Why is it important?:Analysis of the conditions for which people are admitted to hospital reveals that in many cases, the hospital admission could have been prevented if more effective non-hospital care were available, either at an earlier stage in the disease progression or as an alternative to hospital care. Conditions that are sensitive to the effectiveness, timeliness and adequacy of non-hospital care are referred to as ambulatory care sensitive conditions (NHPC 2001; Public Health Division 2001; Centre for Epidemiology and Research 2006). Studies of hospitalisation for these conditions suggest that the availability of non-hospital care explains a significant component of the variation between geographic areas in hospitalisation rates for the specified conditions (Weissman et al. 1992; Billings et al. 1993; Bindman et al. 1995; University of California San Francisco and Stanford University Evidence-based Practice Center 2001; Ansari et al. 2006).
Ambulatory care sensitive conditions are usually grouped into three categories:
- vaccine-preventable conditions—including invasive pneumococcal disease, influenza, tetanus, measles, mumps, rubella, pertussis, and polio;
- potentially preventable acute conditions—including dehydration/gastroenteritis, kidney infection, perforated ulcer, cellulitis, pelvic inflammatory disease, dental conditions, and ear, nose and throat infections; and
- potentially preventable chronic conditions—including diabetes, asthma, angina, hypertension, congestive heart failure, and chronic obstructive pulmonary disease.
Findings:In the two-year period from July 2006 to June 2008, admission rates for ambulatory care sensitive conditions were 5 times as high for Aboriginal and Torres Strait Islander peoples compared with other Australians. Ambulatory care sensitive conditions accounted for 39% of all hospital admissions (excluding those for dialysis) for Indigenous Australians. Differences in rates between Indigenous and other Australians are particularly striking for older age groups.
For Indigenous Australians vaccine-preventable conditions account for around 2% of all ambulatory care sensitive hospital admissions, acute conditions for 23% of admissions and chronic conditions for 79% of admissions. The sum of components may be more than total as hospitalisations may be defined by multiple categories. The majority of these hospitalisations are due to diabetes complications (69%). Other significant conditions include chronic obstructive pulmonary disease, convulsions/epilepsy and pyelonephritis. For children, the most common conditions are ear, nose and throat infections and dental conditions, while for adults, diabetes complications are the most prevalent.
Compared with other Australians, hospitalisation rates for ambulatory care sensitive conditions were around 3 times as high for Aboriginal and Torres Strait Islander peoples living in New South Wales and Victoria, 4 times as high in Queensland, South Australia and Northern Territory and 14 times as high in Western Australia.
Rates for vaccine preventable conditions have been declining steadily between 2001–02 and 2007–08 (at 0.2% per annum). There were no significant trends in the admission rates for acute conditions for Indigenous Australians for the same period. However, there were significant increases in acute conditions for other Australians.
The rates for chronic ambulatory care sensitive conditions have been increasing dramatically. Although rates for other Australians have also increased, these increases have been more moderate. Therefore, the gap between the two groups has increased in both absolute and relative terms.
Implications:Declines in rates of vaccine-preventable ambulatory care sensitive conditions mainly reflect improvements in the coverage of childhood and adult immunisation (see measure 3.02). The main challenges are to address gaps in coverage (e.g. in Aboriginal and Torres Strait Islander adults over 40 years receiving influenza and pneumococcal vaccines).
Hospitalisation rates for acute ambulatory care sensitive conditions have remained steady since 2001–02. The most significant conditions included in this group are ear, nose and throat infections and dental conditions. The significant gap between Aboriginal and Torres Strait Islander peoples and other Australians requires attention to address service deficits in the primary health care system, including access to dental health services.
Hospitalisation for chronic ambulatory care sensitive conditions for Indigenous Australians occurs at rates that are between 7 and 9 times as high as for the rest of the population (depending on the jurisdictions included in the totals). These high rates reflect gaps in non-hospital care including primary care, the absence of alternatives to hospital care in the more remote areas of Australia, and the much higher rates of illness among Indigenous Australians. The major conditions within the chronic group—diabetes complications, chronic obstructive pulmonary disease, and heart conditions—all require effective primary care with good links to out-of-hospital specialist/outpatient care. The high rates highlight the need for strengthening services that intervene earlier in the disease process, particularly at the primary care level and addressing barriers Indigenous Australians face in accessing these services. In the medium-term, improved primary care may result in increased admissions, as patients with established disease are appropriately identified and treated.
Under National Health Reform, the Australian Government announced funding of $477 million over four years to establish a network of primary health care organisations (Medicare Locals) across Australia. They will support health professionals to provide more coordinated care, improve access to services, and drive integration across the primary health care, Indigenous health, and hospital and aged care sectors.
Figure 152 – Age-standardised hospitalisation rates for ambulatory care sensitive hospital admissions, Qld, WA, SA and NT, 2001–02 to 2007–08 plus NSW, 2004–05 to 2007–08
Source: AIHW Analysis of National Hospital Morbidity Database
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Figure 153 – Top 10 ambulatory care sensitive hospital admissions, by Indigenous status, NSW, Vic., Qld, WA, SA and NT, July 2006 to June 2008
Source AIHW Analysis of National Hospital Morbidity Database
Text description of figure 153 (TXT 1KB)
Figure 154 – Hospitalisation rates for ambulatory care sensitive hospital admissions, by Indigenous status and age group, NSW, Vic., Qld, WA, SA and NT, July 2006 to June 2008
Source AIHW Analysis of National Hospital Morbidity Database
Text description of figure 154 (TXT 1KB)