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1دورية أكاديمية
المؤلفون: David Youens
المصدر: International Journal of Population Data Science, Vol 5, Iss 5 (2020)
مصطلحات موضوعية: Demography. Population. Vital events, HB848-3697
الوصف: Introduction Research has demonstrated continuity and regularity of general practitioner (GP) contacts to be associated with reduced hospitalisations and emergency department (ED) presentations. Opportunities for improved medication management are often cited as a potential causal mechanism, but little research has directly addressed this. Objectives and Approach To determine associations between continuity of primary care and adherence with statin medications amongst individuals at risk of cardiovascular disease outcomes, taking statins through the exposure period of July 2011 - June 2012. We used self-report and administrative data from 267,153 participants of the 45 and Up Study conducted in New South Wales, Australia from 2006-2009. Medicare Benefits Schedule and Pharmaceutical Benefits Scheme data, from the Australian Government Department of Human Services, were linked to survey, hospital and death data by the NSW Centre for Health Record Linkage. Exposures were the Usual Provider of Care (UPC) index, i.e. the proportion of visits made to the usual GP; and a regularity index assessing whether patients were visiting the GP on a regular basis. Cox regression estimated associations between these exposures and time to cessation of statin medication, defined as a 30-day period without supply. Results Preliminary findings amongst a cohort of approximately 48,000 indicated that increases in both regularity and continuity of primary care were associated with reduced likelihood of statin cessation. After controlling for socio-demographic and health status indicators the hazard ratio for cessation in the most regular quintile (baseline least) was 0.84 (95%CI 0.80 – 0.87) and in the highest continuity quintile was 0.93 (95%CI 0.89 – 0.96). Conclusion / Implications Previous work assessed relationships between continuity of care and downstream hospital and ED outcomes. This work complements existing literature by assessing intermediate outcomes, aiding understanding of potential causal pathways. These findings are relevant given adherence to statin medication is often sub-optimal.
وصف الملف: electronic resource
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2دورية أكاديمية
المؤلفون: David Youens, Rachael Moorin, Amy Harrison, Richard Varhol, Suzanne Robinson, Caroline Brooks, James Boyd
المصدر: International Journal of Population Data Science, Vol 5, Iss 1 (2020)
مصطلحات موضوعية: General practice, Administrative data, Big data, Health information systems, Medical records systems, Demography. Population. Vital events, HB848-3697
الوصف: General practice is often a patient’s first point of contact with the health system and the gateway to specialist services. In Australia different aspects of the health system are managed by the Commonwealth Government and individual state/territory governments. Although there is a long history of research using administrative data in Australia, this split in the management and funding of services has hindered whole-system research. Additionally, the administrative data typically available for research are often collected for reimbursement purposes and lack clinical information. General practices collect a range of patient information including diagnoses, medications prescribed, results of pathology tests ordered and so on. Practices are increasingly using clinical information systems and data extraction tools to make use of this information. This paper describes approaches used on several research projects to access clinical, as opposed to administrative, general practice data which to date has seen little use as a resource for research. This information was accessed in three ways. The first was by working directly with practices to access clinical and management data to support research. The second involved accessing general practice data through collaboration with Primary Health Networks, recently established in Australia to increase the efficiency and effectiveness of health services for patients. The third was via NPS MedicineWise’s MedicineInsight program, which collects data from consenting practices across Australia and makes these data available to researchers. We describe each approach including data access requirements and the advantages and challenges of each method. All approaches provide the opportunity to better understand data previously unavailable for research in Australia. The challenge of linking general practice data to other sources, currently being explored for general practice data, is discussed. Finally, we describe some general practice data collections used for research internationally and how these compare to collections available in Australia. Keywords: General practice; administrative data; big data, health information systems, medical records systems
وصف الملف: electronic resource
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3دورية أكاديمية
المؤلفون: Rachael Moorin, David Youens, David Preen, Mark Harris, Cameron Wright
المصدر: International Journal of Population Data Science, Vol 4, Iss 3 (2019)
مصطلحات موضوعية: Demography. Population. Vital events, HB848-3697
الوصف: Background and rationale We have previously reported decreased rates and costs of diabetes-related hospitalisations with increasing regularity of general practitioner (GP) contact. However previous work has not adjusted for continuity of provider. Thus, despite the relevance for policy development, whether increased regularity is actually a proxy for, or a consequence of, increasing continuity of provider, or is a discrete facet of continuity of care is unknown. Main Aim To assess the association between continuity of provider-adjusted regularity of GP contact and unplanned diabetes-related hospitalisation or emergency department (ED) presentation. Methods/Approach This retrospective, cross-sectional study used linked administrative (from the Centre for Health Record Linkage & the Department of Human Services) and survey data from the baseline 45 and Up Study (2006-09 n=267,153) with a history of diabetes and at least two GP contacts (n=27,409). Multivariable zero-inflated negative binomial and two part generalised linear models were used to asses unplanned diabetes-related hospitalisations or ED presentations, associated costs and cumulative bed days. Results Highest regularity of GP contact was associated with a lower probability (-0.28) of diabetes-related hospitalisation or ED presentations. For those with a previous hospitalisation or ED presentation, higher regularity was associated with a reduction in the number of hospitalisations or ED presentations (6 to 8%); bed days (30 to 44%); and average cost (23 to 41%). Importantly, continuity of provider did not significantly modify the effect of GP regularity for any outcome. Conclusion Higher regularity of GP contact – that is more evenly dispersed, not necessarily more frequent care – has the potential to reduce health care costs and, for those with a previous hospitalisation, the time spent in hospital, irrespective of continuity of provider. These findings argue for the advocacy of regular care, as distinct from solely continuity of provider, when designing policy and financial incentives for GP-led primary care.
وصف الملف: electronic resource
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4دورية أكاديميةRegular General Practitioner contact - analysis of methods for measurement using administrative data
المؤلفون: David Youens, Rachael Moorin, David B Preen, Mark Harris, Suzanne Robinson
المصدر: International Journal of Population Data Science, Vol 3, Iss 4 (2018)
مصطلحات موضوعية: Demography. Population. Vital events, HB848-3697
الوصف: Introduction There is a small body of literature examining the relationship between “regularity” of contact with General Practitioners (GPs), i.e. the pattern of visits over time, and health outcomes. Methods previously used to measure regularity may be conflated with the number of GP visits (frequency) which may impact on effect estimates. Objectives and Approach Two published regularity measures, one derived from the variance in the days between GP visits and the second a categorical indicator, were assessed alongside a new measure designed to be uncorrelated with frequency. A cohort at risk of diabetes-related hospitalisation was identified from primary care and hospitalisation data. Associations between regularity and frequency were assessed for each measure using negative binomial regression. Hospitalisation outcomes were regressed on regularity scores using negative binomial models, with and without frequency included, to assess whether associations between regularity and frequency biased estimates. Simulated data tested each measure’s responsiveness to changes in GP visit patterns. Results The new regularity measure showed a substantially weaker association between regularity and frequency than the two previously published scores. According to the new measure, more regular GP contact was associated with a reduction in the rate of hospitalisation and this association was unchanged by the inclusion of frequency as a covariate. Under the existing measures regular contact was also associated with reduced hospitalisation, but the association differed depending on whether frequency was included in the model, suggesting that associations between regularity and frequency may confound relationships with health outcomes if uncontrolled for. Simulated data suggested that the measures responded differently to changes in visitation pattern with the existing categorical indicator being the least responsive. Conclusion/Implications Despite a large body of literature on provider continuity, little research has examined regularity of GP contact. This is the first work to compare measures of regularity and represents an important methodological advancement. Researchers should consider regularity of contact as a dimension of continuity of care when designing studies.
وصف الملف: electronic resource
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5دورية أكاديمية
المؤلفون: Rachael Moorin, Cameron Wright, David Youens
المصدر: International Journal of Population Data Science, Vol 3, Iss 4 (2018)
مصطلحات موضوعية: Demography. Population. Vital events, HB848-3697
الوصف: Introduction Expected time to death is often used to determine eligibility to publicly funded community-based palliative care (CPC) because most acute care costs in the end-of-life period are incurred immediately prior death. We know CPC use reduces acute care costs but the impact of timing of initiation is unknown. Objectives and Approach We explored the association between timing of CPC initiation and unplanned hospital use, over the final year of life for Western Australian cancer decedents who died between 1/1/2001 and 31/12/2011 using linked Cancer Registry, Mortality System, Hospital Morbidity Data Collection, Emergency Department (ED) Data Collection and CPC records. The relationship between first-time use of CPC and unplanned hospitalisations and ED presentations was evaluated using multivariable negative binomial regression and Cragg-hurdle models. The exposure was month of CPC initiation (adjusted for intensity of use); outcomes were the rate, length of stay and cost of unplanned hospitalisations and emergency department presentations. Results Of the 28,331 decedents residing in the CPC catchment area, 16,439 (58%) accessed CPC, mostly (64%) in the last three months of life. Initiation of CPC prior to the last six months of life was associated with a lower mean number of unplanned hospitalisations in the last six months of life (1.4 versus 1.7 for initiation within six months of death); associated average costs were also lower ((AU$, 2012) 12,976 versus $13,959). While patients initiating CPC earlier showed a trend toward fewer hospital admissions, earlier initiation was associated with a higher cumulative and average length of stay. Indirect adjustment for admission complexity suggests that this may be due to more complicated indications. Conclusion/Implications This study provides more detail to guide policy around timing of access to CPC. Our results argue against restricting access to the final few months of life, as earlier initiation may result in fewer and lower the cost of unplanned hospitalisations and ED presentations at the very end of life.
وصف الملف: electronic resource
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6دورية أكاديمية
المؤلفون: David Youens, Rachael Moorin
المصدر: International Journal of Population Data Science, Vol 1, Iss 1 (2017)
مصطلحات موضوعية: Demography. Population. Vital events, HB848-3697
الوصف: ABSTRACT Objectives Potentially preventable hospitalisations (PPHs) place a substantial burden on the Australian health system, with over 212,000 PPHs reported for diabetes alone in 2005/06. Timely and effective primary care may reduce the risk of acute episodes and subsequent hospitalisation among those with chronic diseases. The Medicare Enhanced Primary Care program, introduced to improve the regularity and quality of healthcare provided by GPs to Australians with chronic disease, has been shown to improve regularity of GP access. The aim of our study is to ascertain whether more regular GP access reduces diabetes PPHs. Approach Whole of population longitudinal study using linked hospital, mortality, and general practice data. Regularity of GP access was determined through calculating the variance in the number of days between GP visits within a year. Regular GP contact was taken to indicate planned, proactive primary care, and irregular GP contact taken to indicate unplanned, reactive care. Multilevel modelling techniques were used to determine the relationship between regularity of GP access and diabetic PPHs in the population at risk of diabetes. Analyses were performed for the periods prior to and following the introduction of policies aimed at promoting primary care contact. Results This paper will report results on the relationship between regular, proactive GP contact and diabetes PPHs in the population with and at risk of diabetes. Socio-demographic, geo-spatial and access factors were found to influence the regularity of GP access. Individual factors, in particular disease status, were found to substantially modify the relationship between regularity and PPH outcome. Findings differed between the periods prior to and following the introduction of government policies aimed at promoting proactive primary care in chronic disease. Conclusion Findings from this study will provide important evidence concerning strategies to reduce PPHs in relation to diabetes, which will be of interest to policy-makers wishing to reduce unnecessary hospitalisations. This work will extend to examine the impact of regularity on PPHs for a number of other chronic conditions considered priorities in Australia.
وصف الملف: electronic resource
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7دورية أكاديمية
المؤلفون: Rachael Moorin, David Youens
المصدر: International Journal of Population Data Science, Vol 1, Iss 1 (2017)
مصطلحات موضوعية: Demography. Population. Vital events, HB848-3697
الوصف: ABSTRACT Objectives Correctly ascertaining person-time at risk is paramount to longitudinal studies of health services research and relies on the ability to track the status of individuals throughout the study. Administrative health data contain limited information on where study subjects live in the time between episodes of health service use. Accurate ascertainment of person-time at risk is important particularly when it varies differentially across exposure groups or covariates. Historical electoral roll data allows better specification of person-time and also provides longitudinal information on geographic location facilitating the inclusion of accessibility and socio-economic status longitudinally. This study evaluated the utility of Australian historical electoral roll data to capture place of residence throughout the time line of a whole of population longitudinal cohort study over 20 years to better ascertain person-time at risk and changes in socio-economic status (SES). Approach The association between regularity of GP contact and potentially preventable hospitalisations (PPHs) in WA was modelled using person-level linked data where the time at risk and socio-economic status for both the exposure (regularity of GP contact) and outcome (PPHs) was assumed to be constant throughout the follow up until death. The analysis was then repeated incorporating historical (longitudinal) electoral roll data. These data partitioned follow up time and socio-economic status according to location of residence within the State to better characterise access and SES and included removal (out-of-State/country migration) and re-enrolment records. Results Substantial differences were found in the number of people at risk (46,625 (13%) of people were never at risk) and person-time at risk (reduction of 473,708 (22%) person-years at risk) when cross-sectional electoral roll and health administrative data were augmented using historical electoral roll data. Substantial changes in residential postcode (up to 25 changes) were observed and these impacted on the accessibility and SES classification across the duration of the study. These changes significantly impacted the magnitude of the relationship between GP contacts on PPHs determined by models. Conclusions Currently cross-sectional electoral roll data are available to researchers in WA solely for the purposes of identifying and characterising a cohort at baseline. However these data are longitudinal and contain important information that improve analyses. Information on their utility is important so as to leverage their availability from the Australian Electoral Commission.
وصف الملف: electronic resource
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