhospitals.gov.au/getmedia/6e630b7e-46be-49ad-8d6a-6985274de9e6/hp_lengthofstay_2011-12_rpt.aspx [verified 21 August 2017].

[15]  Australian Government Department of Health. Primary Health Care Advisory Group Final Report. Better Outcomes for People with Chronic and Complex Health Conditions. 2016: Canberra.

[16]  Harris MF, Zwar NA. Care of patients with chronic disease: the challenge for general practice. Med J Aust 2007; 187 104–7.

[17]  Patterson E, Muencberger H, Kendal E. The role of practice nurses in coordinated care of people with chronic and complex conditions. Aust Health Rev 2007; 31 231–8.
The role of practice nurses in coordinated care of people with chronic and complex conditions.CrossRef |

[18]  Australian Government Department of Health. National strategic framework for rural and remote health. 2011. Available at: http://www.health.gov.au/internet/main/publishing.nsf/content/national-strategic-framework-rural-remote-health [verified 21 August 2017].

[19]  Independent Hospital Pricing Authority (IHPA). International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-1AM) – Tabular list of Diseases. 9th Edition. Darlinghurst, NSW: IHPA; 2015.



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