PMID- 37440860
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230718
IS  - 2399-5351 (Electronic)
IS  - 2399-5351 (Linking)
VI  - 4
IP  - 1
DP  - 2022
TI  - Understanding potentially avoidable hospitalisations in a rural Australian 
      setting from the perspectives of patients and health professionals: a qualitative 
      study and logic model.
PG  - e000124
LID - 10.1136/ihj-2021-000124 [doi]
LID - e000124
AB  - BACKGROUND: Potentially avoidable hospitalisations (PAHs) are proxy measures of 
      effective primary care at a population level. PAHs are higher in rural and 
      disadvantaged areas. This qualitative study sought a deeper understanding of PAHs 
      for chronic health conditions in a rural context from the perspectives of 
      patients and health professionals, and aimed to develop a logic model for rural 
      health services to identify intervention targets. METHODS: Patients with chronic 
      obstructive pulmonary disease, congestive cardiac failure or type 2 diabetes, 
      admitted to a rural hospital in Australia and local health professionals were 
      invited to participate in interviews in late 2019. Semistructured interviews were 
      recorded, transcribed verbatim and thematically analysed. Themes were mapped 
      against a programme logic model developed in a similar study. RESULTS: patients 
      and 16 health professionals participated. The logic model encompassed patient 
      level (knowledge, skills, health status), provider level (workforce availability, 
      attributes) and system level (clinical pathways) contexts. These contexts 
      influenced key mechanisms of relationships, continuity of care and capacity to 
      offer services. Outcomes included responsive and timely access to care, improved 
      clinical outcomes and resource use. Themes that did not readily map to the logic 
      model included socioeconomic disadvantage and healthcare costs, which influenced 
      affordability and equity of access. CONCLUSION: Patients' complex health and 
      social circumstance, health service access and unclear care pathways were strong 
      themes associated with PAH in this rural context. Patient, provider and system 
      contexts influencing key mechanisms and outcomes need to be understood when 
      designing solutions to address PAHs in rural settings. Ideally, interventions 
      should address the cost of healthcare alongside interventions to enhance 
      relationships, continuity of care and capacity to offer services.
CI  - (c) Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No 
      commercial re-use. See rights and permissions. Published by BMJ.
FAU - Glenister, Kristen
AU  - Glenister K
AUID- ORCID: 0000-0003-0510-5314
AD  - Department of Rural Health, The University of Melbourne, Wangaratta, 
      Albury-Wodonga, Shepparton, Victoria, Australia.
FAU - Archbold, Tessa
AU  - Archbold T
AD  - Northeast Health Wangaratta, Wangaratta, Victoria, Australia.
FAU - Moran, Anna
AU  - Moran A
AD  - Department of Rural Health, The University of Melbourne, Wangaratta, 
      Albury-Wodonga, Shepparton, Victoria, Australia.
FAU - Kidd, David
AU  - Kidd D
AD  - Institute for Healthcare Improvement, Regional team, Victoria, Australia.
FAU - Wilson, Sue
AU  - Wilson S
AD  - Albury Wodonga Health, Wodonga, Victoria, Australia.
FAU - Disler, Rebecca
AU  - Disler R
AD  - Department of Rural Health, The University of Melbourne, Wangaratta, 
      Albury-Wodonga, Shepparton, Victoria, Australia.
LA  - eng
PT  - Journal Article
DEP - 20220615
PL  - England
TA  - Integr Healthc J
JT  - Integrated healthcare journal
JID - 9918609088006676
PMC - PMC10241033
OTO - NOTNLM
OT  - Ambulatory care
OT  - Chronic disease management
OT  - Qualitative research
COIS- Competing interests: None declared.
EDAT- 2023/07/13 19:15
MHDA- 2023/07/13 19:16
PMCR- 2022/06/15
CRDT- 2023/07/13 15:15
PHST- 2021/12/21 00:00 [received]
PHST- 2022/05/30 00:00 [accepted]
PHST- 2023/07/13 19:16 [medline]
PHST- 2023/07/13 19:15 [pubmed]
PHST- 2023/07/13 15:15 [entrez]
PHST- 2022/06/15 00:00 [pmc-release]
AID - ihj-2021-000124 [pii]
AID - 10.1136/ihj-2021-000124 [doi]
PST - epublish
SO  - Integr Healthc J. 2022 Jun 15;4(1):e000124. doi: 10.1136/ihj-2021-000124. 
      eCollection 2022.