Relationship Between Primary Care Physician Visits and Hospital/Emergency Use for Uncomplicated Hypertension, an Ambulatory Care-Sensitive Condition

As health systems seek to incentivize physicians to deliver high-value care, the relationship between physician compensation and health care delivery is an important knowledge gap. To examine physician compensation nationally and its relationship with care delivery, we examined 2012-2015 cross-sectional data on ambulatory primary care physician visits from the National Ambulatory Medical Care Survey. Among 175 762 office visits with 3826 primary care physicians, 15.4% of primary care physicians reported salary-based, 4.5% productivity-based, and 12.9% “mixed” compensation, while 61.4% were practice owners. After adjustment, delivery of out-of-visit/office care was more common for practice owners and “mixed” compensation primary care physicians, while there was little association between compensation type and rates of high- or low-value care delivery. Despite early health reform efforts, the overall landscape of physician compensation has remained strongly tethered to fee-for-service. The lack of consistent association between compensation and care delivery raises questions about the potential impact of payment reform on individual physicians’ behavior.

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Mortality related to ambulatory care sensitive hospitalisations in Finland

Scandinavian Journal of Public Health ◽

10.1177/1403494820944722 ◽

2020 ◽

Vol 48 (8) ◽

pp. 839-846

Author(s):

Veli-Matti Partanen ◽

Martti Arffman ◽

Kristiina Manderbacka ◽

Ilmo Keskimäki

Keyword(s):

Primary Care ◽

General Population ◽

Ambulatory Care ◽

Excess Mortality ◽

Hospital Admissions ◽

Mortality Rates ◽

Ambulatory Care Sensitive Conditions ◽

Ambulatory Care Sensitive Condition ◽

Ambulatory Care Sensitive ◽

Sensitive Conditions

Aims: Hospitalisations for ambulatory care sensitive conditions are used as an outcome indicator of access to and quality of primary care. Evidence on mortality related to these hospitalisations is scarce. This study analysed the effect of ambulatory care sensitive condition hospitalisations to subsequent mortality and time or geographical trends in the mortality indicating variations in ambulatory care sensitive conditions outcomes. Methods: This retrospective cohort study used individual-level data from national registers concerning ambulatory care sensitive condition hospitalisations. Crude and age-adjusted 365-day mortality rates for the first ambulatory care sensitive condition-related admission were calculated for vaccine-preventable, acute, and chronic ambulatory care sensitive conditions separately, and for three time periods stratified by gender. The mortality rates were also compared to mortality in the general Finnish population to assess the excess mortality related to ambulatory care sensitive condition hospitalisations. Results: The data comprised a total of 712,904 ambulatory care sensitive condition hospital admissions with the crude 365-day mortality rate of 14.2 per 100 person-years. Mortality for those hospitalised for vaccine-preventable conditions was approximately 10-fold compared to the general population and four-fold in chronic and acute conditions. Of the 10 most common ambulatory care sensitive conditions, bacterial pneumonia and influenza and congestive heart failure were associated with highest age-standardised mortality rates. Conclusions: Hospitalisations for ambulatory care sensitive conditions were shown to be associated with excess mortality in patients compared to the general population. Major differences in mortality were found between different types of ambulatory care sensitive condition admissions. There were also minor differences in mortality between hospital districts. These differences are important to consider when using preventable hospital admissions as an indicator of primary care performance.

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Does a policy that requires adherence to a regular primary care physician improve the actual adherence of patients?

Israel Journal of Health Policy Research ◽

10.1186/s13584-021-00475-9 ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

A. Golan-Cohen ◽

G. Blumberg ◽

E. Merzon ◽

E. Kitai ◽

Y. Fogelman ◽

...

Keyword(s):

Primary Care ◽

Primary Care Physician ◽

Continuity Of Care ◽

Economic Status ◽

Care Physician ◽

Policy Implications ◽

Cross Sectional ◽

Physician Visits ◽

Personal Physician ◽

Adherence Group

Abstract Background Continuity of care by the same personal physician is a key factor in an effective and efficient health care system. Studies that support the association between high adherence and better outcomes were done in settings where allocation to the same physician was a long-term policy. Objectives To evaluate the influence that changing organizational policy from the free choice of a primary care physician to a mandatory continuity of care by the same physician has on adherence to a personal physician. Methods A cross-sectional study based on electronic databases; comparison of adherence and demographic characteristics (sex, age, and socio-economic status) of 208,286 Leumit enrollees who met the inclusion criteria, according to change in the adherence to a personal physician. To evaluate adherence, we used the Usual Provider of Care (UPC) index, which measures the number of visits made to the personal doctor out of the total primary care physician visits over the same period. The patients were divided into groups according to their UPC level. Results The data shows that 54.5% of the patients were high adherers even before the organizational change; these rates are similar to those published by various organizations worldwide, years after mandating continuity of care by the same physician. In the year following the intervention, only 34.5% of the patients changed the level of their adherence group. Of these, 64% made a shift to a higher adherence group. Before the intervention, the high adherers were older (mean age 57.8 vs. 49.3 years in the low adherers group) and from a higher SES (mean SES status 9.32 vs. 8.71). After the intervention, a higher proportion of older patients and patients from a higher SES changed their adherence to a higher group. Sex distribution was similar over all the adherence level groups and did not change after the intervention. Conclusions and policy implications A policy change that encouraged adherence to an allocated primary care physician managed to improve adherence only in specific groups. Health organizations need to examine the potential for change and the groups they want to influence and direct their investment wisely. Trial registration retrospectively registered.

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