Improved primary care may help reduce hospital readmissions for diabetes patients

PEOPLE who regularly visit their family doctor following discharge for a diabetes-related hospitalisation significantly reduce their chance of being readmitted, an Australian study has found

Researchers at the University of South Australia have discovered that more than 40 per cent of hospital readmissions for people living with diabetes are preventable if appropriate primary care is provided.

The study, published today, included 848 patients between the ages of 76-89 years old who had a diabetes hospitalization in 2012 and of these 209 were re-hospitalised within 30 days.

Lead Researcher and Senior Research Fellow in the School of Pharmacy and Medical Sciences Gillian Caughey said although the study was centred around the Australian population, its results were applicable for older patients with diabetes worldwide.

She said diabetes patients who visited a General Practitioner or had increased primary care following hospitalisation would reduce the likelihood of a re-admission, which would in turn reduce hospital inpatient care costs.

“This study highlights the need for improved continuity of care during the transition between hospital and primary care, which includes discharge planning and communication with the patient’s GP,” she said.

“Readmission has a significant effect on patients’ overall wellbeing and morbidity, and places considerable strain on the healthcare system.

“The identification of these at-risk patients may also help care providers to target appropriate interventions for preventing these re-admissions.”

Dr Caughey said post-discharge support visits had also been shown to reduce re-admission rates in the general older population.

She said this highlighted the potential for holistic care to be applied to other co-morbid conditions, to potentially reduce re-admission rates in older patients.

The main re-admission causes were diabetes-related conditions (24 per cent), including diabetes-related foot ulcer (9.1 per cent) and hyperglycaemia or hypoglycaemia (5.7 per cent).

Cardiovascular conditions accounted for 21 per cent (heart failure 5 per cent) and respiratory disorders 4 per cent.

Almost half of the people in the study who were re-admitted within 14 days of discharge had not seen their GP between hospital stays.

It also found that patients with comorbid heart failure, multiple recent hospitalisations, and multiple prescribers involved in their care were at greatest risk of re-admission.

According to the Australian Institute of Health and Welfare hospital inpatient care for people with diabetes in 2008-2009 was conservatively estimated to cost $647 million, or more than 40 per cent of all diabetes-related health care expenditure in Australia.

“Around 85 per cent of patients hospitalised for type 2 diabetes in Australia are aged 65 years or over and the average cost per hospitalisation is $8755 and many of these admissions could potentially be prevented where appropriate primary care was provided,” Dr Caughey said.

“The risk of re-admission involves a complex relationship between the presence of chronic and acute conditions, the health status of the patient, and health system factors, such as the transition between primary and hospital care and co-ordination of care, including timely, comprehensive communication.”

The number of people with diabetes in 2014 was 422 million, up from 108 million in 1980. In 2012, an estimated 1.5 million deaths were directly caused by diabetes and another 2.2 million deaths were attributable to high blood glucose according to the World Health Organisation.

Understanding 30-day re-admission after hospitalisation of older patients for diabetes: identifying those at greatest risk by Gillian E Caughey, Nicole L Pratt, John D Barratt, Sepehr Shakib, Anna R Kemp-Casey, Elizabeth E Roughead was published in the Medical Journal of Australia today.

The paper also undertook a retrospective cohort study of administrative data in the health claims database of the Department of Veterans’ Affairs (DVA) for all patients hospitalised for a diabetes related condition between 1 January 2012 and 31 December 2012.

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