Academic journal article Australian Health Review

Gatekeepers to Home and Community Care Services: The Link between Client Characteristics and Source of Referral

Academic journal article Australian Health Review

Gatekeepers to Home and Community Care Services: The Link between Client Characteristics and Source of Referral

Article excerpt


There is growing evidence that the effective transition of patients across healthcare networks improves the quality of care, posi- tively affects health and lowers financial burden.1-3 In response, recent reforms of the Australian Home and Community Care (HACC) program have moved towards greater integration of healthcare services.4 The HACC Program is an integral part of the health system and central to the Australian Government aged care policy. It aims to provide a comprehensive, coordinated and integrated range of basic maintenance and support services for frail aged people and those with disabilities so that they can reside independently in their own home. Within the program, the referral is the primary path in which to access services. Agencies can receive referrals from almost any source, including health workers, family and friends or self. Once an agency receives a referral, it assesses the individual's eligibility for assistance.

The premature and inappropriate transfer of patients from hospitaltothecare ofunskilledfamilymembers inthecommunity can lead to a rise in health burden.5 Furthermore, the absence of a referral to a suitable home care program can place pressure on formalised institutions such as hospitals since it can often lead to early re-admission into hospital and increased emergency room use.5 Bowles and colleagues'5 investigation of referral decisions within the home care sector found that the majority of a sample of hospitalised older US Americans was discharged without post- discharge referrals. Factors largely unrelated to healthcare needs, such as living arrangements, race and gender carried significant weight in determining discharge referral decisions. Pressures to control costs, shorten the length of stay and the inconsistent assessment criteria led to some patients receiving inconsistent follow-up care.5 These inconsistencies were compounded by varying levels of expertise by health professionals,6,7 varying hospital policies and procedures and the risk tolerance of decision makers.5,8 Financial incentives to hospitals were also found to influence the destination of patients following their release from hospital.9,10

A body of literature has identi fied several patient character- istics other than clinical need that are associated with the decision by a health professional to refer. Patients living with a spouse or caregiverwere less likely to receive referrals for skilled home care than were those living alone.11 Women who possessed the same limitation in their activities of daily living (ADL) as did men were one quarter as likely to receive referrals for skilled home care.12 Other investigations noted differences in the doctor referral patterns based on the race of the patient.13,14

In addition to patient characteristics, studies have shown that referral rates reflected doctor-driven behaviour.15,16 General practitioner (GP) referral decisions were influenced by financial incentives and knowledge concerning home care services and criteria.17-19 Chromiak20 reported that the source of referral for any given agency in the US depended on factors such as agency size, structure, location, services offered and surrounding competition.

Objective of the study

An ageing population, the continued trend towards shorter hos- pital stays and a preference to receive care and treatment at home rather than in institutions are expected to escalate demand for home care services. The effectiveness of the HACC program is dependent on the referrer who acts to inform about and facilitate individuals' access to the program. The purpose of this study is to identify the characteristics associated with the likelihood of a client receiving a referral to the HACC program from various sources. The findings form part of the initial process in examining the potential opportunities available to government and health- care organisations for developing interventions to achieve a cost- effective and high-outcome-based program that meet the needs of individuals and their carers. …

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