The vital role of primary care in aged care

It’s only been six months since the Productivity Commission Inquiry Report ‘Delivering quality care more efficiently’, but it’s not too soon to reiterate the importance of the recommendations of this report. In particular, the integration of care services being essential to drive efficiency nationally and the need for a more strategic framework investing in prevention. 

While the Productivity Commission’s recommendations were more focused on the integration issues between primary and acute care sectors, in addition to early prevention, the findings from our recent studies (here and here) support the need for aged care to also be part of future government efforts resulting from these recommendations. Specifically, for aged care to deliver on its intended purpose, primary care needs to be central in the care of older people, with shared governance between care sectors, and purposeful targeted funding arrangements in the context of the complex multi-level government funding applied to health care in Australia.

Preventative primary care

Older people entering and accessing the aged care system in Australia are reliant on good primary care to help them stay home and not be hospitalised. Primary care that is preventive, helps manage chronic conditions, and is delivered by a known general practitioner (GP), is associated with less emergency department presentations, less potentially preventable hospitalisations, and other specific types of hospitalisations (here and here). 

Patterns of primary care service use that includes high use of preventive services, like health assessments and chronic disease management plans, can also influence older people’s risk of death while in care. And for those that have dementia, seeing their known GPs also means less hospitalisations for dementia-related reasons. 

These are some of the highlights of the findings from a five-year study using national integrated aged and health care data led by the Registry of Senior Australians Research Centre, recently published in Age and Ageing and the Journal of the American Geriatrics Society. The Age and Ageing publication presents the results of a comprehensive analysis of the impact of 17 primary care services, delivered by both GPs and allied health professionals, their combinations and patterns of use, as well as continuity of GP care on mortality and nine hospitalisation-related outcomes, for more than 358 000 older people living in residential aged care homes. The analysis published in the Journal of the American Geriatrics Society described the outcomes of a similar analysis on more than 120 500 older people living at home with long term care support (ie, recipients of the now retired Home Care Package program).

Two studies, similar findings

While the studies were carried out independently and focused on two different cohorts (older people still in the community and older people in residential care ), the findings were consistent, lending support to strength of the evidence that several aspects of primary care are key to ensuring that older people remain at home (or in their residential care homes) and not in the hospital. 

At a time when hospitals are crowded, older people want to remain at home for as long as possible, and access to services like transition care, rehabilitation care, and restorative care are known to be limited and difficult to access. Focusing on the basics — good preventive care delivered by primary care, particularly GPs that are known to the individuals in question — seems like an optimal place to invest in. The aged care sector alone cannot be responsible for the growing older population accessing aged care supports, and the hospital sector should not be expected to deal with the fall-out from shortcomings of a siloed health and aged care system: primary care is central to all.

In both studies, a preventative pattern of care involving high use of health assessments, multidisciplinary management plans, team care allied health services, and a low number of after-hour attendances, offered the most benefits compared to care patterns that included a lower use of all services, or a reactive care pattern that had high after-hour attendances. 

To translate the study’s findings into today’s terms — using previously published estimates (here and here) that approximately 38% of the (260 000) annual residents in residential care and 43% of the (352 000) annual home care recipients experience an emergency department presentation yearly, a trajectory of preventive primary care use would result in a 16-19% reduction in the rate of these events in residential care residents and 15-20% in home care recipients. These reductions could translate into 15 200 to 19 000 less ED presentations by residents and 22 575-30 000 less in home care recipients. This is of course, one example extrapolating from these studies estimates. Numerous other examples with more modest effects also were also consistently identified in these studies.

Since 2024, payments of up to $430 per resident a year have been implemented to support improved primary care access for aged care residents. While not sizable, we hope this investment translates into better care access and outcomes for residents. Government investment should not stop there, these recent studies provide even more evidence to not only reinforce the Productivity Commission’s most recent recommendations for more integration of care services and investing in prevention, but also to extend its focus and priority to aged care (in addition to primary and acute care) when considering its staged approach to future implementation.

Professor Maria Inacio is the Director of the Registry of Senior Australians Research Centre at the South Australian Health and Medical Research Institute and Flinders University. She is an epidemiologist with expertise in population health and aged care surveillance systems, using existing data and informatics to enhance these systems.

Professor Gillian Caughey is the Associate Director of the Registry of Senior Australians Research Centre at SAHMRI and Flinders University. She is a pharmacoepidemiologist with expertise in improving care and health outcomes for older people, particularly in aged care, using large population-based data and registries.

Dr Johannes Schwabe is a Senior Research Fellow with the Registry of Senior Australians Research Centre at SAHMRI and Flinders University. His research uses linked aged care and health data to examine variation in care and define achievable benchmarks for high-quality care to improve outcomes for older Australians.

Dr Andrew Kellie is a health care system researcher collaborating with the Registry of Senior Australians Research Centre at SAHMRI and Flinders University.Dr Kellie is a practicing general practitioner and Clinical Senior Lecturer in the School of Medicine in the College of Health at Adelaide University. His special interests are education in primary health care, general practice psychiatry, chronic disease management, and clinical and corporate governance as they inform best practice.