Given the aging world population, there is international interest in helping older people live longer and healthier lives. Avoiding unplanned hospital admissions is an important aspect of care for older people. Palapar et al focused on the way primary care practice characteristics influence outcomes such as unplanned hospitalizations, function and well-being. They investigated the variability in older people's outcomes by primary care physician and practice characteristics in New Zealand and the Netherlands. Findings revealed that none of the physician or practice characteristics were significantly associated with rates of unplanned admissions in the New Zealand sample. In contrast, in the Netherlands sample, researchers found higher rates of admissions in large practices and practices staffed with a practice nurse who typically works in the primary care setting with general practitioners. Practice nurses are common in primary care practices in New Zealand but are relatively new and only in a portion of practices in the Netherlands, the authors note. It is unclear if these associations are causal or if the increase in hospitalizations represent higher or lower quality care. Considering these findings, the authors conclude that the central focus of international health policies on reducing hospital overuse should approach primary health care structural reform carefully.
