Patterns of Medicare-funded primary health and specialist consultations in Aboriginal and non-Aboriginal Australians in the two years before hospitalisation for ischaemic heart disease

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Abstract

Background: Ischaemic heart disease (IHD) remains the leading cause of morbidity and mortality for both Aboriginal and non-Aboriginal Australians. Patterns of primary and specialist care in patients leading up to the first hospitalisation for IHD potentially impact on prevention and subsequent outcomes. We investigated the differences in general practice (GP), specialist and emergency department (ED) consultations, and associated resource use in Aboriginal and non-Aboriginal people in the two years preceding hospitalisation for IHD. Methods: Linked-data were used to identify first IHD admissions for Western Australians aged 25-74 years in 2002-2007. Person-linked GP, specialist and ED consultations were obtained from the Medicare Benefits Schedule (MBS) and ED records to assess health care access and costs for the preceding 2 years. Results: Aboriginal people constituted 4.7% of 27,230 IHD patients, 3.5% of 1,348,238 MBS records, and 14% of 33,170 ED presentations. Aboriginal (vs. non-Aboriginal) people were younger (mean 50.2 vs 60.5 years), more commonly women (45.2% vs 28.4%), had more comorbidities [Charlson index≥1, 35.2% vs 26.3%], were more likely to have had GP visits (adjusted rate-ratio 1.07, 95% CI 1.02-1.12), long/prolonged (16.0% vs 11.9%) consults and non-vocationally registered GP consults (17.1% vs 3.2%), but less likely to received specialist consults (mean 1.0 vs 4.1). Mean number of urgent/semi-urgent ED presentations in the year preceding the IHD admission was higher in Aboriginal people (2.9 vs 1.9). Aboriginal people incurred 2.7% of total associated MBS expenditure (estimated at 59.7 million). Mean total cost per person was 43.3% lower in Aboriginal patients, with cost differentials being greatest in diabetic and chronic kidney disease patients. Conclusions: Despite being over-represented in urgent/semi-urgent ED presentations and admissions for IHD, Aboriginal people were under-resourced compared with the rest of the population, particularly in terms of specialist care prior to first IHD hospitalisation. The findings underscore the need for better primary and specialist shared care delivery models particularly for Aboriginal people.

Original languageEnglish
Article number111
JournalInternational Journal for Equity in Health
Volume17
Issue number1
DOIs
Publication statusPublished - 2 Aug 2018

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Medicare
Myocardial Ischemia
Hospitalization
Referral and Consultation
Hospital Emergency Service
Health
General Practice
Appointments and Schedules
Costs and Cost Analysis
Diabetic Nephropathies
Health Expenditures
Chronic Renal Insufficiency
Health Care Costs
Comorbidity
Primary Health Care
Morbidity
Mortality
Population

Cite this

@article{c7c072cad1d244679be2e8079720a5a3,
title = "Patterns of Medicare-funded primary health and specialist consultations in Aboriginal and non-Aboriginal Australians in the two years before hospitalisation for ischaemic heart disease",
abstract = "Background: Ischaemic heart disease (IHD) remains the leading cause of morbidity and mortality for both Aboriginal and non-Aboriginal Australians. Patterns of primary and specialist care in patients leading up to the first hospitalisation for IHD potentially impact on prevention and subsequent outcomes. We investigated the differences in general practice (GP), specialist and emergency department (ED) consultations, and associated resource use in Aboriginal and non-Aboriginal people in the two years preceding hospitalisation for IHD. Methods: Linked-data were used to identify first IHD admissions for Western Australians aged 25-74 years in 2002-2007. Person-linked GP, specialist and ED consultations were obtained from the Medicare Benefits Schedule (MBS) and ED records to assess health care access and costs for the preceding 2 years. Results: Aboriginal people constituted 4.7{\%} of 27,230 IHD patients, 3.5{\%} of 1,348,238 MBS records, and 14{\%} of 33,170 ED presentations. Aboriginal (vs. non-Aboriginal) people were younger (mean 50.2 vs 60.5 years), more commonly women (45.2{\%} vs 28.4{\%}), had more comorbidities [Charlson index≥1, 35.2{\%} vs 26.3{\%}], were more likely to have had GP visits (adjusted rate-ratio 1.07, 95{\%} CI 1.02-1.12), long/prolonged (16.0{\%} vs 11.9{\%}) consults and non-vocationally registered GP consults (17.1{\%} vs 3.2{\%}), but less likely to received specialist consults (mean 1.0 vs 4.1). Mean number of urgent/semi-urgent ED presentations in the year preceding the IHD admission was higher in Aboriginal people (2.9 vs 1.9). Aboriginal people incurred 2.7{\%} of total associated MBS expenditure (estimated at 59.7 million). Mean total cost per person was 43.3{\%} lower in Aboriginal patients, with cost differentials being greatest in diabetic and chronic kidney disease patients. Conclusions: Despite being over-represented in urgent/semi-urgent ED presentations and admissions for IHD, Aboriginal people were under-resourced compared with the rest of the population, particularly in terms of specialist care prior to first IHD hospitalisation. The findings underscore the need for better primary and specialist shared care delivery models particularly for Aboriginal people.",
keywords = "Aboriginal health, Administrative datasets, Health care disparity, Indigenous health services, Ischaemic heart disease, Primary health care",
author = "Teng, {Tiew Hwa Katherine} and Katzenellenbogen, {Judith M.} and Elizabeth Geelhoed and Gunnell, {Anthony S.} and Matthew Knuiman and Sanfilippo, {Frank M.} and Joseph Hung and Qun Mai and Alistair Vickery and Thompson, {Sandra C.}",
year = "2018",
month = "8",
day = "2",
doi = "10.1186/s12939-018-0826-9",
language = "English",
volume = "17",
journal = "International Journal for Equity in Health",
issn = "1475-9276",
publisher = "BioMed Central",
number = "1",

}

TY - JOUR

T1 - Patterns of Medicare-funded primary health and specialist consultations in Aboriginal and non-Aboriginal Australians in the two years before hospitalisation for ischaemic heart disease

AU - Teng, Tiew Hwa Katherine

AU - Katzenellenbogen, Judith M.

AU - Geelhoed, Elizabeth

AU - Gunnell, Anthony S.

AU - Knuiman, Matthew

AU - Sanfilippo, Frank M.

AU - Hung, Joseph

AU - Mai, Qun

AU - Vickery, Alistair

AU - Thompson, Sandra C.

PY - 2018/8/2

Y1 - 2018/8/2

N2 - Background: Ischaemic heart disease (IHD) remains the leading cause of morbidity and mortality for both Aboriginal and non-Aboriginal Australians. Patterns of primary and specialist care in patients leading up to the first hospitalisation for IHD potentially impact on prevention and subsequent outcomes. We investigated the differences in general practice (GP), specialist and emergency department (ED) consultations, and associated resource use in Aboriginal and non-Aboriginal people in the two years preceding hospitalisation for IHD. Methods: Linked-data were used to identify first IHD admissions for Western Australians aged 25-74 years in 2002-2007. Person-linked GP, specialist and ED consultations were obtained from the Medicare Benefits Schedule (MBS) and ED records to assess health care access and costs for the preceding 2 years. Results: Aboriginal people constituted 4.7% of 27,230 IHD patients, 3.5% of 1,348,238 MBS records, and 14% of 33,170 ED presentations. Aboriginal (vs. non-Aboriginal) people were younger (mean 50.2 vs 60.5 years), more commonly women (45.2% vs 28.4%), had more comorbidities [Charlson index≥1, 35.2% vs 26.3%], were more likely to have had GP visits (adjusted rate-ratio 1.07, 95% CI 1.02-1.12), long/prolonged (16.0% vs 11.9%) consults and non-vocationally registered GP consults (17.1% vs 3.2%), but less likely to received specialist consults (mean 1.0 vs 4.1). Mean number of urgent/semi-urgent ED presentations in the year preceding the IHD admission was higher in Aboriginal people (2.9 vs 1.9). Aboriginal people incurred 2.7% of total associated MBS expenditure (estimated at 59.7 million). Mean total cost per person was 43.3% lower in Aboriginal patients, with cost differentials being greatest in diabetic and chronic kidney disease patients. Conclusions: Despite being over-represented in urgent/semi-urgent ED presentations and admissions for IHD, Aboriginal people were under-resourced compared with the rest of the population, particularly in terms of specialist care prior to first IHD hospitalisation. The findings underscore the need for better primary and specialist shared care delivery models particularly for Aboriginal people.

AB - Background: Ischaemic heart disease (IHD) remains the leading cause of morbidity and mortality for both Aboriginal and non-Aboriginal Australians. Patterns of primary and specialist care in patients leading up to the first hospitalisation for IHD potentially impact on prevention and subsequent outcomes. We investigated the differences in general practice (GP), specialist and emergency department (ED) consultations, and associated resource use in Aboriginal and non-Aboriginal people in the two years preceding hospitalisation for IHD. Methods: Linked-data were used to identify first IHD admissions for Western Australians aged 25-74 years in 2002-2007. Person-linked GP, specialist and ED consultations were obtained from the Medicare Benefits Schedule (MBS) and ED records to assess health care access and costs for the preceding 2 years. Results: Aboriginal people constituted 4.7% of 27,230 IHD patients, 3.5% of 1,348,238 MBS records, and 14% of 33,170 ED presentations. Aboriginal (vs. non-Aboriginal) people were younger (mean 50.2 vs 60.5 years), more commonly women (45.2% vs 28.4%), had more comorbidities [Charlson index≥1, 35.2% vs 26.3%], were more likely to have had GP visits (adjusted rate-ratio 1.07, 95% CI 1.02-1.12), long/prolonged (16.0% vs 11.9%) consults and non-vocationally registered GP consults (17.1% vs 3.2%), but less likely to received specialist consults (mean 1.0 vs 4.1). Mean number of urgent/semi-urgent ED presentations in the year preceding the IHD admission was higher in Aboriginal people (2.9 vs 1.9). Aboriginal people incurred 2.7% of total associated MBS expenditure (estimated at 59.7 million). Mean total cost per person was 43.3% lower in Aboriginal patients, with cost differentials being greatest in diabetic and chronic kidney disease patients. Conclusions: Despite being over-represented in urgent/semi-urgent ED presentations and admissions for IHD, Aboriginal people were under-resourced compared with the rest of the population, particularly in terms of specialist care prior to first IHD hospitalisation. The findings underscore the need for better primary and specialist shared care delivery models particularly for Aboriginal people.

KW - Aboriginal health

KW - Administrative datasets

KW - Health care disparity

KW - Indigenous health services

KW - Ischaemic heart disease

KW - Primary health care

UR - http://www.scopus.com/inward/record.url?scp=85051077512&partnerID=8YFLogxK

U2 - 10.1186/s12939-018-0826-9

DO - 10.1186/s12939-018-0826-9

M3 - Article

VL - 17

JO - International Journal for Equity in Health

JF - International Journal for Equity in Health

SN - 1475-9276

IS - 1

M1 - 111

ER -