Association of processes of primary care and hospitalisation for people with diabetes: A record linkage study.
OBJECTIVE
To explore the association of primary care and hospitalisation for people with diabetes.


METHODS
The study comprised 20,433 diabetic participants in the Sax Institute's 45 and Up Study. Data on processes of care at recruitment (15 months) were extracted from the Department of Human Services Medicare database. Processes included continuity of primary care (47.1%), and claims for completion of an annual cycle of care (25.0%), GP management plan/team care arrangement (GPMP/TCA, 41.3%), review of GPMP/TCA (24.0%), and monitoring including HbA1c (62.7%). Hospitalisation (12 months) following recruitment was extracted from administrative data held by NSW Ministry of Health. Adjusted incidence rate ratios (aIRR) with 95% confidence interval were calculated.


RESULTS
A hospital admission was reported for 33.0% of participants. Continuity of care (aIRR: 0.92 (95%CI: 0.89-0.96)), or claims for an annual cycle of care (aIRR: 0.77 (0.74-0.80)) or HbA1c testing (aIRR: 0.92 (0.89-0.96) were associated with a reduced likelihood of hospitalisation. While claims for preparation of GPMP/TCA were not associated with hospitalisation, a claim for review of GPMP/TCA was associated with a reduced likelihood of hospitalisation (aIRR: 0.92 (95%CI: 0.89 0.96)).


CONCLUSIONS
This study has implications for hospital avoidance programmes suggesting that strengthening primary care may be more important than care coordination for this group of patients.
Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW 2052, Australia. Electronic address: E.Comino@unsw.edu.au.
Elizabeth Jean
EJ
Comino
Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW 2052, Australia. Electronic address: f.islam@unsw.edu.au.
Md Fakhrul
MF
Islam
Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW 2052, Australia. Electronic address: Danielle.tran@unsw.edu.au.
Duong Thuy
DT
Tran
Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW 2052, Australia. Electronic address: L.Jorm@unsw.edu.au.
Louisa
L
Jorm
Medicine, University of New South Wales, Sydney, NSW 2052, Australia; Diabetes Centre, Bankstown-Lidcombe Hospital, Eldridge Road, Bankstown, NSW 2200, Australia. Electronic address: Jeff.Flack@sswahs.nsw.gov.au.
Jeff
J
Flack
Centre for Research, Evidence Management and Surveillance, Sydney and South Western Sydney Local Health Districts, Locked Bag 7017, Liverpool, NSW 1871, Australia; School of Public Health and Community Medicine, University of New South Wales, Sydney 2052, Australia. Electronic address: bin.jalaludin@sswahs.nsw.gov.au.
Bin
B
Jalaludin
Centre for Health Economics Research and Evaluation, Faculty of Business, University of Technology, Sydney, PO Box 123, Level 4, 645 Harris Street Ultimo, Broadway, NSW 2007, Australia. Electronic address: Marion.Haas@chere.uts.edu.au.
Marion
M
Haas
Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW 2052, Australia. Electronic address: M.F.Harris@unsw.edu.au.
Mark Fort
MF
Harris
D000368:Aged; D000369:Aged, 80 and over; D001315:Australia / Q000453:epidemiology; D016208:Databases, Factual; D003920:Diabetes Mellitus / Q000453:epidemiology* / Q000628:therapy*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008498:Medical Record Linkage; D008875:Middle Aged; D010347:Patient Care Planning; D011320:Primary Health Care / Q000458:organization & administration* / Q000592:standards; D012042:Registries / Q000706:statistics & numerical data
Diabetes; Healthy ageing; Hospitalisation; Primary health care