Rural Patients’ Perceptions of Their Potentially Preventable Hospitalisation: A Qualitative Study

Abstract

Potentially preventable hospitalisations (PPHs) occur when patients receive hospital care for a condition that could have been more appropriately managed in the primary healthcare setting. It is anticipated that the causes of PPHs in rural populations may differ from those in urban populations; however, this is understudied. Semi-structured interviews with 10 rural Australian patients enabled them to describe their recent PPH experience. Reflexive thematic analysis was used to identify the common factors that may have led to their PPH. The analysis revealed that most participants had challenges associated with their health and its optimal self-management. Self-referral to hospital with the belief that this was the only treatment option available was also common. Most participants had limited social networks to call on in times of need or ill health. Finally, difficulty in accessing primary healthcare, especially urgently or after-hours, was described as a frequent cause of PPH. These qualitative accounts revealed that patients describe nonclinical risk factors as contributing to their recent PPH and reinforces that the views of patients should be included when designing interventions to reduce PPHs.

Risk Factors Associated with Preventable Hospitalisation among Rural Community-Dwelling Patients: A Systematic Review

“…A further 26 papers were excluded for not meeting inclusion criteria, leaving 13 papers for review and analysis ( Figure 1 ). Eight papers were quantitative/descriptive studies [ 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 ] and five were qualitative studies [ 40 , 41 , 42 , 43 , 44 ]. Only one study reported no statistically significant association between the variables studied (physician supply) and rural PPH risk [ 35 ].…”

“…The population for study was variably described; this included being conducted in administrative areas serviced by “rural Indian Health Services” [ 34 ] or rural “health professional shortage areas” in Nebraska [ 39 ]. Other studies described a specific rural region of Tasmania [ 36 , 40 , 41 ], Victoria [ 32 ], or New South Wales [ 37 , 42 , 43 , 44 ] as the setting. The remainder used large, usually national, datasets from which rural patient data could be extracted.…”

“…All the qualitative studies in this review were from two research groups, each with their own geographical location of interest, namely the north coast of New South Wales [ 42 , 43 , 44 ] or Southern Tasmania [ 40 , 41 ].…”

“…Characteristics defining rurality were taken from definitions issued by Australian Government organisations [ 32 , 36 , 37 , 40 , 41 , 43 , 44 , 46 ] or similar American bodies [ 33 , 35 , 39 , 47 ]. Korenbrot et al included patients who were treated at rural Indian Health Services [ 34 ].…”

Yonder: Brexit, preventable hospitalisations, prescribing assessments, and doctor retention

“…A recent Australian study sought to identify common risk factors that rural patients described as contributing factors associated with their recent PPH. 2 They found that health literacy, social support networks, the ability to access primary healthcare services, and perceptions of primary care were determinants of PPH risk. While access and utilisation of wellintegrated primary healthcare services is a part of the solution, the researchers emphasise that community- and individuallevel factors also need to be addressed when considering future interventions.…”