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ACSC 04-05 Barwon South West ACSC 2004-2005 Update Barwon-South Western Region (Including Primary Care Partnerships and Local Government Areas) Victorian Ambulatory Care Sensitive Conditions Study Ambulatory care sensitive conditions (ACSCs) are those for which hospitalisation is thought to be avoidable if preventive care and Figure 1: ACSCs Admission Rates, Barwon-South Western early disease management are applied, usually in an ambulatory Region, 1995–96 to 2004–05 setting1. In theory, access to timely and effective ambulatory care 50 can reduce the risks of hospitalisation. 40 The Victorian Ambulatory Sensitive Conditions Study is updated annually by the Chronic Disease Surveillance and Epidemiology 30 Section of the Department of Human Services (DHS). This fact sheet presents analyses of ACSCs for the DHS Barwon 20 South-Western Region as a whole and for the primary care partnerships and local government areas in this region, using the 10 Victorian Admitted Episodes Dataset (VAED) from 1995-96 to Population 1000 Rate per 2004-05. Rates of admission were age- and sex-standardised to 0 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 the Victorian population (1996) using the direct method. –96 –97 –98 –99 -2000 –01 –02 –03 –04 –05 Barwon-South Western Region Figure 2: Total ACSCs Admission Rate Ratios, Barwon-South The Barwon-South Western Region covers an area of 29,637 Western Region (Victoria = 1), 1995–96 to 2004–05 square kilometres. It covers the southwest of the state from 1.2 Queenscliffe in the east to the far southwest border with South Australia. It had an estimated population of 350,801 in 2004. 1.1 The region includes three Primary Care Partnerships (PCPs) and o nine Local Government Areas (LGAs). i 1.0 Variations in Rates of ACSCs Admission, 1995–96 to 2004–05 Rate Rat There were 16,558 admissions for total ACSCs in 2004–05, 0.9 with an average of 5.08 bed days. The admission rate for total ACSCs increased from 25.26 per 1,000 persons (24.73–25.80) 0.8 in 1995–96 to 38.46 per 1,000 persons (37.48–39.47) in 2004– 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 (Figure 1). The increase between 2003–04 and 2004–05 –96 –97 –98 –99 –2000 –01 –02 –03 –04 –05 may be due, in part, to a change in coding practices for diabetes complications2. Contents Barwon–South Western Region 1 Variations in Rates of ACSCs Admission, 1995–96 to Southern Grampians/Glenelg Primary Care Partnership 3 2004–05 • Glenelg 4 Barwon-South Western region’s admission rate ratios for total • Southern Grampians 4 ACSCs have declined relative to Victorian averages between South West Primary Care Partnership 5 1995–96 and 2004–05 (Figure 2). In 2004–05 the region’s • Corangamite 6 admission rate ratios were below the Victorian average. • Moyne 6 • Warrnambool 6 Barwon Primary Care Partnership 7 • Colac–Otway 8 • Greater Geelong 8 1 Billings J, Zeitel L, Lukomnik J, Carey T, Blank A, Newman L. Impact of socioeconomic status • Queenscliffe 8 on hospital use in New York City. Health Affairs, 1993, 12, 162173. 2 From 1 July 2004, changes to Australian Coding Standard 0401 Diabetes mellitus and • Surf Coast 8 impaired glucose regulation impacted on ICD-10-AM diagnosis coding with respect to three codes relevant to diabetic complications ACSCs viz. E11.72, E12.72 and E13.72. These codes refer to diabetes mellitus (except Type 1) with hypertension and/or other factors (including obesity, insulin resistance, acanthosis nigricans, dyslipidaemia etc.). The higher number of admissions for diabetes complications may, in part, refl ect this change (See Appendix for further details). 1 Top 10 Individual ACSCs Admissions, (Victoria = 1), 2004–05 Table 1 summarises the admission rates and average bed days for the top 10 ACSCs in 2004–05. In addition to chronic ACSCs (diabetes complications and chronic obstructive pulmonary disease), the top fi ve ACSCs admissions also included dental conditions, dehydration and gastroenteritis and pyelonephritis. The top 10 ACSCs accounted for 90.02 per cent of the total ACSCs admission in the region. The average bed days for the top 10 ACSCs was 5.10 in 2004–05. Table 1: Top 10 ACSCs in Region 1—Barwon-South Western Region, 2004–05 Number of Rate per Lower Upper Average Total ACSC admissions 1,000 persons 95% CI 95% CI bed days bed days Diabetes complications 7,161 16.49 16.11 16.88 6.31 45,205 Dental conditions 1,140 3.28 3.10 3.48 1.13 1,291 COPD 1,124 2.43 2.29 2.57 7.68 8,627 Dehydration and gastroenteritis 883 2.35 2.20 2.51 2.33 2,057 Pyelonephritis 859 2.13 1.99 2.28 5.00 4,298 Angina 959 2.11 1.98 2.25 2.67 2,556 Ear, nose and throat infections 657 2.03 1.88 2.19 1.75 1,147 Asthma 674 1.97 1.82 2.12 2.45 1,648 Congestive cardiac failure 909 1.84 1.73 1.97 8.49 7,719 Convulsions and epilepsy 540 1.60 1.47 1.74 2.69 1,451 Note: CI = confi dence interval. Admission Rate Ratios for Top 10 ACSCs, Barwon-South Western Region, (Victoria = 1), 2004–05 Key Findings— Compared with the Victorian average, the region’s admission Barwon-South Western Region rate ratios were signifi cantly lower for diabetes complications, • Admission rates for ACSCs increased in the region over the chronic obstructive pulmonary disease (COPD), dehydration ten-year period. and gastroenteritis, pyelonephritis and congestive cardiac • In addition to including chronic conditions, the top 5 failure (Figure 3). The region’s admission rate ratios for diabetes ACSCs also included dental conditions dehydration and complications, COPD, dehydration and gastroenteritis, gastroenteritis, and pyelonephritis. pyelonephritis and congestive heart failure were signifi cantly lower • The region’s admission rate ratios for diabetes than the Victorian averages in 2004–05. Ear, nose and throat complications, COPD, dehydration and gastroenteritis, infections accounted for the region’s highest admission rate ratio, pyelonephritis and congestive heart failure were which was 1.44 (1.32–1.55). signifi cantly lower than the Victorian averages in 2004–05. • The region’s admission rate ratios for dental conditions and Figure 3: Top 10 ACSCs Admission Rate Ratios for Barwon-South ear, nose and throat infections were signifi cantly higher Western Region, (Victoria = 1), 2004–05 than the Victorian averages. 1.6 1.4 o i 1.2 Rate rat 1.0 0.8 0.6 ns COPD Dental Angina Asthma Diabetes ation and conditions troenteritis Congestive Convulsions and epilepsy complications gas Pyelonephritis ENT infectio cardiac failure Dehydr 2 PCP1PCP1 Southern Grampians/Glenelg Primary Care Partnership (PCP 1) Variations in Rates of ACSCs Admission, 2000–01 to Admission Rate Ratios for the Top 10 Individual ACSCs, 2004–05 (Victoria = 1), 2004–05 The Primary Care Partnership’s (PCP) admission rates for total The PCP’s admission rate ratios for fi ve of the top 10 ACSCs ACSCs increased over the fi ve-year period. The admission rates (diabetes complications, dehydration and gastroenteritis, asthma, for total ACSCs increased from 38.45 per 1,000 persons (36.64– convulsions and epilepsy, and ear, nose and throat infections) 40.34) in 2000–01 to 55.29 per 1,000 persons (53.16–57.51) in were signifi cantly higher than the Victorian averages in 2004–05 2004–05 (Figure 4). (Figure 5). The PCP’s highest admission rate ratio was for diabetes complications, which was 1.52 (1.44–1.58). Figure 4: ACSCs Admission Rates in Southern Grampians/ Glenelg PCP, 2000–01 to 2004–05 Figure 5: Top 10 ACSC Admission Rate Ratios in Southern 60 Grampians/Glenelg PCP, (Victoria = 1), 2004–05 2.0 50 40 1.5 30 20 Rate ratio 1.0 Rate per 1000 Population Population 1000 Rate per 10 0 2000–01 2001–02 2002–03 2003–04 2004–05 0.5 tive ons COPD Dental Asthma Angina Diabetes Top 10 Individual ACSCs Admissions, 2004–05 conditions Conges Convulsi heart failure and epilepsyEar, nose and complicationsgastroenteritis Pyelonephritis Table 2 summarises the admission rates and average bed days for Dehydration and throat infections the top 10 ACSCs in 2004–05. Diabetes complications was the leading cause of ACSCs admissions for the PCP in 2004–05. The top 10 ACSCs admissions accounted for 93.11 per cent of the total ACSCs admissions in the region. The average bed days for the top 10 ACSCs admissions was 3.82 in 2004–05. Table 2: Top 10 ACSCs in PCP1 —Southern Grampians/Glenelg, 2004–05 Number of Rate per Lower Upper Average Total ACSC admissions 1,000 persons 95% CI 95% CI bed days bed days Diabetes complications 1,453 30.28 28.77 31.88 3.60 5,227 Dehydration and gastroenteritis 126 3.25 2.73 3.88 2.23 281 Dental conditions 117 3.20 2.67 3.83 1.20 140 COPD 146 2.83 2.41 3.33 6.36 928 Asthma 88 2.40 1.95 2.95 2.61 230 Congestive heart failure 135 2.39 2.02 2.83 9.53 1,287 Convulsions and epilepsy 75 2.24 1.79 2.81 2.23 167 Ear, nose and throat infections 69 2.06 1.62 2.60 2.28 157 Angina 104 2.03 1.68 2.46 3.12 324 Pyelonephritis 78 1.94 1.55 2.42 4.90 382 Note: CI = confi dence interval. 3 Top 5 Individual ACSCs Admissions for Local Government Areas in the Southern Grampians/Glenelg PCP, 2004–05 The Southern Grampians/Glenelg PCP includes two local government areas (LGAs), Glenelg and Southern Grampians.
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