Regional, temporal and age trends in avoidable hospitalization rates among older adults in British Columbia, Canada, 1991-2000
Date
2010-11-10T22:36:41Z
Authors
Druyts, Eric Bene Furnes
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Abstract
Certain indicators are useful in examining the impact of health care restructuring on the population. Avoidable hospitalization rates are used as an indicator of access to primary care. The purpose of this study was to examine regional, temporal, and age-related trends in avoidable hospitalization rates among older adults during a decade of significant health care restructuring in British Columbia, 1991-2000. The specific objectives of this study were 1) to calculate avoidable hospitalization rates among older adults in British Columbia by regional health authority and health services delivery area, 2) to examine the extent to which avoidable hospitalization rates among older adults in each regional health authority and health service delivery area differ from the provincial avoidable hospitalization rate, and 3) to examine the temporal changes in avoidable hospitalization rates among older adults in British Columbia by regional health authority.
Analyses draw on linked administrative health data from the province of British Columbia for the population of health system users age 55 and older. Analyses are stratified by age group (55 to 64, 65 to 74, and 75 and older) and regional health authority and health service delivery area. Age-sex standardized avoidable hospitalization rates for the years 1991 through 2000 were first calculated. Analysis of means for rate data were also undertaken to examine the extent to which avoidable hospitalization rates in each region differed from the provincial average. Additionally, joinpoint regression analyses of annual avoidable hospitalization rates were performed to examine temporal changes in the trends.
Comparing the avoidable hospitalization rates observed in the health authorities and health service delivery areas to the avoidable hospitalization rates for the province revealed regional disparities, whereby the most rural and northern health authorities and health service delivery areas tended to have higher avoidable hospitalization rates. Joinpoint regression results showed significantly decreasing trends over time. The results also generally indicated that as age increased, so did the likelihood of encountering an avoidable hospitalization. This was consistent across geographical locations and time.
The data suggest that access to primary care services may be problematic in several areas of the province, including northern British Columbia, and rural and remote areas. Although avoidable hospitalization rates decreased over time, it may be the case that health care restructuring initiatives in the 1990s have not completely addressed regional disparities in access to primary care. Additionally, the finding that the oldest adults tend to be more prone to an avoidable hospitalization is of concern. Policy efforts intended to reduce the overall number of avoidable hospitalizations should address the complexities associated with access to the primary care system.
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Keywords
hospitalization, older people, trends, British Columbia