Primary, allied health, selected specialists, and mental health service utilisation by home care recipients in Australia before and after accessing the care, 2017–2019

Abstract

Objectives To examine changes in primary, allied health, selected specialists, and mental health service utilisation by older people in the year before and after accessing home care package (HCP) services. Methods A retrospective cohort study using the Registry of Senior Australians Historical National Cohort (≥ 65 years old), including individuals accessing HCP services between 2017 and 2019 (N = 109,558), was conducted. The utilisation of general practice (GP) attendances, health assessments, chronic disease management plans, allied health services, geriatric, pain, palliative, and mental health services, subsidised by the Australian Government Medicare Benefits Schedule, was assessed in the 12 months before and after HCP access, stratified by HCP level (1–2 vs. 3–4, i.e., lower vs. higher care needs). Relative changes in service utilisation 12 months before and after HCP access were estimated using adjusted risk ratios (aRR) from Generalised Estimating Equation Poisson models. Results Utilisation of health assessments (7-10.2%), chronic disease management plans (19.7–28.2%), and geriatric, pain, palliative, and mental health services (all ≤ 2.5%) remained low, before and after HCP access. Compared to 12 months prior to HCP access, 12 months after, GP after-hours attendances increased (HCP 1–2 from 6.95 to 7.5%, aRR = 1.07, 95% CI 1.03–1.11; HCP 3–4 from 7.76 to 9.32%, aRR = 1.20, 95%CI 1.13–1.28) and allied health services decreased (HCP 1–2 from 34.8 to 30.7%, aRR = 0.88, 95%CI 0.87–0.90; HCP levels 3–4 from 30.5 to 24.3%, aRR = 0.80, 95%CI 0.77–0.82). Conclusions Most MBS subsidised preventive, management and specialist services are underutilised by older people, both before and after HCP access and small changes are observed after they access HCP.