14 February 2023

Being single and living alone is one of the most significant predictors of potentially preventable hospitalisations (which is where a patient is admitted to hospital with a condition that could have been avoided or managed with timely and adequate primary care) in regional areas, according to a new article published in the Royal Australasian College of Physicians’ (RACP) Internal Medicine Journal.

A potentially preventable hospitalisation (PPH) occurs when a patient is admitted to hospital with a condition that could have been avoided or managed with timely and adequate primary care.

Mr Ridge and his co-researchers (who included Professor Gregory Peterson, Dr Rosie Nash and Professor Bastian Seidel) examined 1,368 hospital admissions to the Royal Hobart Hospital.

The study found that being single increased the risk of PPH by 243% and was by far one of the strongest predictors of preventable hospitalisation in regional and rural communities.

The paper’s corresponding author and PhD Candidate, School of Pharmacy and Pharmacology, Andrew Ridge, says “This research has revealed a sad truth that singles living alone are more at risk of being hospitalised unnecessarily.

“This is a wake-up call for us all, to remember to take extra care of our neighbours and those who don’t have someone to lean on.

“The data from these regional and rural communities in Tasmania clearly shows that being single is one of the biggest predictors or whether or not you end up in hospital with a problem that could’ve been otherwise prevented or addressed in the community.

“The research also found that socioeconomic and social factors appear to be just as important as medical ailments when it comes to unnecessary hospitalisation.” Mr Ridge said.

The paper found having a high comorbidly burden was also significant factor for preventable hospitalisation, and that patients who frequently visited a GP were also more at risk of being admitted to hospital with a preventable condition.

One of the authors of the paper, Professor Gregory Peterson, Professor of Pharmacy and Pharmacology at the University of Tasmania says “Patients who visit the GP being at higher risk of PPH may seem counter intuitive, however this is likely due to limited access to secondary services such as other medical specialists and chronic disease management services,” Professor Peterson said.

“Those living in regional and rural Australia often don’t have the access to specialised care that those living in metropolitan areas take for granted.  It may be that patients have no choice but to present themselves to a hospital for treatment, since there is little else available when it comes to managing chronic conditions.”

The data also found that Indigenous Australians were also at increased risk of PPH. According to the data, Indigenous-identifying people were 269% more at risk of hospitalisation due to preventable conditions. This is in line with other studies, which found Indigenous Australians have a PPH risk approximately three times the rate of the wider population, with outcomes even worse for those living in rural or remote communities. [1]

“While we did not have a large sample size of Indigenous Australians in this survey, the result backs up previous research on this topic. Regrettably, First Nations people continue to be overrepresented when it comes to preventable hospitalisations. We know that limited access to healthcare, low socioeconomic status and other social factors contribute to poorer outcome for First Australians,” Professor Peterson said.

During 2017-18 (the last time the figure was calculated), approximately 748,000 hospitalisations across Australia were avoidable,[2] equating to 1 in 15 hospital admissions.[3]  It is also costing the budget roughly 2.3 billion annually[4].

“While this study was based on one multi-site rural region, the rate and range of PPH in this rural Tasmanian population is indicative of wider, national trends,” Professor Peterson said.

“What we can glean from the data is social factors are just as importance as purely medical ones when it comes to preventable hospitalisation. Doctors must be cognizant that living alone poses as great a risk as patients with comorbidities.  Recognising the role of social factors, particularly those patients who are isolated from family or friends, should be part of a broad-ranging review into how to reduce PPH within our community.”