Your likelihood of having a preventable hospitalisation varies by where you live, and your circumstances, according to a new report from the Australian Institute of Health and Welfare (AIHW) released this month. The Report reinforces our view at Catherine Henry Lawyers – that poorer resourcing of health services in regional and rural Australia leads to poorer health outcomes for local people.

The report, Disparities in potentially preventable hospitalisations across Australia 2012–13 to 2017–18, shows that 748,000 (1 in 15 or 6.6%) hospital admissions were classified as potentially preventable in 2017–18. It also found:

• about 1 in every 15 hospitalisations in Australia is classified as potentially preventable
• overall and for men, chronic obstructive pulmonary disease is the most common reason for potentially preventable hospitalisations
• for women, urinary tract infections are the leading cause of potentially preventable hospitalisations
• in recent years, there has been an increase in potentially preventable hospitalisations, largely driven by influenza
• older people, Indigenous Australians and people who live in remote or disadvantaged areas are more likely to be hospitalised for potentially preventable reasons.

Symptomatic of poorer health care in regional and rural Australia

The last point (above) reinforces our view – that poorer resourcing of health services in regional and rural Australia leads to poorer health outcomes for local people. Our view is based on data from this and other reports as well as the experience of the many people we help to seek justice and compensation for medical negligence or medical malpractice. Outside of major cities, Australians not only experience poorer access to health care – this report shows their hospitalisation is more likely to have been preventable.

What are potentially preventable hospitalisations and why are they useful to measure?

Potentially preventable hospitalisations (PPH) are admissions to hospital that could potentially have been avoided through preventive care (such as vaccination), or appropriate disease management (such as treatment of infections or management of chronic conditions) in the community. They are a proxy measure of primary care effectiveness.

PPH are a useful tool for identifying and investigating variations in health outcomes between different populations and understanding health inequalities.

The AIHW points out that a higher rate of PPH doesn’t always indicate a less effective health system. Classifying a hospitalisation as “potentially preventable” does not mean that the hospitalisation itself was unnecessary, however, it indicates that management at an earlier stage may have prevented the patient’s condition worsening to the point of hospitalisation. Some PPH may not be avoidable, such as those for chronically ill or elderly patients who have received optimum primary care, or procedures such as tonsillectomies that are an appropriate follow-up to primary care.

PPH rates in regional NSW

Nationally, the rate of potentially preventable hospitalisations in 2017–18 was around 2,800 per 100,000 people. Rates were highest in the Northern Territory and lowest in the Australian Capital Territory.

Data is available for three areas of regional NSW (matched to a Primary Health Network area) – Hunter, New England and Central Coast; Western NSW and North Coast NSW.

For Hunter, New England and Central Coast in 2017–18, there were 40,334 PPH for total potentially preventable conditions (a rate of 2,631 PPH per 100,000 persons). There was an average length of stay of 4.6 days (with 186,289 bed days total) and 26.0% were same day admissions.

For Western NSW in 2017–18, there were 10,499 PPH for total potentially preventable conditions (a rate of 2,969 PPH per 100,000 persons). There was an average length of stay of 4.4 days (with 45,740 bed days total) and 23.4% were same day admissions.

For North Coast NSW in 2017–18, there were 19,282 PPH for total potentially preventable conditions (a rate of 2,847 PPH per 100,000 persons). There was an average length of stay of 4.2 days (with 80,129 bed days total) and 29.7% were same day admissions.

Common causes of PPH?

The most common cause (10%) of potentially preventable hospitalisations was chronic obstructive pulmonary disease (COPD). Vaccine-preventable pneumonia and influenza, and congestive cardiac failure accounted for the most days of hospital care.

People aged 65 years and over accounted for almost half (46%) of all PPH, and children (aged 0–14) made up 13% (1 in 8).

Aboriginal and/or Torres Strait Islander people experienced PPH at a rate 3 times as high as other Australians. There were about 45,000 PPH for Indigenous Australians in 2017–18, up 25% on 2012–13.

Unsurprising to people living in regional and remote NSW, and regional and remote areas in other states, the Report shows that PPH rates often rise with increasing remoteness and socioeconomic disadvantage. The gap between people living in very remote areas and major cities widened between 2012–13 and 2017–18.

How might hospitalisations be prevented?

The AIHW Report says that primary health care interventions that can help people avoid hospitalisation for some conditions include:

• reducing and managing risk factors for disease
• vaccination
• oral health checks
• sexual health checks
• antenatal care
• diagnosis and prescribing to manage infections
• lifestyle interventions to reduce the development of chronic conditions
• management of chronic conditions to slow progression and risk of complications, including support for self-management.

This care is usually delivered by general practitioners, medical specialists, dentists, nurses and allied health professionals and may be accessed through a variety of community settings, including Aboriginal and Community Controlled Health Services.

What factors affect PPH other than primary care?

It is important not to assume that higher rates of PPH always indicate a less effective primary care system. There are other reasons why an area or group of people may have higher rates of PPH – including higher rates of disease, lifestyle factors and other risks, as well as a genuine need for hospital services.

Changes in hospital coding standards, admission policies and clinical practices can artificially affect PPH rates – conditions known to be impacted include hepatitis B, iron deficiency anaemia, angina and some conditions requiring rehabilitation care.

Where to next?

It would be good if, as the AIHW calls for, linked data sets were used for a better understanding of the complex relationships between potentially preventable hospitalisations and disease prevalence, use of primary health care, use of medicines and health outcomes.

In terms of addressing the broader issue of people living in regional and remote Australia experiencing poorer health outcomes that those living in metropolitan areas – the Government needs to increase funding and attention to the issues of rural health service provision and rural health workforce issues. In 2017 a National Rural Health Commissioner was appointed. I welcomed the Commissioner’s appointment but predicted progress on rural health reform would be slow. Progress will continue to be slow. Meanwhile, we still have agencies such as the National Health Performance Authority refusing to release national data on death rates and adverse events in hospitals. In countries such as the United States and England, this information is available to the public – by postcode – at the touch of a button.

If you’ve had a negative health care experience that has left you with an ongoing injury, contact us to speak to a solicitor and find out whether you might be entitled to make a claim.