Community based service providers' perspectives on frequent and/or avoidable admission of older people with chronic disease in rural NSW: a qualitative study

Abstract

BackgroundFrequent and potentially avoidable hospital admission amongst older patients with ambulatory care sensitive (ACS) chronic conditions is a major topic for research internationally, driven by the imperative to understand and therefore reduce hospital admissions. Research to date has mostly focused on analysis of routine data using ACS as a proxy for 'potentially avoidable'. There has been less research on the antecedents of frequent and/or avoidable admission from the perspectives of patients or those offering community based care and support for these patients. This study aimed to explore community based service providers' perspectives on the factors contributing to admission among older patients with chronic disease and a history of frequent and potentially avoidable admission.Methods15 semi-structured interviews with community based providers of health care and other services, and an emergency department physician were conducted. Summary documents were produced and thematic analysis undertaken.ResultsA range of complex barriers which limit or inhibit access to services were reported. We classified these as external and internal barriers. Important external barriers included: complexity of provision of services, patients' limited awareness of different services and their inexperience in accessing services, patients needing a higher level or longer length of service than they currently have access to, or an actual lack of available services, patient poverty, rurality, and transport. Important internal barriers included: fear (of change for example), a 'stoic' attitude to life, and for some, the difficulty of accepting their changed health status.ConclusionsThe factors underlying frequent and/or potentially avoidable admission are numerous and complex. Identifying strategies to improve services or interventions for this group requires understanding patient, carer and service providers' perspectives. Improving accessibility of services is also complex, and includes consideration of patients' social, emotional and psychological ability and willingness to use services as well as those services being available and easily accessed.

The role of social isolation in frequent and/or avoidable hospitalisation: rural community-based service providers’ perspectives

“…These services often have long waiting lists and there are often considerable additional barriers to accessing services, sometimes specific to rural locations. 25,37 A limitation of our study is that we did not aim to explore social isolation and it was not discussed in depth in every interview. We acknowledge that in-depth exploration of social isolation within interviews would have yielded greater detail and insight.…”

“…Our methods are described in greater detail in our previous paper. 25 The study was approved by the North Coast Area Health Services Human Research Ethics Committee.…”

“…12 This paper describes additional analyses of data from an exploratory scoping study by our group, 25 which reported that the factors underlying frequent and/or avoidable ACS hospital admission among older people are numerous and complex, and include significant external and internal barriers to accessing services. The current paper explores one central theme that emerged when providers were asked about common factors or characteristics of older rural patients frequently admitted for ACS conditions: the role of social isolation.…”

Community pharmacy in Australia: A health hub destination of the future

“…Furthermore, this gap in the health system was recently highlighted in an Australian study that also interviewed community based service providers. 24 Our study identified that pharmacists are ideally placed to address this disconnect in the health system by navigating (or signposting) consumers from two perspectives: to other health professionals in a clinical triage role and to non-government consumer health organizations, thereby providing a more holistic approach to care. This can be viewed as complementary to the pharmacist's current role in the provision of medication advice.…”

“…Semi-structured interviews were used, giving stakeholders the opportunity to express their opinion(s) and experiences 24 , enabling exploration of a number of areas: concerns related to the management of a chronic illness and medication use that community pharmacy could assist with, views of the current and future role(s) of community pharmacy and potential barriers in developing these role(s). An interview guide (Table 1) …”