Post-hospital GP care saves the system money

A NSW Health study has shown the value of patients returning to their GP after being discharged.

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Continuity of GP care and prompt review of patients following hospitalisation reduces admissions and readmissions, new analysis has shown.

The research, conducted by NSW Health’s Lumos program team, showed that as well as the obvious patient health benefits, GPs are significantly reducing the cost of care.

During the study, NSW Health explored “high-connectivity practices” – those where more than 30% of patients had visited the practice at least 12 times in the previous two years.

Patients at high-connectivity practices were 10% overall less likely to have an emergency department presentation and were 12% less likely to have an unplanned hospitalisation, according to an RACGP statement.

The analysis puts a dollar value on primary care now compared with tertiary care later. For each dollar paid through Medicare rebates at such practices, the NSW Health system saw a $1.60 benefit overall, and the benefit-to-cost ratio increased for patients at younger ages: $3.24 for children up to nine; $1.96 for those aged 10-19; $2.21 for people aged 20-29; and $2.82 for people aged 30-39.

The study was based on data in the NSW Health Lumos program, which links information gathered from GP practices with other health services data. Currently, the program includes data from 23% of NSW practices and more than half of NSW residents. The data is anonymised to prevent the identification of patients.

The RACGP’s NSW/ACT faculty chair, Associate Professor Charlotte Hespe, presented the research at the college’s recent GP22 conference.

She said the research had found “a significant gap” where practices lacked records of a patient’s chronic conditions.

“Better continuity of care across the acute and primary care interfaces can significantly improve patient outcomes. It is also a strong argument for the use of de-identified patient data for cross-health sector linkage through Lumos.

“The study is also another example of why government support for patients after an unplanned hospital visit is so important. When GPs are informed that their patient has been in hospital and can provide follow-up care, it helps ensure the patient has the best possible outcomes and doesn’t end up back in hospital.”

While high-connectivity practices were found to have more older and more complex patients, after adjusting for patient and practice level differences (such as age, chronic disease, socio-economic status and location), patients of these GPs had significantly fewer ED presentations and unplanned hospitalisations.

When patients visited their GP promptly after being discharged from hospital, the number of admissions reduced considerably in the next three months.

Further analysis of the Lumos data showed that where a patient had received a chronic mental health diagnosis at a hospital, but this was not recorded at their general practice, they were 25% more likely to attend an emergency department in the following year than were patients whose diagnosis has been recorded at their general practice for at least two years.

Patients with chronic mental health conditions who also had two or more chronic physical conditions that were recorded at a hospital, but not their general practice, were 60% more likely to attend an emergency department than were patients whose chronic conditions were recorded in their GP’s systems in the following 12 months.

Meanwhile, patients whose diabetes was first recorded in general practice were less likely to present to ED or be admitted to hospital.

Glebe Family Medical Practice in Sydney, where Professor Hespe practices, was the first practice from the central/eastern Sydney PHN to enrol in the Lumos program.

Professor Hespe has previously said that the program gave the practice a much better idea of what its patient cohort looked like and how it compared with others around Sydney and NSW.

And she told TMR today the benefits of the Lumos program weren’t confined to improved post-discharge health and reduced costs.

“A lot of this is about GPs’ recognising and understanding their value,” she said, “because a lot of GPs are starting to feel undervalued – but the work we do, particularly in complexity, really counts. I want GPs to take stock and say, the value of the care I provide is through that continuity.

“Don’t undersell yourself, and try to deliver that sort of care.”

The Lumos program links de-identified data from general practices with other NSW health service data to provide a more comprehensive view of patients’ movement through the health system. The volume of data is growing and spans regional, remote and metropolitan areas across NSW.

In early 2020, following five pilot programs, Lumos was introduced state-wide with all NSW PHNs participating and a rapid growth in general practice participation. Currently, 600 NSW GP practices have enrolled, comprising four million patients.

Data from these practices are linked to other healthcare services twice per year. Sources of the health services data include EDs, public and private hospital-admitted patients, non-admitted patients, ambulance, cancer and cause of death data.

The data from general practices include service dates, demographics, diagnoses, medications, immunisations and billing information.

After each linkage, participating general practices and PHNs receive a customised report about patients who visit their practice.

Professor Hespe said the results strengthened existing evidence that funding continuity of care, such as through a VPE system, contributed to better health outcomes, while investment in general practice will reduce the need for expensive hospital care.

“The RACGP is continuing to call on the government to provide funding for patients to see their GP within seven days of an unplanned hospital admission or emergency department presentation,” Professor Hespe said.