Healthcare Providers’ Perceptions of Potentially Preventable Rural Hospitalisations: A Qualitative Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Setting and Participants
2.2. Data Collection
2.3. Ethics
3. Results
… broadly speaking, preventable hospital admission would be one that is a diagnosis or condition that could reasonably be treated out in the community but perhaps due to lack of resources or other types of backup, that the patients actually require admission to hospital …(313)
… lots of chronic long-term illnesses that are probably not overly managed all that well in the community but end up [in hospital] …(316)
… the various kind of conditions that people have and the ones that are specifically amenable to earlier intervention as a means of preventing hospitalisation …(325)
… the types of admissions that sort of stick in my mind more commonly are the elderly, more frail type people that have multiple comorbid illnesses, that have more social type issues for admission.(313)
They’re older. They’re not particularly well educated. Often dependent on some form of government support, even if working. And often there are a number of complicating factors…(325)
3.1. Patient Health Literacy
… people just aren’t thinking about their own health enough and coming to emergency with really minor things… [patients should be] clear about… when they need to access ED and when they need to access GPs…(302)
… what we might consider as a minor problem, to them is a major problem and they think it’s appropriate to go to emergency, so there’s partly an education thing about what’s minor and what’s not.(309)
… rural patients are more likely to stay at home for longer, you know, wait longer before seeking medical care.(312)
… people will wait until the point where it’s no longer getting better in their mind; it’s actually getting worse, and this is where they actually start to present to the hospitals.(324)
… [they] genuinely don’t know what to do, so they end up with us in an ambulance.(317)
… I think people get frightened and they want to go to hospital sometimes(319)
I don’t think people really know who to call, and it gets to the point where the only option they can do is call 000.(324)
… their condition isn’t managed correctly, and again that goes back to just our population, the lack of health literacy and socioeconomic factors prevent them from accessing their good community care …they don’t feel like they’re unwell so they’re not managing their condition, that lack of awareness of what can happen if they don’t…(316)
… long term poor chronic disease management,… is often due to patients not doing the right thing and not looking after themselves and not going along to see the GP, unfortunately.(312)
3.2. Patient Access to Primary Care
I think some people find it difficult to access GP services… certainly in some areas access to GPs is poor. They may have a limited number of on-the-day appointments.(315)
… people are waiting four weeks to get into a GP here and then they can’t often see the same one and if they’ve got a chronic illness…(316)
People don’t conveniently have their medical issues during business hours, it happens after hours.(317)
… they can’t just walk out their front door and jump on a bus. If these people don’t drive, they don’t have the social networks to actually get them there readily.(317)
… arguably with ambulance, access to ambulance with no cost, there’s an incentive that makes for very good access to that sort of treatment and that sort of care. And from the perspective of a person who doesn’t have many resources or may be isolated, and doesn’t want to make the multiple trips associated with diagnostics, it could potentially present as a no-brainer to seek help in that regard.(325)
… if someone comes to ED from a rural area and it’s something quite minor that I would usually say, ‘Look, I don’t even want to triage you. I think you could probably go to your GP,’ if they’re from a rural area, I’d be less likely to do that, because it’s just they’ve driven all the way in, it’s a big drive back.(302)
… I think it probably boils down to two main reasons: one is that most people in Tasmania find it hard to afford a private billing GP(314)
… patients in rural areas identified as being lower socioeconomic, their understanding is that for them to actually go to their GP is an out-of-pocket expense, and that money is somewhat better spent, in their mind, on the requirements of everyday living.(324)
I just find Healthline, I think they seem to increase our presentations, because their protocol [results in them advising] ‘You better go to ED,’ seems to happen very regularly.(302)
Again, I have experience of people rocking up and saying, ‘Well, I rang Call the Doctor, and they said, ‘Come straight in.’’(308)
… you either forget about it or you never hear about it in the first place or two years later you realise there’s been some service running you’ve never heard of.(315)
[paramedics] do have antibiotics that we can administer for patients for… acute otitis media, if we in the first instance gain an agreement with the GP for a follow-up appointment and the GP for continuations of that prescription because we are limited to one singular dose only.(324)
3.3. Perceptions of Hospital Care
A lot of people, I think, use [the hospital] as their GP, really.(314)
People just want to be sorted straight away … I think there’s a perception that if you come to emergency, you’re getting everything at once.(302)
There’s probably a culture in Tasmania… of substituting ED and hospital presentations for access to primary care … why go to your general practitioner and they write you up for an X-ray, when you can front up to the ED and if you need it, you can get a chest X-ray, you get a CT, full panel of bloods and all sorts of stuff done.(325)
… in my experience in ED, people needing suturing and small procedures like incision and drainage, that sort of thing, now have to get admitted to hospital because GPs don’t seem to be doing that stuff… they don’t have enough time.(302)
3.4. Suggested Solutions
… one of the solutions obviously is better education about how to self-manage your chronic condition.(302)
There just seems to me to be lack of preventative health and I don’t know if that goes back to as far as early prevention at schools, more intervention in communities, more education…(316)
… I think people who see their GPs more often are more engaged, have better understanding of their chronic conditions, might be more likely to seek help earlier perhaps.(315)
… I definitely think that better resourcing for out of hours general practice would reduce emergency department visits and hospital admissions…(312)
… better access to bulk-bill GPs with minimal wait times for appointments would certainly stop people turning up.(314)
… I mean GP Assist are brilliant. Without them I think we would really struggle, so I think that ongoing funding and provision of GP Assist is essential…(309)
… if the GP could just follow them up a bit tighter and make sure they have an appointment there for them to come back, they knew someone was going to review them if they were still well but just a bit unsure, that would save a lot of re-presentations(314)
… disseminating information about [the Community Rapid Response Service] service, and maybe expanding it… to me that sounds like a great thing, where a patient can come to a clinic, be seen, and then be treated in their own home.(302)
… [ideally] if you’re in a more regional or rural area, you’d have basically easy referral structures for social workers and other allied health professionals and also making sure that … there’s a means by which the GPs or other providers can actively engage services that—to which patients are entitled to make sure that they’re supported at home.(313)
… I think if you’ve got an opportunity to create a standard bulk billing non-financial out-of-pocket for patients, then in rural areas you may actually see more people wanting to access medical care.(324)
4. Discussion
4.1. Health Literacy
4.2. Service Accessibility
4.3. Convenience of Hospital Care
5. Limitations and Future Directions
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Appendix A
Participant Identifier | Profession | Position | Location |
---|---|---|---|
302 | Registered Nurse | Lecturer; Nurse | Emergency Department, RHH |
308 | Registered Nurse | Nurse | Emergency Department, RHH |
309 | Doctor | GP | Huon-Bruny Island area |
312 | Doctor | Emergency Specialist | Emergency Department, RHH |
313 | Doctor | Emergency Specialist | Emergency Department, RHH |
314 | Doctor | Registrar | Emergency Department, RHH |
315 | Doctor | Emergency Registrar & GP | Emergency Department, RHH & Community GP |
316 | Registered Nurse | Nurse | Emergency Department, RHH |
317 | Paramedic | Intensive Paramedic | Hobart area |
318 | Doctor | GP | Huon-Bruny Island area |
319 | RN | Associate Nurse Manager | Huon-Bruny Island area |
320 | Health Administrator | Managerial | Department of Health, Hobart |
324 | Paramedic | Intensive Care Paramedic;Extended Care Paramedic | Hobart area |
325 | Health Administrator | Managerial | Department of Health, Hobart |
Appendix B. Semi-Structured Telephone Interview Guide
Healthcare Providers’ Perceptions of Potentially Preventable Hospitalisations: A Qualitative Study
- Welcome to telephone interview and thanks
- Any initial questions (e.g., risks that may be posed)
- Healthcare providers’ perceptions of potentially preventable hospitalisations:
- a qualitative study
- i.e., ‘seeking to understand healthcare providers’ perspectives on (potentially avoidable) hospital admission.’
- Further explanation of study (if required)
- What are the characteristics of a typical PPH patient?
- What are the distal causes of PPH?
- What are the proximal causes of a PPH?
- How could PPH be avoided, minimised or addressed (if not covered by above)?
- Potential for further contact for follow up interview
- Opportunity for questions
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Ridge, A.; Peterson, G.M.; Seidel, B.M.; Anderson, V.; Nash, R. Healthcare Providers’ Perceptions of Potentially Preventable Rural Hospitalisations: A Qualitative Study. Int. J. Environ. Res. Public Health 2021, 18, 12767. https://doi.org/10.3390/ijerph182312767
Ridge A, Peterson GM, Seidel BM, Anderson V, Nash R. Healthcare Providers’ Perceptions of Potentially Preventable Rural Hospitalisations: A Qualitative Study. International Journal of Environmental Research and Public Health. 2021; 18(23):12767. https://doi.org/10.3390/ijerph182312767
Chicago/Turabian StyleRidge, Andrew, Gregory M. Peterson, Bastian M. Seidel, Vinah Anderson, and Rosie Nash. 2021. "Healthcare Providers’ Perceptions of Potentially Preventable Rural Hospitalisations: A Qualitative Study" International Journal of Environmental Research and Public Health 18, no. 23: 12767. https://doi.org/10.3390/ijerph182312767