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3.07 Selected potentially preventable hospital admissions

Why is it important?

Analysis of the conditions for which people are admitted to hospital reveals that, in many cases, the hospital admission could have been prevented through timely and effective care outside of hospital (Li et al. 2009).

Hospitalisations for conditions that can be effectively treated in a non-hospital setting are referred to as 'potentially preventable admissions'. These include conditions for which hospitalisation could potentially be avoided through effective preventive measures or early diagnosis and treatment in primary health care (Page et al. 2007). The list of conditions for which hospitalisation is potentially preventable is subject to debate (Li et al. 2009) and is reviewed from time to time in Australia to reflect advances in health care.

Potentially preventable conditions are usually grouped into three categories:

  • vaccine-preventable conditions—including invasive pneumococcal disease, influenza, tetanus, measles, mumps, rubella, pertussis, and polio
  • potentially preventable acute conditions—including dehydration/gastroenteritis, kidney infection, perforated ulcer, cellulitis, pelvic inflammatory disease, dental conditions, and ear, nose and throat infections
  • potentially preventable chronic conditions—including diabetes, asthma, angina, hypertension, congestive heart failure, and chronic obstructive pulmonary disease.

Systematic differences in hospitalisation rates for Indigenous and non-Indigenous Australians could indicate gaps in the provision of population health interventions (such as immunisation), primary care services (such as early interventions to detect and treat chronic disease), and continuing care support (such as care planning for people with chronic illnesses, e.g. congestive heart failure). Among Indigenous Australians, there is also a higher prevalence for the underlying diseases, and Indigenous Australians are more likely to live in remote areas where non-hospital alternatives are limited (Gibson et al. 2009; Li et al. 2009).

Findings

In the two-year period from July 2011 to June 2013, rates for potentially preventable hospital admissions were 3 times as high for Aboriginal and Torres Strait Islander peoples compared with non-Indigenous Australians. Potentially preventable hospital admissions (excluding those for dialysis) accounted for 21% of all hospital admissions for Indigenous Australians. Differences in hospitalisation rates between Indigenous and non-Indigenous Australians were particularly striking for older age groups.

For Indigenous Australians, vaccine-preventable conditions accounted for around 4% of all selected potentially preventable hospital admissions, acute conditions for 41% of admissions and chronic conditions for 56% of admissions. Diabetes complications were the leading cause of Indigenous potentially preventable hospitalisations (34%), with rates 7.9 times as high as non-Indigenous Australians. Other significant conditions included chronic obstructive pulmonary disease, pyelonephritis, convulsions/epilepsy, dental conditions, and ear, nose and throat infections. For children, the most common conditions were dental conditions, and ear, nose and throat infections, while for adults, diabetes complications were the most prevalent.

Compared with non-Indigenous Australians, hospitalisation rates for selected potentially preventable conditions were 7.3 times as high for Indigenous Australians living in remote areas, 3.5 times as high in very remote areas, 2.8 times as high in outer regional areas, 2.7 times as high in major cities and 2.1 times as high in inner regional areas. Potentially preventable hospitalisations rates for Indigenous Australians were highest in remote areas (254 per 1,000) and very remote areas (118 per 1,000) and lowest in inner regional areas (66 per 1,000) and major cities (72 per 1,000).

Indigenous hospitalisation rates for vaccine-preventable diseases have increased significantly between 2004–05 and 2012–13 in NSW, Victoria, Qld, WA, SA and the NT combined. Due to changes in coding since 2007–08, resulting in an apparent decline for diabetes complication and increase for gastroenteritis, time-series data are not currently available for hospitalisation rates for chronic and acute conditions under this performance measure.

Implications

The most common conditions within the acute group included convulsions and epilepsy, dental, and ear, nose and throat infections. Dental care access issues have been discussed elsewhere in this report (see measures 1.11 and 3.14). The majority of hospitalisations for ear, nose and throat infections occurred in the 0–14 year age group, rates were 2.5 times the non-Indigenous rate for infants (less than 1 year old) and two times the non-Indigenous rate for children aged 1–14. Analysis of data on ear/hearing problems for this age group found self-reported prevalence rates twice that of the non-Indigenous rate, yet GP consultations only 1.1 times as high (see measure 1.15).

Hospitalisation rates for potentially preventable chronic conditions were five times as high for Indigenous Australians as for non-Indigenous Australians. The major conditions within the chronic group were diabetes complications, chronic obstructive pulmonary disease, and asthma. These high rates reflect the higher rate of chronic conditions in the population and the need to strengthen services that intervene earlier in the disease process, including prevention, early detection, and improved chronic disease management (Li et al. 2009).

A number of studies have found that improving patient provider communication and collaboration makes it easier for people to navigate, understand and use information and services to take care of their health e.g. matching information to the patient's needs and abilities, recognising the importance of asking questions, shared decision making, and providing a range of avenues for communication (Øvretveit 2012; Hernandez et al. 2012).Changes in hospitalisation rates for vaccine-preventable conditions are linked to population immunisation rates (see measure 3.02).

The Indigenous Australians' Health Programme, which started on 1 July 2014, aims to assist in reducing avoidable hospitalisations of Aboriginal and Torres Strait Islander peoples by preventing and managing chronic disease and infectious disease through expanded access to and coordination of comprehensive primary health care. Achieving the objectives of this programme will be influenced and supported by the successful implementation of other Indigenous-specific initiatives including early childhood reforms, broader health system changes, improvements in identification of Indigenous patients and measures to address the underlying social determinants of poor health.

Figure 3.07-1 Potentially preventable hospital admissions, by Indigenous status and remoteness, July 2011–June 2013
chart showing Potentially preventable hospital admissions

Figure 3.07-1 shows the rate of hospitalisations (number per 1,000 population) for ambulatory care sensitive conditions among Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians. Data is presented for between July 2011 and June 2013. Data is presented separately for major cities; inner regional areas; outer regional areas; remote areas; and very remote areas. Refer to the findings section of this measure for a description of key results found in this figure.

Source: AIHW Analysis of National Hospital Morbidity Database

Figure 3.07-2 Potentially preventable hospital admissions, by Indigenous status and age group, July 2011–June 2013
chart showing Potentially preventable hospital admissions

Figure 3.07-2 shows the rate of hospitalisations (number per 1,000 population) for ambulatory care sensitive hospital admissions among Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians. Data is presented for between July 2011 and June 2013. Data is presented separately for the following age groups: 0-4 years, 5-14 years, 15-24 years, 25-34 years, 35-44 years, 45-54 years, 55-64 years, and 65 years and over. Refer to the findings section of this measure for a description of key results found in this figure.

Source: AIHW Analysis of National Hospital Morbidity Database

Figure 3.07-3 Top 10 potentially preventable hospital admissions, by Indigenous status, July 2011–June 2013
chart showing Top 10 potentially preventable hospital admissions

Figure 3.07-3 shows the rate of hospitalisations (number per 1,000 population) for the top 10 ambulatory care sensitive hospital admissions among Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians. Data is presented for between July 2011 and June 2013 for diabetes complications, COPD, convulsions and epilepsy, pyelonephritis (an inflammation of the kidney and upper urinary tract), congestive heart failure, cellulitis, dehydration and gastroenteritis, asthma, dental conditions, and ear, nose and throat infections. Refer to the findings section of this measure for a description of key results found in this figure.

Source: AIHW Analysis of National Hospital Morbidity Database