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Objective: The study examined emergency department (ED) presentations, unplanned hospitalisations and potentially preventable hospitalisations in older people receiving long-term care by type of care received (i.e. permanent residential aged care or home care packages in the community), in Australia in 2019. Methods: A retrospective cohort study was conducted using the Registry of Senior Australians National Historical Cohort. Individuals were included if they resided in South Australia, Queensland, Victoria or New South Wales, received a home care package or permanent residential aged care in 2019 and were aged ≥65 years. The cumulative incidence of ED presentations, unplanned hospitalisations and potentially preventable hospitalisations in each of the long-term care service types were estimated during the year. Days in hospital per 1000 individuals were also calculated. Results: The study included 203,278 individuals accessing permanent residential aged care (209,639 episodes) and 118,999 accessing home care packages in the community (127,893 episodes). A higher proportion of people accessing home care packages had an ED presentation (43.1% [95% confidence interval, 42.8–43.3], vs 37.8% [37.6–38.0]), unplanned hospitalisation (39.8% [39.6–40.1] vs 33.4% [33.2–33.6]) and potentially preventable hospitalisation (11.8% [11.6–12.0] vs 8.2% [8.1–8.4]) than people accessing permanent residential aged care. Individuals with home care packages had more days in hospital due to unplanned hospitalisations than those in residential care (7745 vs 3049 days/1000 individuals). Conclusions: While a high proportion of older people in long-term care have ED presentations, unplanned hospitalisations and potentially preventable hospitalisations, people in the community with home care packages experience these events at a higher frequency. What is known about the topic? Unplanned hospitalisations and emergency department presentations are frequent and burdensome for older people receiving long-term aged care. What does this paper add? While unplanned hospitalisations and emergency department presentations were high in all people receiving long-term care, these events were higher in people receiving home care packages than those in residential aged care. What are the implications for practitioners? Further efforts to address the high unplanned hospitalisations and emergency department presentations experienced by the increasing number of older adults accessing home care packages are required to allow this population to remain at home successfully. This article belongs to the Special Issue: Value-based Healthcare. [ABSTRACT FROM AUTHOR]

Objective. This study aimed to map the geographic distribution of tertiary hospitals in Australia’s most populous cities. Good access to hospital facilities improves the health and welfare of a community. The use of geographic information system (GIS) technology can assist in understanding spacial accessibility to services. Methods. Using Quantum GIS, a geodatabase was constructed to incorporate hospital locations and demographic distribution data throughout Australia’s 20 most populous cities. Data on the population’s age groups were integrated into the geodatabase to investigate the distribution of age groups and their utilisation of access to emergency departments in tertiary public health care. Overall this study reported the geospatial distribution of 89 tertiary hospitals and the demographics of the population in areas around these hospitals. Results. The majority of hospitals were located in the three most populated cities of New South Wales (NSW), Sydney, Wollongong and Newcastle, which contain a total of 32 hospitals, with 23 (72%) of the hospitals in Sydney. There were 7.8, 24.0, 53.4 and 81.0% of the population in NSW within 1.5, 3, 6 and 50 km of the hospitals, respectively. The second-highest number of hospitals was in Victoria (n = 22), with 18 (82%) hospitals located in Melbourne. This was followed by Queensland (n = 14), with eight (57%) hospitals located in Brisbane. Conclusions. The results indicate that 82.2% of the Australian population lives within a 50 km radius of a tertiary hospital, with NSW having higher age distribution percentages than the other states. The results of this study could be used to locate and improve areas of need with a high burden of disease and low accessibility to healthcare services. [ABSTRACT FROM AUTHOR]

Objective: The aims of this study were to review the demographic details of those who have undergone lower limb amputation (LLA) surgery in Central Australia and determine the region-specific age-adjusted incidence rate of LLA. Methods: A retrospective audit of service users who underwent LLA in a Central Australian hospital from 2012 to 2017 was undertaken. Demographic, operative and postoperative outcomes data were collected. The age-adjusted incidence rate of LLA was determined using the direct method. Demographic data were analysed using descriptive parametric analysis. Results: In the period 2012–17, 166 service users underwent a total of 291 amputations in 231 episodes of care (hospital admissions). The age-adjusted incidence rate of LLA was 87.4 per 100 000 for females and 104.6 per 100 000 for males in this region. In total, 84% (n = 140) of those requiring amputation surgery identified as Aboriginal Australians (P < 0.001), 54% (n = 75) of whom were female. Aboriginal Australians who underwent LLA were, on average, 13 years younger and were more likely to have type 2 diabetes (P < 0.001) and require renal dialysis (P < 0.001) than the non-Aboriginal Australian cohort. Of the Aboriginal Australians who underwent LLA, 82% (n = 103) lived very remotely (>100 km from the central town's centre), compared with 23% of non-Aboriginal Australians (P < 0.001). In addition, 46% (n = 64) of Aboriginal Australians who underwent LLA required renal dialysis. Those requiring renal dialysis were more likely to require subsequent amputation (P = 0.014) and had a higher mortality rate following amputation (P = 0.031). Partial foot amputation was the most common level of amputation in Central Australia (38%). Conclusions: Central Australia appears to have the highest incidence rate of LLA for any region in Australia, with Aboriginal Australians, particularly females and those undergoing renal dialysis, being disproportionately represented. Further studies should aim to determine targeted, culturally safe and successful methods of diabetic foot ulcer prevention, early detection and management with a view to reducing the high amputation rates for these cohorts. What is known about the topic?: Large health inequalities between Aboriginal and non-Aboriginal Australians exist. Aboriginal Australians are currently fourfold as likely as non-Aboriginal Australians to have type 2 diabetes (T2D), increasing their risk of LLA. There is a geographical variance in the incidence of LLA in Australia; the Northern Territory is overrepresented, with rates two- to threefold higher than that of the national average. Regional incidence rates are not currently known. What does this paper add?: This study showed that the age-adjusted incidence rate for LLA in Central Australia is significantly higher than in other regions in Australia. Most LLA surgeries undertaken in Central Australia were performed for Aboriginal Australians who have T2D, with a disproportionate representation of females and those requiring renal dialysis. What are the implications for practitioners?: This study shows that there is a need for further research and preventative measures to address the high rates of LLA among Aboriginal Australians, particularly for females and those with renal impairment. These groups could benefit from targeted, culturally safe approaches to early identification, referral and management of lower limb ulceration by relevant service providers. [ABSTRACT FROM AUTHOR]

Objective Access to primary healthcare (PHC) services is key to improving health outcomes in rural areas. Unfortunately, little is known about which aspect of access is most important. The objective of this study was to determine the relative importance of different dimensions of access in the decisions of rural Australians to utilise PHC provided by general practitioners (GP). Methods Data were collected from residents of five communities located in 'closely' settled and 'sparsely' settled rural regions. A paired-comparison methodology was used to quantify the relative importance of availability, distance, affordability (cost) and acceptability (preference) in relation to respondents' decisions to utilise a GP service for non-emergency care. Results Consumers reported that preference for a GP and GP availability are far more important than distance to and cost of the service when deciding to visit a GP for non-emergency care. Important differences in rankings emerged by geographic context, gender and age. Conclusions Understanding how different dimensions of access influence the utilisation of PHC services is critical in planning the provision of PHC services. This study reports how consumers 'trade-off' the different dimensions of access when accessing GP care in rural Australia. The results show that ensuring 'good' access requires that policymakers and planners should consider other dimensions of access to services besides geography. [ABSTRACT FROM AUTHOR]

Objective. To determine whether there are real differences in emergency department (ED) performance between Australian states and territories. Methods. Cross-sectional analysis of 2009-10 attendances at an ED contributing to the Australian non-admitted patient ED care database. The main outcome measure was difference in waiting time across triage categories. Results. There were more than 5.8 million ED attendances. Raw ED waiting times varied by a range of factors including jurisdiction, triage category, geographic location and hospital peer group. All variables were significant in a model designed to test the effect of jurisdiction on ED waiting times, including triage category, hospital peer group, patient socioeconomic status and patient remoteness. When the interaction between triage category and jurisdiction entered the model, it was found to have a significant effect on ED waiting times (P < 0.001) and triage was also significant (P < 0.001). Jurisdiction was no longer statistically significant (P = 0.248 using all triage categories and 0.063 using only Australian Triage Scale 2 and 3). Conclusions. Although the Council of Australian Governments has adopted raw measures for its key ED performance indicators, raw waiting time statistics are misleading. There are no consistent differences in ED waiting times between states and territories after other factors are accounted for. [ABSTRACT FROM AUTHOR]