Integrating primary and secondary care: the case of Christchurch South Health Centre

Aims. To study health services utilisation linkages and methodological issu es in integrating primary and secondary care services for a defined general practice population (Christchurch South Health Centre, CSHC). Methods. The Centre supplied national health index (NHI) linked data on dat e of birth, gender and community services card (CSC) status for 10 174 pati ents, and data on primary care. Secondary care providers supplied NHI linke d data on specialist outpatients, emergency department usage for 1996 to 19 98, and waiting lists. The Health Funding Authority (HFA) supplied NHI link ed data on inpatient/daypatients for 1996 and 1997. Data were also obtained relating to community support services and long-term care. Rates of hospit al utilisation for the Centre's population were standardised for comparison with national and Christchurch figures using age, gender and CSCs. Overall per capita expenditure was calculated for this population. Results. Patients with CSCs constituted 31.2% of the practice population, b ut generated 60.8% of bed-days. Patients with high use health cards (HUHCs) constituted 8.6% of the population, but generated 42.4% of bed-days. This group was at high risk of hospitalisation over a wide range of disease cate gories. Standardised rates of hospital utilisation were significantly lower for the Centre's older patients, especially for bed-days, than both nation al and Christchurch figures. Only a small proportion elf referrals to speci alist outpatients, 28.2% in 1998, was from the Centre's general practitione rs (GPs), the remainder being generated internally within the specialist se rvices. The overall expenditure per capita on the Centre's population was $ 1012, which was substantially less than expected in comparison with nationa l figures. Conclusion. The study demonstrates the importance of primary care factors i n the utilisation of secondary care, especially acute hospitalisation in ol der patients. This needs further study as it could provide important insigh ts into ways of reducing acute admissions. If there is to be more effective management of the primary/secondary care interface, more research and deve lopment effort is needed into the characteristics of patients at high risk of referral and admission, and how inappropriate secondary care can be aver ted.