Patterns of Medicare-funded primary health and specialist consultations in Aboriginal and non-Aboriginal Australians in the two years before hospitalisation for ischaemic heart disease

Tiew-Hwa Katherine Teng,Matthew Knuiman,Judith M Katzenellenbogen,Joseph Hung,Anthony S Gunnell,Alistair Vickery,Qun Mai,Frank M Sanfilippo,Elizabeth Geelhoed,Sandra C Thompson

doi:10.1186/s12939-018-0826-9

Abstract

BackgroundIschaemic heart disease (IHD) remains the leading cause of morbidity and mortality for both Aboriginal and non-Aboriginal Australians. Patterns of primary and specialist care in patients leading up to the first hospitalisation for IHD potentially impact on prevention and subsequent outcomes. We investigated the differences in general practice (GP), specialist and emergency department (ED) consultations, and associated resource use in Aboriginal and non-Aboriginal people in the two years preceding hospitalisation for IHD.MethodsLinked-data were used to identify first IHD admissions for Western Australians aged 25–74 years in 2002–2007. Person-linked GP, specialist and ED consultations were obtained from the Medicare Benefits Schedule (MBS) and ED records to assess health care access and costs for the preceding 2 years.ResultsAboriginal people constituted 4.7% of 27,230 IHD patients, 3.5% of 1,348,238 MBS records, and 14% of 33,170 ED presentations. Aboriginal (vs. non-Aboriginal) people were younger (mean 50.2 vs 60.5 years), more commonly women (45.2% vs 28.4%), had more comorbidities [Charlson index≥1, 35.2% vs 26.3%], were more likely to have had GP visits (adjusted rate-ratio 1.07, 95% CI 1.02–1.12), long/prolonged (16.0% vs 11.9%) consults and non-vocationally registered GP consults (17.1% vs 3.2%), but less likely to received specialist consults (mean 1.0 vs 4.1). Mean number of urgent/semi-urgent ED presentations in the year preceding the IHD admission was higher in Aboriginal people (2.9 vs 1.9). Aboriginal people incurred 2.7% of total associated MBS expenditure (estimated at $59.7 million). Mean total cost per person was 43.3% lower in Aboriginal patients, with cost differentials being greatest in diabetic and chronic kidney disease patients.ConclusionsDespite being over-represented in urgent/semi-urgent ED presentations and admissions for IHD, Aboriginal people were under-resourced compared with the rest of the population, particularly in terms of specialist care prior to first IHD hospitalisation. The findings underscore the need for better primary and specialist shared care delivery models particularly for Aboriginal people.

Highlights

Ischaemic heart disease (IHD) remains the leading cause of morbidity and mortality for both Aboriginal and non-Aboriginal Australians
Despite being over-represented in urgent/semi-urgent emergency department (ED) presentations and admissions for IHD, Aboriginal people were under-resourced compared with the rest of the population, in terms of specialist care prior to first IHD hospitalisation
For both Aboriginal and non-Aboriginal patients, costs were significantly higher in the year closest to the index event compared to 2nd year (56.3% vs 43.7%) preceding index admission

Summary

Introduction

Ischaemic heart disease (IHD) remains the leading cause of morbidity and mortality for both Aboriginal and non-Aboriginal Australians. Ischaemic heart disease (IHD) remains the leading cause of morbidity and mortality for both Aboriginal and non-Aboriginal populations [1, 2]. Despite the fact that Aboriginal Australians have access to primary care through multiple avenues, a recent cost analysis highlighted that 60% of the health expenditure on Aboriginal Australians was on secondary care in public hospitals [9]. Primary health care (Medicare services and medicines) expenditure per person was significantly less than for non-Aboriginal Australians [9, 10], suggesting underinvestment of funds into prevention, early intervention, secondary prevention and community services for Aboriginal people [10]

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