Pathways to ambulatory sensitive hospitalisations for Māori in the Auckland and Waitemata regions.
OBJECTIVE
Ambulatory Sensitive Hospitalisations (ASH) are a group of conditions potentially preventable through interventions delivered in the primary health care setting. ASH rates are consistently higher for Māori compared with non-Māori. This study aimed to establish Māori experience of factors driving the use of hospital services for ASH conditions, including barriers to accessing primary care.


METHODS
A telephone questionnaire exploring pathways to ASH was administered to Māori (n=150) admitted to Auckland and Waitemata District Health Board (DHB) hospitals with an ASH condition between January 1st-June 30th 2015.


RESULTS
A cohort of 1,013 participants were identified; 842 (83.1%) were unable to be contacted. Of the 171 people contactable, 150 agreed to participate, giving an overall response rate of 14.8% and response rate of contactable patients of 87.7%. Results demonstrated high rates of self-reported enrolment, utilisation and preference for primary care. Many participants demonstrated appropriate health seeking behaviour and accurate recall of diagnoses. While financial barriers to accessing primary care were reported, non-financial barriers including lack of after-hours provision (12.6% adults, 37.7% children), appointment availability (7.4% adults, 17.0% children) and lack of transport (13.7% adults, 20.8% children) also featured in participant responses.


CONCLUSIONS
Interventions to reduce Māori ASH include: timely access to primary care through electronic communications, increased appointment availability, extended opening hours, low cost after-hours care and consistent best management of ASH conditions in general practice through clinical pathways. Facilitated enrolment of ASH patients with no general practitioner could also reduce ASH. Research into transport barriers and enablers for Māori accessing primary care is required to support future interventions.
Department of Planning, Funding and Outcomes, Auckland and Waitemata District Health Boards, Auckland.
Carol
C
Barker
Invercargill Medical Centre, Invercargill.
Sue
S
Crengle
Chief Executive Officer, Waitemata District Health Board, Auckland.
Dale
D
Bramley
Department of Planning, Funding and Outcomes, Auckland and Waitemata District Health Boards, Auckland.
Karen
K
Bartholomew
Department of Planning, Funding and Outcomes, Auckland and Waitemata District Health Boards, Auckland.
Patricia
P
Bolton
Department of Planning, Funding and Outcomes, Auckland and Waitemata District Health Boards, Auckland.
Michael
M
Walsh
Department of Planning, Funding and Outcomes, Auckland and Waitemata District Health Boards, Auckland.
Jean
J
Wignall
D000293:Adolescent; D000328:Adult; D039602:After-Hours Care; D000553:Ambulatory Care / Q000592:standards*; D002648:Child; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D011795:Surveys and Questionnaires; D055815:Young Adult