Primary and Secondary Care Related Quality Indicators for Dementia Care Among Australian Aged Care Users: National Trends, Risk Factors, and Variation

Article type: Research Article

Authors: Rahja, Miia^{a; b; *} | Air, Tracy^a | Ahern, Susannah^c | Ward, Stephanie A.^{c; d; e} | Caughey, Gillian E.^{a; f} | Sluggett, Janet K.^{a; f; g} | Cations, Monica^{a; h} | Lin, Xiaoping^c | Wallis, Kasey^c | Crotty, Maria^{a; b} | Inacio, Maria C.^{a; f}

Affiliations: [a] Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, SA, Australia | [b] Flinders Health and Medical Research Institute, Division of Rehabilitation, Aged and Palliative Care, Flinders Drive, Bedford Park, SA, Australia | [c] School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia | [d] Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia | [e] Department of Geriatric Medicine, Prince of Wales Hospital, Randwick, NSW, Australia | [f] University of South Australia, UniSA Allied Health and Human Performance, Adelaide, SA, Australia | [g] Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC, Australia | [h] College of Education, Psychology and Social Work, Flinders University, Bedford Park, SA, Australia

Correspondence: [*] Correspondence to: Dr. Miia Rahja, Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, North Terrace, Adelaide, SA 5001, Australia. Tel.: +61 412 860 226; E-mail: [email protected].

Abstract: Background:Studies related to clinical quality indicators (CQIs) in dementia have focused on hospitalizations, medication management, and safety. Less attention has been paid to indicators related to primary and secondary care. Objective:To evaluate the incidence of primary and secondary care CQIs for Australians with dementia using government-subsidized aged care. The examined CQIs were: comprehensive medication reviews, 75+ health assessments, comprehensive geriatric assessments, chronic disease management plans, general practitioner (GP) mental health treatment plans, and psychiatrist attendances. Methods:Retrospective cohort study (2011–2016) of 255,458 individuals. National trend analyses estimated incidence rates and 95% confidence intervals (CI) using Poisson or negative binomial regression. Associations were assessed using backward stepwise multivariate Poisson or negative binomial regression model, as appropriate. Funnel plots examined geographic and permanent residential aged care (PRAC) facility variation. Results:CQI incidence increased in all CQIs but medication reviews. For the overall cohort, 75+ health assessments increased from 1.07/1000 person-days to 1.16/1000 person-days (adjusted incidence rate ratio (aIRR) = 1.03, 95% CI 1.02–1.03).Comprehensive geriatric assessments increased from 0.24 to 0.37/1000 person-days (aIRR = 1.12, 95% CI 1.10–1.14). GP mental health treatment plans increased from 0.04 to 0.07/1000 person-days (aIRR = 1.13, 95% CI 1.12–1.15). Psychiatric attendances increased from 0.09 to 0.11/1000 person-days (aIRR = 1.05, 95% CI 1.03–1.07). Being female, older, having fewer comorbidities, and living outside a major city were associated with lower likelihood of using the services. Large geographical and PRAC facility variation was observed (0–92%). Conclusion:Better use of primary and secondary care services to address needs of individuals with dementia is urgently needed.

Keywords: Dementia, health care, health services for the aged, primary health care, quality indicators, secondary care

DOI: 10.3233/JAD-220336

Journal: Journal of Alzheimer's Disease, vol. 88, no. 4, pp. 1511-1522, 2022