Integration between hospitals and general practices ‘critical’

New data from NSW Health’s Lumos program has revealed that a visit to the GP within two days of hospital discharge from an unplanned admission can result in 32% fewer readmissions within the first week.
 
The figures, which combine deidentified patient data from emergency departments (EDs) and general practices also showed that a GP visit within the first week of hospital discharge was followed by 7% fewer readmissions within 28 days, while a visit in the first four weeks was followed by 13% fewer readmissions over the following 1–3 months.
 
The latest analysis, from the study period January 2017 – December 2019, includes patient records from 344 general practices, linking with 2,852,691 attending patients aged over two years.
 
There were 180,143 unplanned readmissions and 55% of patients did not have a GP visit prior to an unplanned readmission.
 
RACGP NSW&ACT Chair Associate Professor Charlotte Hespe presented the research findings at GP22 on 26 November, alongside Sydney GP and member of the Strengthening Medicare Taskforce, Dr Walid Jammal.
 
‘This research provides evidence of what GPs know: that good general practice improves patient health outcomes, and this reduces emergency presentations, unplanned admissions and readmissions to hospital,’ Associate Professor Hespe said.
 
‘It’s clear GPs play a vital and high-value role in Australia’s health system, and it’s critical that there is good integration between hospitals and general practices.’
 
In her GP22 presentation, Associate Professor Hespe also cited Lumos data on ‘high-connectivity practices’ – where more than 30% of patients have visited the practice at least 12 times over the previous two years.
 
Patients who went to high-connectivity practices had a 10% less chance of ED department presentations and a 12% less chance of unplanned hospitalisations.
 
Associate Professor Hespe, along with other GP colleagues, is concerned that there are ‘real gaps in care’ between the handover from a hospital back into the community.
 
Patients are discharged from hospital with instructions to make their own GP appointments, with this often not happening within the required five days after discharge because the GP is unaware they have been in hospital.
 
‘Better continuity of care across the acute and primary care interfaces can significantly improve patient outcomes,’ Associate Professor Hespe said.
 
‘It is also a strong argument for the use of de-identified patient data for cross-health sector linkage through Lumos.
 
‘This study is also another example of why government support for patients after an unplanned hospital visit is so important, because when GPs are informed that their patient has been in hospital and can provide follow-up care, it helps ensure the patient has the best possible outcomes and doesn’t end up back in hospital.’
 
Patients with chronic mental health conditions who also had two or more chronic physical conditions that were recorded at a hospital, but not their general practice, were 60% more likely to attend an ED than patients whose chronic conditions were recorded in their GP’s systems in the following 12 months, the Lumos report showed.
 
A similar ‘significant gap’ occurs where practices do not have a record of a patient’s chronic conditions, Associate Professor Hespe said.
 
When a mental health condition was only recorded in hospital data and not the general practice, these patients were 25% more likely to have an ED presentation in the next 12 months than people whose diagnosis had been recorded at the general practice for over two years.
 
According to Associate Professor Hespe, these results support existing evidence that stronger investment in general practice to enable continuity of care contributes to better health outcomes and reduces the need for hospital care – a central focus of the RACGP advocacy for system reform.
 
‘The RACGP is continuing to call on the [Federal] Government to provide funding for patients to see their GP within seven days of an unplanned hospital admission or ED presentation,’ she said.
 
The Australasian College of Emergency Medicine has also backed calls to strengthen primary care amid an unprecedented number of ED presentations across Australia in 2020⁠–⁠21.
 
Part of this continuity of care, which the Lumos data spotlights the value of, includes the voluntary patient enrolment model to better coordinate multidisciplinary care for patients with chronic conditions – currently under review by the Federal Government.
 
The RACGP’s advocacy priorities include reforms aimed at improving patient health outcomes in the short term, such as support for patients after an unplanned hospital visit, and enhanced primary care services for people aged over 65, people with mental health conditions, and people with disability.
 
Additionally, the Lumos data highlighted the impact general practice has on helping to reduce healthcare costs.
 
For each dollar paid through Medicare rebates at the practices in the study, there was a $1.60 benefit to the NSW Health system. But when accounting for patients’ ages, the benefit:cost ratio for younger patients was even higher. Each dollar of Medicare rebate returned $3.24 in benefit for children aged 0–9 years; $1.96 for ages 10–19; $2.21 for ages 20–29; and $2.82 for people aged 30–39.
 
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continuity of care emergency department hospital admissions NSW primary care reform