Primary, allied health, geriatric, pain and palliative healthcare service utilisation by aged care residents, 2012-2017

Abstract

Objectives: To examine the incidence and trends in primary care, allied health, geriatric, pain and palliative care service use by permanent residential aged care (PRAC) residents and the older Australian population.

Methods: Repeated cross-sectional analyses on PRAC residents (N = 318,484) and the older (≥65 years) Australian population (N ~ 3.5 million). Outcomes were Medicare Benefits Schedule (MBS) subsidised primary care, allied health, geriatric, pain and palliative services between 2012-13 and 2016-17. GEE Poisson models estimated incidence rates and incidence rate ratios (IRR).

Results: In 2016-17, PRAC residents had a median of 13 (interquartile range [IQR] 5-19) regular general medical practitioner (GP) attendances, 3 (IQR 1-6) after-hours attendances and 5% saw a geriatrician. Highlights of utilisation changes from 2012-13 to 2016-17 include the following: GP attendances increased by 5%/year (IRR = 1.05, 95% confidence interval [CI] 1.05-1.05) for residents compared to 1%/year (IRR = 1.01, 95%CI 1.01-1.01) for the general population. GP after-hours attendances increased by 15%/year (IRR = 1.15, 95%CI 1.14-1.15) for residents and 9%/year (IRR = 1.08, 95%CI 1.07-1.20) for the general population. GP management plans increased by 12%/year (IRR = 1.12, 95%CI 1.11-1.12) for residents and 10%/year (IRR = 1.10, 95%CI 1.09-1.11) for the general population. Geriatrician consultations increased by 28%/year (IRR = 1.28, 95%CI 1.27-1.29) for residents compared to 14%/year (IRR = 1.14, 95%CI 1.14-1.15) in the general population.

Conclusions: The utilisation of most examined services increased in both cohorts over time. Preventive and management care, by primary care and allied health care providers, was low and likely influences the utilisation of other attendances. PRAC residents' access to pain, palliative and geriatric medicine services is low and may not address the residents' needs.

Keywords: epidemiology; health services for the aged; palliative care; primary health care; residential facilities.

FIGURE 1

Adjusted incidence rates (per 1000 people) of Medicare Benefits Schedule subsidised primary care (general attendances, health assessments/management plans), allied health, geriatric, pain and palliative services among the general Australian population (left) and permanent residential aged care residents (right) per financial year, 2012/13–2016/17. A01, GP attendances; A02, non‐referred attendance to medical practitioner; A10, optometrical services; A11, urgent GP attendance after‐hours; A14, GP health assessments; A15, GP management plans/team care arrangements and multidisciplinary care plans attendances; A17, comprehensive medication reviews; A18, GP attendance associated with PIP; A19, non‐referred attendance associated with PIP; A22, GP after‐hours attendance; A23, non‐referred after‐hours attendance with medical practitioners; A24, pain and palliative medicine; A28, geriatric medicine; A35, medical services at residential aged care facilities; M03, allied health service part of chronic disease management plan; M14, nurse practitioners; O01, dentistry; PRAC, Permanent Residential Aged Care. 1. Standardised by sex and age. 2. Adjusted for sex, age category, number of comorbid conditions and state of residence.