In reply: The national and international use of avoidable hospitalisations as an indicator of accessibility and overall effectiveness of primary care1 has included reporting differences in hospital admissions for different ethnic populations and across different geographical regions to highlight inequities in access to primary care. Avoidable hospitalisation rates are also routinely reported for the Aboriginal and Torres Strait Islander population.2 Currently, there is no “gold standard”, but compared with other indicators, such as self-reported data from population surveys, avoidable hospitalisation rates are regarded as an objective and robust measure of primary care.3
Despite the established use, there are well recognised limitations in the interpretation of avoidable hospitalisations, which are outlined in our article,4 and also raised in the letter by Gibson and Segal. What our article highlights, using well identified data sources, is the difference in avoidable hospitalisation rates between the Northern Territory Aboriginal and non-Aboriginal populations, as well as the very different trends. There are expectations that current reforms in the delivery of primary care for Aboriginal Australians can be directly monitored by improvements in avoidable hospitalisation rates. Our results highlight the need for caution in interpreting changes in these rates, and the substantial risks associated with unrealistic performance benchmarks.
- 1. Ansari Z, Laditka JN, Laditka SB. Access to health care and hospitalization for ambulatory care sensitive conditions. Med Care Res Rev 2006; 63: 719-741.
- 2. Australian Institute of Health and Welfare. Aboriginal and Torres Strait Islander Health Performance Framework 2008 report: detailed analyses. Canberra: AIHW, 2008. (AIHW Cat. No. IHW 22.)
- 3. Ansari Z. The concept and usefulness of ambulatory care sensitive conditions as indicators of quality and access to primary health care. Aust J Primary Health 2007; 13 (3): 91-110.
- 4. Li SQ, Gray NJ, Guthridge SL, Pircher SLM. Avoidable hospitalisation in Aboriginal and non-Aboriginal people in the Northern Territory. Med J Aust 2009; 190: 532-536. <MJA full text>