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How much emergency department use by vulnerable populations is potentially preventable?: A period prevalence study of linked public hospital data in South Australia

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dc.contributor.authorBanham, D.
dc.contributor.authorKarnon, J.
dc.contributor.authorDensley, K.
dc.contributor.authorLynch, J.W.
dc.date.issued2019
dc.description.abstractOBJECTIVES:To quantify emergency department (ED) presentations by individuals within vulnerable populations compared with other adults and the extent to which these are potentially preventable. DESIGN:Period prevalence study from 2005-2006 to 2010-2011. SETTING:Person-linked, ED administrative records for public hospitals in South Australia. PARTICIPANTS:Adults aged 20 or more in South Australia's metropolitan area presenting to ED and categorised as Refugee and Asylum Seeker Countries of birth (RASC); Aboriginal; those aged 75 years or more; or All others. MAIN OUTCOME MEASURES:Unadjusted rates of ambulatory care sensitive condition (ACSC), general practitioner (GP)-type presentations and associated direct ED costs among mutually exclusive groups of individuals. RESULTS:Disparity between RASC and All others was greatest for GP-type presentations (423.7 and 240.1 persons per 1000 population, respectively) with excess costs of $A106 573 (95% CI $A98 775 to $A114 371) per 1000 population. Aboriginal had highest acute ACSC presenter rates (125.8 against 51.6 per 1000 population) with twice the risk of multiple presentations and $A108 701 (95% CI $A374 to $A123 029) per 1000 excess costs. Those aged 75 or more had highest chronic ACSC presenter rates (119.7vs21.1 per 1000), threefold risk of further presentations (incidence rate ratio 3.20, 95% CI 3.14 to 3.26) and excess cost of $A385 (95% CI $A178 160 to $A184 609) per 1000 population. CONCLUSIONS:Vulnerable groups had excess ED presentations for a range of issues potentially better addressed through primary and community healthcare. The observed differences suggest inequities in the uptake of effective primary and community care and represent a source of excess cost to the public hospital system.
dc.identifier.citationBMJ Open, 2019; 9(1):e022845-e022845
dc.identifier.doi10.1136/bmjopen-2018-022845
dc.identifier.issn2044-6055
dc.identifier.issn2044-6055
dc.identifier.orcidKarnon, J. [0000-0003-3220-2099]
dc.identifier.orcidLynch, J.W. [0000-0003-2781-7902]
dc.identifier.urihttps://hdl.handle.net/11541.2/137028
dc.language.isoen
dc.publisherBMJ
dc.rightsCopyright 2019 Author(s) (or their employer(s)). This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially,and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. (http://creativecommons.org/licenses/by-nc/4.0/)
dc.source.urihttps://doi.org/10.1136/bmjopen-2018-022845
dc.subjectdelivery of health care
dc.subjectelderly
dc.subjectemergency departments
dc.subjecthospital costs
dc.subjectindigenous population
dc.subjectrefugees
dc.titleHow much emergency department use by vulnerable populations is potentially preventable?: A period prevalence study of linked public hospital data in South Australia
dc.typeJournal article
pubs.publication-statusPublished
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ror.mmsid9916253198601831

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