Healthcare Providers' Perceptions of Potentially Preventable Rural Hospitalisations: A Qualitative Study.

Andrew Ridge,Vinah Anderson,Bastian M Seidel,Gregory M Peterson,Rosie Nash

doi:10.3390/ijerph182312767

Abstract

Potentially preventable hospitalisations (PPHs) are common in rural communities in Australia and around the world. Healthcare providers have a perspective on PPHs that may not be accessible by analysing routine patient data. This study explores the factors that healthcare providers believe cause PPHs and seeks to identify strategies for preventing them. Physicians, nurses, paramedics, and health administrators with experience in managing rural patients with PPHs were recruited from southern Tasmania, Australia. Semi-structured telephone interviews were conducted, and reflexive thematic analysis was used to analyse the data. Participants linked health literacy, limited access to primary care, and perceptions of primary care services with PPH risk. The belief that patients did not have a good understanding of where, when, and how to manage their health was perceived to be linked to patient-specific health literacy challenges. Access to primary healthcare was impacted by appointment availability, transport, and financial constraints. In contrast, it was felt that the prompt, comprehensive, and free healthcare delivered in hospitals appealed to patients and influenced their decision to bypass rural primary healthcare services. Strategies to reduce PPHs in rural Australian communities may include promoting health literacy, optimising the delivery of existing services, and improving social support structures.

Highlights

Preventable hospitalisations (PPHs), referred to as admissions for ambulatory care sensitive (ACS) conditions, are used to measure the performance of primary healthcare (PHC) in Australia [1,2] and overseas [3,4,5]
Our study shows that the perceived root causes of Potentially preventable hospitalisations (PPHs) among rural Tasmanian adults were consistent across a wide range of hospital, community, and managerial healthcare providers
Long-standing health literacy challenges, the relative inaccessibility of local, timely, and affordable healthcare, and the perceived convenience of hospital-based care were identified by the participants as factors contributing to PPHs

Summary

Introduction

Preventable hospitalisations (PPHs), referred to as admissions for ambulatory care sensitive (ACS) conditions, are used to measure the performance of primary healthcare (PHC) in Australia [1,2] and overseas [3,4,5]. In Australia, a PPH is defined in the National Healthcare Agreement as an ‘admission to hospital for a condition where the hospitalisation could have potentially been prevented through the provision of appropriate individualised preventative health interventions and early disease management usually delivered in primary care and community-based care settings’ [6,7]. The universal health insurance scheme, Medicare, provides free hospital treatment at public hospitals throughout the country and subsidises healthcare services provided by general practitioners (GPs) and some allied healthcare professions. Additional charges may be levied by providers; dental services are delivered outside the Medicare system, while ambulance services are provided without charge in some states (including Tasmania)

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