Regional variation in non-admitted patient health service use for people hospitalised with dementia

Introduction People living with dementia experience a higher number of comorbidities and challenges to access coordinated healthcare services. The Royal Commission into Aged Care Quality and Safety recommended a post diagnostic support pathway be developed for people living with dementia to improve access to services to maintain health, wellbeing and independence. Regional and rural communities can experience inequity in health care access. The Shoalhaven region includes over 2,500 people living with dementia in a predominantly rural area. High quality evidence is required to inform needs-based health care planning and delivery. Methods A retrospective matched cohort study was carried out. Study participants were residents living in the Illawarra Shoalhaven Local Health District (ISLHD) aged 65 or older with a first inpatient diagnosis of dementia from July 2015 to March 2019. A propensity matched cohort were matched on admission date, socio-demographics, admission characteristics and comorbidities. Descriptive statistics (percentage of participants accessing services, median visits conditional on use) measured health service access and use in the non-admitted patient setting 12 months after hospitalisation. Variations in access and use were assessed in three health service planning zones: Northern Illawarra, Southern Illawarra and Shoalhaven. Results Shoalhaven had the most equitable access to non-admitted patient care (72.2% of people with dementia accessed care compared to 75.7% of matched cohort). The access gap was wider in Southern Illawarra (67.7% vs 78.1%) and Northern Illawarra (65.2% vs 74.9%). People in the Shoalhaven had less service use, a median of 7 visits compared to 9 for people without dementia. Among people with dementia, the Shoalhaven had the highest access to geriatric services (32.8%) compared to Northern Illawarra (25.1%) or Southern Illawarra (19.8%). Shoalhaven had the most equitable access to occupational therapists (21.6% compared to 21.7% for people without dementia). Implications for rural health Additional allied health and geriatric services were provided to the Shoalhaven during the study period. The service uptake among people with dementia demonstrates there was a need for these services. Access to occupational therapy has been a long-standing issue for people with dementia in Australia, the Shoalhaven provides an example of equitable service access.