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. 2015 May;53(5):436-45.
doi: 10.1097/MLR.0000000000000342.

Sociodemographic and health characteristics, rather than primary care supply, are major drivers of geographic variation in preventable hospitalizations in Australia

Michael O Falster  1 , Louisa R Jorm, Kirsty A Douglas, Fiona M Blyth, Robert F Elliott, Alastair H Leyland
Affiliations

Sociodemographic and health characteristics, rather than primary care supply, are major drivers of geographic variation in preventable hospitalizations in Australia

Michael O Falster et al. Med Care. 2015 May.

Abstract

Background: Geographic rates of preventable hospitalization are used internationally as an indicator of accessibility and quality of primary care. Much research has correlated the indicator with the supply of primary care services, yet multiple other factors may influence these admissions.

Objective: To quantify the relative contributions of the supply of general practitioners (GPs) and personal sociodemographic and health characteristics, to geographic variation in preventable hospitalization.

Methods: Self-reported questionnaire data for 267,091 participants in the 45 and Up Study, Australia, were linked with administrative hospital data to identify preventable hospitalizations. Multilevel Poisson models, with participants clustered in their geographic area of residence, were used to explore factors that explain geographic variation in hospitalization.

Results: GP supply, measured as full-time workload equivalents, was not a significant predictor of preventable hospitalization, and explained only a small amount (2.9%) of the geographic variation in hospitalization rates. Conversely, more than one-third (36.9%) of variation was driven by the sociodemographic composition, health, and behaviors of the population. These personal characteristics explained a greater amount of the variation for chronic conditions (37.5%) than acute (15.5%) or vaccine-preventable conditions (2.4%).

Conclusions: Personal sociodemographic and health characteristics, rather than GP supply, are major drivers of preventable hospitalization. Their contribution varies according to condition, and if used for performance comparison purposes, geographic rates of preventable hospitalization should be reported according to individual condition or potential pathways for intervention.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

FIGURE 1
FIGURE 1
Association between quintiles of the density of full-time workload equivalent (FWE) general practitioners (GPs) per capita within Statistical Local Areas, with the rate of preventable and “nonpreventable” hospitalizations, from multilevel Poisson models adjusted for age and sex, and further adjusted for personal sociodemographic, health, and behavioral characteristics.
FIGURE 2
FIGURE 2
Incidence rate ratios for person-level predictors of preventable hospitalization, in multilevel Poisson models simultaneously adjusted for all person-level variables and area-level quintiles of full-time workload equivalent general practitioners.
See this image and copyright information in PMC

References

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