BackgroundThe continued increase in hospital admissions is a significant and complex issue facing health services. There is little research exploring patient perspectives or examining individual admissions among patients with frequent admissions for chronic ambulatory care sensitive (ACS) conditions. This paper aims to describe characteristics of older, rural patients frequently admitted with ACS conditions and identify factors associated with their admissions from the patient perspective.MethodsPatients aged 65+ resident in North Coast NSW with three or more admissions for selected ACS chronic conditions within a 12 month period, were invited to participate in a postal survey and follow up telephone call. Survey and telephone data were linked to admission and health service program data. Descriptive statistics were generated for survey respondents; logistic regression models developed to compare characteristics of patients with 3 or with 4+ admissions; and comparisons made between survey respondents and non-respondents.ResultsSurvey respondents (n=102) had a mean age of 77.1 years (range 66–95 years), and a mean of 4.1 admissions within 12 months; 49% had at least three chronic conditions; the majority had low socioeconomic status; one in five (22%) reported some difficulty affording their medication; and 35% lived alone. The majority reported psychological distress with 31% having moderate or severe psychological distress. While all had a GP, only 38% reported having a written GP care plan. 22% of those who needed regular help with daily tasks did not have a close friend or relative who regularly cared for them. Factors independently associated with more frequent (n=4+) relative to less frequent (n=3) admissions included having congestive heart failure (p=0.003), higher social isolation scores (p=0.040) and higher Charlson Comorbidity Index scores (p=0.049). Most respondents (61%) felt there was nothing that could have avoided their most recent admission, although some potential avoidability of admission was described around medication and health behaviours. Respondents were younger and less sick than non-respondents.ConclusionsThis study provides a detailed description of older patients with multiple chronic conditions and a history of frequent admission in rural Australia. Our results suggest that programs targeting medication use, health behaviours and social isolation may help reduce multiple hospital admissions for chronic disease.

Socioeconomic disadvantage remains one of the dominant determinants of SGA, even in a developed country with universal insurance. This relation appears to be strengthening. Smoking patterns, inadequate antenatal care and clinical conditions partially account for this association and trend, however, most is mediated by other factors.

H 10,000 new infections each year.'Transmission is predominantly via blood, with shared drug injection equipment being the major exposure.2 Little is known about the impact of HCV on behaviour or circumstance of infected individuals. Media reports suggest community concern regarding bloodborne viruses (BBVs) such as HCV, compounded by negative stereotyping of injecting drug users (IDUs). We report on the impact of HCV infection on behaviour, treatment choices and lifestyle in people notified with HCV on the NSW North Coast. MethodsStudy methods have been described prev i o~s l y .~ Briefly, all persons notified with HCV over a 21-month period during 1993 and 1994 were asked to complete a questionnaire examining exposures, therapies and behaviours. Subjects were asked specifically how their infection had influenced behaviours such as alcohol and tobacco intake, and personal circumstances such as relationships and working ability. Details of symptoms were requested on a separate questionnaire from attending medical practitioners with patients' written consent. ResultsKnowledge of potential risk factors for HCV infection varied. Of 467 resident cases who responded, 321 (69%) were aware of potential exposures. Of 398 IDUs, 238 (60%) identified this as an exposure. Forty-three IDUs believed they were infected via other means, 34 did not know and 83 did not state how they were infected. Of 30 non-IDU transfusion recipients, 24 identified this as an exposure. Only 9 of 176 tattooed subjects stated this as a potential exposure.The major reported symptom was fatigue affecting some aspect of daily life, e.g. relationship, work, sleep (n=212; 45%). Some 182 (39%) also reported reduced ability to perform daily duties, 50 (1 1%) nausea and 77 (16%) emotional disturbances (e.g. stress, depression). There was no association between symptoms and hepatitis B virus coinfection (x2=0.21, df=l, p=0.65).Symptoms observed by medical practitioners were reported for a sub-sample of 2 19 subjects (1 17 male, 102 female): 78 (36%) reported fatigue, 47 (21 %) nausea, 46 (21 %) abdominal pain, 28 (13%) loss of appetite, 14 (6%) vomiting, and 7 (3%) jaundice. Fifty-nine (27%) were asymptomatic.Many subjects (n=338; 72%) reported no treatment for HCV, many having not so far returned since diagnosis. Twelve (3%) had used interferon, 37 (8%) anti-emetics, 34 (7%) pain relief and 15 (3%) sedatives. A variety of complementary therapies were also trialed (Table 1). Other steps to improve health included stress management, exercise, reduced alcohol/drug intake, yoga, meditation and counselling.Many people reported n o change in circumstance due to their infection. Others reported negative effects on physical and mental health, and social interaction ( Table 2). Reports of isolation and discrimination related to community concern about HCV, stereotyping of people with H C V and adverse media portrayal of the disease. Respondents had concerns about commencing relationships, HCV infection having ended relationships, introduced fear and/or tension, a...

A retrospective follow-up survey was undertaken of residents of the North Coast of New South Wales infected with Ross River virus in 1992. The aims of the study were to describe the epidemiology and acute symptomatology of Ross River virus infection, its natural history during the first 12 months of infection, and its effects on those infected. Questionnaires were distributed to both cases and their medical practitioners. Of 129 people infected, aged between six and 85 years, 81 (63 per cent) were male and 48 (37 per cent) were female. The peak age-specific incidence was in the age group 50 to 59 years. The most common symptoms were arthralgia (95 per cent) and tiredness (91 per cent). Over 60 per cent took time off work. At 12 months follow-up, over 50 per cent reported persistent arthralgia, 35 per cent reported persistent tiredness and 15 per cent were still unable to carry out their normal activities. The median duration of symptoms was in the range 7 to 12 months, and of incapacity was in the range five weeks to three months. There were some differences from previous reports of Ross River virus outbreaks, in the incidence of major symptoms and the duration of illness and incapacity. 'These are likely to be at least partly due to inconsistent measurement methods. In this study, there were systematic differences between medical practitioners' and patients' estimates of periods of incapacity. Previous estimates of the direct economic costs and indirect human costs of infection based on data obtained from medical practitioners, although alarming, are almost certainly underestimates.

Socioeconomic disadvantage increases both the risk of acute coronary syndrome and related mortality. A contributing factor appears to be a reduced chance of receiving appropriate care. Regions with a higher proportion of indigenous residents show risk beyond the effects of general socioeconomic disadvantage, while residents of metropolitan communities had increased utilization of more recent interventions.