Association between continuity of provider-adjusted regularity of general practitioner contact and unplanned diabetes-related hospitalisation: a data linkage study in New South Wales, Australia, using the 45 and Up Study cohort

Rachael E. Moorin, David Youens, David B. Preen, Mark Harris, Cameron M. Wright

Research output: Contribution to journalArticle

Abstract

Objective To assess the association between continuity of provider-adjusted regularity of general practitioner (GP) contact and unplanned diabetes-related hospitalisation or emergency department (ED) presentation.

Design Cross-sectional study.

Setting Individual-level linked self-report and administrative health service data from New South Wales, Australia.

Participants 27 409 survey respondents aged >= 45 years with a prior history of diabetes and at least three GP contacts between 1 July 2009 and 30 June 2015.

Main outcome measures Unplanned diabetes-related hospitalisations or ED presentations, associated costs and bed days.

Results Twenty-one per cent of respondents had an unplanned diabetes-related hospitalisation or ED presentation. Increasing regularity of GP contact was associated with a lower probability of hospitalisation or ED presentation (19.9% for highest quintile, 23.5% for the lowest quintile). Conditional on having an event, there was a small decrease in the number of hospitalisations or ED presentations for the low (-6%) and moderate regularity quintiles (-8%), a reduction in bed days (ranging from -30 to -44%) and a reduction in average cost of between -23% and -41%, all relative to the lowest quintile. When probability of diabetes-related hospitalisation or ED presentation was included, only the inverse association with cost remained significant (mean of $ A3798 to $ A6350 less per individual, compared with the lowest regularity quintile). Importantly, continuity of provider did not significantly modify the effect of GP regularity for any outcome.

Conclusions Higher regularity of GP contact-that is more evenly dispersed, not necessarily more frequent care-has the potential to reduce secondary healthcare costs and, conditional on having an event, the time spent in hospital, irrespective of continuity of provider. These findings argue for the advocacy of regular care, as distinct

Original languageEnglish
Article number027158
Number of pages14
JournalBMJ Open
Volume9
Issue number6
DOIs
Publication statusPublished - Jun 2019

Cite this

@article{68f982291b9b496fadbcab8428045063,
title = "Association between continuity of provider-adjusted regularity of general practitioner contact and unplanned diabetes-related hospitalisation: a data linkage study in New South Wales, Australia, using the 45 and Up Study cohort",
abstract = "Objective To assess the association between continuity of provider-adjusted regularity of general practitioner (GP) contact and unplanned diabetes-related hospitalisation or emergency department (ED) presentation.Design Cross-sectional study.Setting Individual-level linked self-report and administrative health service data from New South Wales, Australia.Participants 27 409 survey respondents aged >= 45 years with a prior history of diabetes and at least three GP contacts between 1 July 2009 and 30 June 2015.Main outcome measures Unplanned diabetes-related hospitalisations or ED presentations, associated costs and bed days.Results Twenty-one per cent of respondents had an unplanned diabetes-related hospitalisation or ED presentation. Increasing regularity of GP contact was associated with a lower probability of hospitalisation or ED presentation (19.9{\%} for highest quintile, 23.5{\%} for the lowest quintile). Conditional on having an event, there was a small decrease in the number of hospitalisations or ED presentations for the low (-6{\%}) and moderate regularity quintiles (-8{\%}), a reduction in bed days (ranging from -30 to -44{\%}) and a reduction in average cost of between -23{\%} and -41{\%}, all relative to the lowest quintile. When probability of diabetes-related hospitalisation or ED presentation was included, only the inverse association with cost remained significant (mean of $ A3798 to $ A6350 less per individual, compared with the lowest regularity quintile). Importantly, continuity of provider did not significantly modify the effect of GP regularity for any outcome.Conclusions Higher regularity of GP contact-that is more evenly dispersed, not necessarily more frequent care-has the potential to reduce secondary healthcare costs and, conditional on having an event, the time spent in hospital, irrespective of continuity of provider. These findings argue for the advocacy of regular care, as distinct",
keywords = "PRIMARY-CARE, HEALTH-CARE, QUALITY, RISK, EMERGENCY, MORTALITY, INDEX",
author = "Moorin, {Rachael E.} and David Youens and Preen, {David B.} and Mark Harris and Wright, {Cameron M.}",
year = "2019",
month = "6",
doi = "10.1136/bmjopen-2018-027158",
language = "English",
volume = "9",
journal = "BMJ (Open)",
issn = "2044-6055",
publisher = "John Wiley & Sons",
number = "6",

}

TY - JOUR

T1 - Association between continuity of provider-adjusted regularity of general practitioner contact and unplanned diabetes-related hospitalisation

T2 - a data linkage study in New South Wales, Australia, using the 45 and Up Study cohort

AU - Moorin, Rachael E.

AU - Youens, David

AU - Preen, David B.

AU - Harris, Mark

AU - Wright, Cameron M.

PY - 2019/6

Y1 - 2019/6

N2 - Objective To assess the association between continuity of provider-adjusted regularity of general practitioner (GP) contact and unplanned diabetes-related hospitalisation or emergency department (ED) presentation.Design Cross-sectional study.Setting Individual-level linked self-report and administrative health service data from New South Wales, Australia.Participants 27 409 survey respondents aged >= 45 years with a prior history of diabetes and at least three GP contacts between 1 July 2009 and 30 June 2015.Main outcome measures Unplanned diabetes-related hospitalisations or ED presentations, associated costs and bed days.Results Twenty-one per cent of respondents had an unplanned diabetes-related hospitalisation or ED presentation. Increasing regularity of GP contact was associated with a lower probability of hospitalisation or ED presentation (19.9% for highest quintile, 23.5% for the lowest quintile). Conditional on having an event, there was a small decrease in the number of hospitalisations or ED presentations for the low (-6%) and moderate regularity quintiles (-8%), a reduction in bed days (ranging from -30 to -44%) and a reduction in average cost of between -23% and -41%, all relative to the lowest quintile. When probability of diabetes-related hospitalisation or ED presentation was included, only the inverse association with cost remained significant (mean of $ A3798 to $ A6350 less per individual, compared with the lowest regularity quintile). Importantly, continuity of provider did not significantly modify the effect of GP regularity for any outcome.Conclusions Higher regularity of GP contact-that is more evenly dispersed, not necessarily more frequent care-has the potential to reduce secondary healthcare costs and, conditional on having an event, the time spent in hospital, irrespective of continuity of provider. These findings argue for the advocacy of regular care, as distinct

AB - Objective To assess the association between continuity of provider-adjusted regularity of general practitioner (GP) contact and unplanned diabetes-related hospitalisation or emergency department (ED) presentation.Design Cross-sectional study.Setting Individual-level linked self-report and administrative health service data from New South Wales, Australia.Participants 27 409 survey respondents aged >= 45 years with a prior history of diabetes and at least three GP contacts between 1 July 2009 and 30 June 2015.Main outcome measures Unplanned diabetes-related hospitalisations or ED presentations, associated costs and bed days.Results Twenty-one per cent of respondents had an unplanned diabetes-related hospitalisation or ED presentation. Increasing regularity of GP contact was associated with a lower probability of hospitalisation or ED presentation (19.9% for highest quintile, 23.5% for the lowest quintile). Conditional on having an event, there was a small decrease in the number of hospitalisations or ED presentations for the low (-6%) and moderate regularity quintiles (-8%), a reduction in bed days (ranging from -30 to -44%) and a reduction in average cost of between -23% and -41%, all relative to the lowest quintile. When probability of diabetes-related hospitalisation or ED presentation was included, only the inverse association with cost remained significant (mean of $ A3798 to $ A6350 less per individual, compared with the lowest regularity quintile). Importantly, continuity of provider did not significantly modify the effect of GP regularity for any outcome.Conclusions Higher regularity of GP contact-that is more evenly dispersed, not necessarily more frequent care-has the potential to reduce secondary healthcare costs and, conditional on having an event, the time spent in hospital, irrespective of continuity of provider. These findings argue for the advocacy of regular care, as distinct

KW - PRIMARY-CARE

KW - HEALTH-CARE

KW - QUALITY

KW - RISK

KW - EMERGENCY

KW - MORTALITY

KW - INDEX

U2 - 10.1136/bmjopen-2018-027158

DO - 10.1136/bmjopen-2018-027158

M3 - Article

VL - 9

JO - BMJ (Open)

JF - BMJ (Open)

SN - 2044-6055

IS - 6

M1 - 027158

ER -