Identifying areas of need relative to liver disease: geographic clustering within a health service district

Abstract

Background Many people with chronic liver disease (CLD) are not detected until they present to hospital with advanced disease, when opportunities for intervention are reduced and morbidity is high. In order to build capacity and liver expertise in the community, it is important to focus liver healthcare resources in high-prevalence disease areas and specific populations with an identified need. The aim of the present study was to examine the geographic location of people seen in a tertiary hospital hepatology clinic, as well as ethnic and sociodemographic characteristics of these geographic areas. Methods The geographic locations of hepatology out-patients were identified via the out-patient scheduling database and grouped into statistical area (SA) regions for demographic analysis using data compiled by the Australian Bureau of Statistics. Results During the 3-month study period, 943 individuals from 71 SA Level 3 regions attended clinic. Nine SA Level 3 regions accounted for 55% of the entire patient cohort. Geographic clustering was seen especially for people living with chronic hepatitis B virus. There was a wide spectrum of socioeconomic advantage and disadvantage in areas with high liver disease prevalence. Conclusions The geographic area from which people living with CLD travel to access liver health care is extensive. However, the greatest demand for tertiary liver disease speciality care is clustered within specific geographic areas. Outreach programs targeted to these areas may enhance liver disease-specific health service resourcing. What is known about the topic? The demand for tertiary hospital clinical services in CLD is rising. However, there is limited knowledge about the geographic areas from which people living with CLD travel to access liver services, or the ethnic, socioeconomic and education characteristics of these areas. What does this paper add? The present study demonstrates that a substantial proportion of people living with CLD and accessing tertiary hospital liver services are clustered within specific geographic areas. The most striking geographic clustering was seen for people living with chronic hepatitis B, in regions with a relatively high proportion of people born in Vietnam and China. In addition to ethnicity, the data show an apparent ecological association between liver disease and both socioeconomic and educational and/or occupational disadvantage. What are the implications for practitioners? Identifying where demand for clinical services arises is an important step for service planning and preparing for potential outreach programs to optimise community-based care. It is likely that outreach programs to engage and enhance primary care services in geographic areas from which the greatest demand for tertiary liver disease speciality care arises would yield greater relative return on investment than non-targeted outreach programs.

<p>Development and Evaluation of the Supportive Needs Assessment Tool for Cirrhosis (SNAC)</p>

“…Chronic liver disease disproportionately affects ethnic minority groups in many developed countries. 7,22,[35][36][37][38] Similar to other studies in underserved and minority patient populations, we used data collection methods suited to these populations. 17,39 Future research could compare selfadministered and interviewer-administered response patterns.…”

Five‐year conditional survival for patients with hepatocellular carcinoma in Queensland, Australia

“…This likely reflects the occurrence of HCC in the absence of cirrhosis for many patients with chronic hepatitis infection who may be under surveillance for HCC, allowing for curative approaches such as resection and RFA. In a tertiary hospital in Queensland, overseas‐born residents accounted for 49% of hepatology clinic patients . Our population‐based data provides a key information source for health service planning to ensure programs target socio‐demographic groups at risk of hepatitis B and HCC.…”

Australian general practitioners’ perceptions of the barriers and opportunities for community-based care of patients with viral hepatitis: a mixed methods study

“…6,7 Although data on treatment uptake was not reported by country of birth, previous studies have shown that a large proportion of people living with HBV who accessed tertiary hospital liver services are clustered within specific geographic areas, in regions with a relatively high proportion of people born in Vietnam and China. 8 In Australia, authorised general practitioners (GPs) can prescribe the treatment of HBV infection; 9 however, the screening, diagnosis and treatment of HBV infection is not funded in primary care and there are cost implications for patients visiting their GP. Therefore, patients are referred to tertiary hospitals for specialty hepatology services.…”