Latest news: 26 October 2017.

The highest rates of health service use by older patients with complex health needs are borne by hospitals and specialist physicians rather than GPs, according to new Australian research drawing on the Sax Institute’s 45 and Up Study.

The researchers say the findings highlight the need for careful planning and policy implementation to ensure greater coordination with primary care services.

The study found GP attendance rates among patients with complex needs were not significantly increased

The research was undertaken by the Agency for Clinical Innovation (ACI) in collaboration with the Sax Institute’s Analysis for Policy program to inform the development and implementation of ACI’s Building Partnerships: Framework for Integrating Care for Older People with Complex Health Needs, which aims to better integrate care for older people with complex health needs.

Researchers linked data from 102,888 people aged 65 years and over who are part of the Sax Institute’s 45 and Up Study with data from hospitalisations, the Medicare Benefits Schedule (MBS) and deaths. The aim was to explore health service use by people hospitalised with “geriatric syndrome” (complex health needs group) compared with a control group.

Geriatric syndrome covers clinical conditions affecting older people such as delirium, falls, frailty, dizziness, syncope and urinary incontinence, which affect their quality of life, disability and health service use.

Higher use of secondary care services

The findings, published online early in Australian Health Review, showed that the rate of hospitalisation in the two years following an index admission w among patients with complex needs was 18% greater than among the comparison group.  (An index admission for the study group was the first admission in the study period with a diagnosis representing geriatric syndrome, while in the comparison group, it was the first admission with a diagnosis other than geriatric syndrome.)

Patients with complex needs had almost twice the mean number of days in hospital and their average length of stay was 50% greater than among the comparison group.

The study also showed that their specialist attendance was 13% higher than the comparison group.

However, in a surprising finding given the prominence of primary care in service integration literature, policy and strategy, the researchers said the rate of GP attendances among those with complex needs was only 2% greater than the comparison group, and was not statistically significant.

“This finding is somewhat unexpected, given the relative volume of services used by people with complex health needs, the emphasis on primary care as the main point of contact with the health system and in the management of people with chronic and complex condition, and the fact that the Australian Government has introduced several funding programs to support and encourage GP management of people with chronic and complex disease,” the authors wrote.

They said the findings could suggest that GPs were not heavily involved in managing people with complex conditions, with that role falling predominantly on hospital and specialist services. Or it may be that the complex health needs group studied had conditions at the severe end of the spectrum, which GPs were less likely to manage.

“Given the… prominence of primary care in service integration literature, policy and strategy, careful planning and policy implementation will be required to ensure GPs are able to contribute significantly to coordinated cooperation between health services,” the study concluded.

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