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Objective. The COVID-19 pandemic in Australia coincided with an early trend of reduced visits to the emergency department (ED), but to determine which patients presented less requires closer evaluation. Identifying which patient groups are presenting less frequently will provide a better understanding of health care utilisation behaviours during a pandemic and inform healthcare providers of the potential challenges in managing these groups. Methods. This single-centre retrospective study examined trends in presentations in 2020 to a private, mixed paediatric and adult ED in an inner city suburb within the state of Victoria that treats both COVID-19 and non-COVID-19 patients. The 2019 dataset was used as a reference baseline for comparison. All analyses were performed using baseline characteristics and triage data. Results. The total number of visits to the ED dropped from 24 775 in 2019 to 22 754 in 2020, representing an overall reduction of 8%. Significant reductions in daily presentations and admissions from the ED were observed in the months immediately following the peak of the two COVID-19 waves in the state of Victoria. Visits by those in the 0- to 17-year age group, triage categories 4 and 5 and musculoskeletal presentations were also reduced for most of 2020. Gastrointestinal/abdominal and urological/renal presentations were reduced immediately after the first COVID-19 wave, whereas infectious diseases visits were reduced during and after the second COVID-19 wave. Conclusions. These findings add to the growing body of evidence regarding emergency care underutilisation during the COVID-19 pandemic. Reduced private ED presentations were observed overall and in paediatric patients, lower acuity triage categories, musculoskeletal, abdominal/gastrointestinal and urological/renal presentations during the first wave, whereas infectious disease cases were reduced during the second wave. [ABSTRACT FROM AUTHOR]

Objective. To evaluate the effect of a diabetes-management program for patients with type 2 diabetes and related comorbidities on acute healthcare utilisation and costs. Methods. This was a retrospective administrative dataset analysis using data for patients enrolled from 2007 to 2008. Inpatient admissions for diabetes-related conditions were compared before, during and following enrolment. Costs per episode were estimated from Weighted Inlier Equivalent Separations (WIES) funding. A cost model was then developed based on admission rates per 100 patients. Results. Data were retrieved for 357 patients; 49% males, mean age 62 years. The mean per-patient cost of the program was AU$524 (s.d. $213). The mean cost of an inpatient admission was $4357(95% CI 2743-5971) pre-enrolment and $4396 (95% CI 2888-5904) post-enrolment. Following program completion the annual costs (per 100 patients) for managing 'diabetes with multiple complications' and hypoglycaemia decreased from $10 181 to $1710 and $9947 to $7800. In contrast, the annual cost of cardiovascular disorders increased from $14 485 to $40 071 per 100 patients. Conclusions. In the short-term diabetes-management programs for patients with comorbid vascular disease may reduce hospital utilisation for diabetes but not for cardiovascular disease. Longer-term follow-up is needed to determine whether intensive management of vascular complications can reduce costs. What is known about the topic? Type 2 diabetes is now recognised as the fastest growing chronic disease in Australia and other western countries. In developed countries, diabetes is a leading cause of cardiovascular disease and renal failure, and, in the over 60 age group, is a leading cause of blindness and non-traumatic lower limb amputations. Glycated haemoglobin (HbA1c) is a measure of diabetes control, with set target levels for the prevention or delay of development of macrovascular and microvascular complications of diabetes. Epidemiological studies have demonstrated that a 1% reduction in HbA1c can lead to a 15-21% reduction in diabetes-related deaths and 33-41% reduction in microvascular complications over a 10-year period. Indicating that improvements in glycaemic control may have the potential to decrease acute healthcare costs associated with management of complications over the long term. What does this paper add? There are limited data available on the short to medium term effect of disease-management programs for patients with already established complications on acute healthcare utilisation. This study evaluated the cost of providing the Northern Alliance Hospital Admission Risk Program for diabetes disease management and its effect on acute healthcare utilisation at Northern Health. In contrast, the overall inpatient costs for the management of diabetes and related conditions were high and did not decrease significantly following program completion. The major acute care cost drivers were surgical interventions for advanced peripheral vascular disease and the management of cardiovascular events. What are the implications for practitioners? These findings demonstrate that in this population with a high prevalence of established cardiovascular and peripheral vascular complications that diabetes-management programs need to be equipped and resourced to manage these complications if potential savings in acute care costs are to be realised. [ABSTRACT FROM AUTHOR]