The effect of primary care policy changes on hospitalisation for ambulatory care sensitive conditions: notes from Brazil

Public Health ◽  
2021 ◽  
Vol 201 ◽  
pp. 26-34
Author(s):  
Raphael Mendonça Guimarães ◽  
Laís Pimenta Ribeiro dos Santos ◽  
Aline Gonçalves Pereira ◽  
Leonardo Graever
Keyword(s):  
Primary Care ◽  
Ambulatory Care ◽  
Ambulatory Care Sensitive Conditions ◽  
Policy Changes ◽  
Care Policy ◽  
Ambulatory Care Sensitive ◽  
Sensitive Conditions

scholarly journals Identifying priorities for primary care investment in Ireland through a population-based analysis of avoidable hospital admissions for ambulatory care sensitive conditions (ACSC)

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e028744 ◽  
Author(s):  
Geraldine McDarby ◽  
Breda Smyth
Keyword(s):  
Primary Care ◽  
Ambulatory Care ◽  
Integrated Care ◽  
Hospital Admissions ◽  
Acute Hospital ◽  
Ambulatory Care Sensitive Conditions ◽  
Hospital System ◽  
Bed Days ◽  
Ambulatory Care Sensitive ◽  
Sensitive Conditions

BackgroundIn 2016, the Irish acute hospital system operated well above internationally recommended occupancy targets. Investment in primary care can prevent hospital admissions of ambulatory care sensitive conditions (ACSCs).ObjectiveTo measure the impact of ACSCs on acute hospital capacity in the Irish public system and identify specific care areas for enhanced primary care provision.DesignNational Hospital In-patient Enquiry System data were used to calculate 2011–2016 standardised bed day rates for selected ACSC conditions. A prioritisation exercise was undertaken to identify the most significant contributors to bed days within our hospital system. Poisson regression was used to determine change over time using incidence rate ratios (IRR).ResultsIn 2016 ACSCs accounted for almost 20% of acute public hospital beds (n=871 328 bed days) with adults over 65 representing 69.1% (n=602 392) of these. Vaccine preventable conditions represented 39.1% of ACSCs. Influenza and pneumonia were responsible for 99.8% of these, increasing by 8.2% (IRR: 1.02; 95% CI 1.02 to 1.03) from 2011 to 2016. Pyelonephritis represented 47.6% of acute ACSC bed days, increasing by 46.5% (IRR: 1.07; 95% CI 1.06 to 1.08) over the 5 years examined.ConclusionsPrioritisation for targeted investment in integrated care programmes is enabled through analysis of ACSC’s in terms of acute hospital bed days. This analysis demonstrates that primary care investment in integrated care programmes for respiratory ACSC’s from prevention to rehabilitation at scale could assist with bed capacity in acute hospitals in Ireland. In adults 65 years and over, including chronic obstructive pulmonary disease patients, the current analysis supports targeting community based pulmonary rehabilitation including pneumococcal and influenza vaccination programmes in order to reduce the burden of infection and hospitalisations. Further exploration of pyelonephritis is necessary in order to ascertain patient profile and appropriateness of admissions.

Primary-Care Visits and Hospitalizations for Ambulatory-Care–Sensitive Conditions in an Inner-City Health Care System

2003 ◽  
Vol 3 (6) ◽  
pp. 324-328 ◽  
Author(s):  
John F. Steiner ◽  
Patricia A. Braun ◽  
Paul Melinkovich ◽  
Judith E. Glazner ◽  
Vijayalaxmi Chandramouli ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Inner City ◽  
Ambulatory Care ◽  
Health Care System ◽  
Ambulatory Care Sensitive Conditions ◽  
Care System ◽  
Ambulatory Care Sensitive ◽  
Sensitive Conditions

scholarly journals Hospitalization of older adults due to ambulatory care sensitive conditions

2014 ◽  
Vol 48 (5) ◽  
pp. 817-826 ◽  
Author(s):  
Aline Pinto Marques ◽  
Dalia Elena Romero Montilla ◽  
Wanessa da Silva de Almeida ◽  
Carla Lourenço Tavares de Andrade
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Information System ◽  
Ambulatory Care ◽  
Rio De Janeiro ◽  
The State ◽  
Ambulatory Care Sensitive Conditions ◽  
Global Rate ◽  
Ambulatory Care Sensitive ◽  
Sensitive Conditions

OBJECTIVE To analyze the temporal evolution of the hospitalization of older adults due to ambulatory care sensitive conditions according to their structure, magnitude and causes. METHODS Cross-sectional study based on data from the Hospital Information System of the Brazilian Unified Health System and from the Primary Care Information System, referring to people aged 60 to 74 years living in the state of Rio de Janeiro, Souhteastern Brazil. The proportion and rate of hospitalizations due to ambulatory care sensitive conditions were calculated, both the global rate and, according to diagnoses, the most prevalent ones. The coverage of the Family Health Strategy and the number of medical consultations attended by older adults in primary care were estimated. To analyze the indicators’ impact on hospitalizations, a linear correlation test was used. RESULTS We found an intense reduction in hospitalizations due to ambulatory care sensitive conditions for all causes and age groups. Heart failure, cerebrovascular diseases and chronic obstructive pulmonary diseases concentrated 50.0% of the hospitalizations. Adults older than 69 years had a higher risk of hospitalization due to one of these causes. We observed a higher risk of hospitalization among men. A negative correlation was found between the hospitalizations and the indicators of access to primary care. CONCLUSIONS Primary healthcare in the state of Rio de Janeiro has been significantly impacting the hospital morbidity of the older population. Studies of hospitalizations due to ambulatory care sensitive conditions can aid the identification of the main causes that are sensitive to the intervention of the health services, in order to indicate which actions are more effective to reduce hospitalizations and to increase the population’s quality of life.

Spatial clusters of chronic preventable hospitalizations (ambulatory care sensitive conditions) and access to primary care

2019 ◽  
Vol 42 (2) ◽  
pp. e134-e141
Author(s):  
Soumya Mazumdar ◽  
Shanley Chong ◽  
Luke Arnold ◽  
Bin Jalaludin
Keyword(s):  
Primary Care ◽  
Ambulatory Care ◽  
Ambulatory Care Sensitive Conditions ◽  
Spatial Clusters ◽  
Preventable Hospitalizations ◽  
Individual Level ◽  
The Usa ◽  
Ambulatory Care Sensitive ◽  
Sensitive Conditions

Abstract Background Potentially preventable hospitalizations (PPHs) or ambulatory care sensitive conditions (ACSCs) represent hospitalizations that could be successfully managed in a primary care setting. Research from the USA and elsewhere on the role of primary care provider (PCP) access as a PPH driver has been conflicting. We investigated the role of PCP access in the creation of areas with persistently significant high rates of PPHs over time or PPH hotspots/spatial clusters. Methods Using a detailed dataset of PCPs and a dataset of 106 334 chronic PPH hospitalizations from South Western Sydney, Australia, we identified hotspots of chronic PPHs. We contrasted how hotspot PPHs were different from other PPHs on a range of factors including PCP access. Results and conclusions Six spatially contiguous areas comprising of eight postcodes were identified as hotspots with risks ranging from 1.6 to 2.9. The hotspots were found to be more disadvantaged and had better PCP access than other areas. Socioeconomic disadvantage explained the most variation (8%) in clustering while PCP access explained only a small fraction though using detailed PCP access measures helped. Nevertheless a large proportion of the variation remained unexplained (86.5%) underscoring the importance of individual level behaviours and other factors in driving chronic PPH clustering.

scholarly journals Individual and area-level factors associated with ambulatory care sensitive conditions in Finland

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
M Satokangas ◽  
M Arffman ◽  
A Leyland ◽  
I Keskimäki
Keyword(s):  
Primary Care ◽  
Health Status ◽  
Ambulatory Care ◽  
Geographic Variation ◽  
Health Centre ◽  
Ambulatory Care Sensitive Conditions ◽  
Hospital Services ◽  
Over Time ◽  
Ambulatory Care Sensitive ◽  
Sensitive Conditions

Abstract Background Geographic variation is common in ambulatory care sensitive conditions (ACSCs) - used as a proxy indicator for primary care quality. Its use is debated as it is more strongly associated with individual socioeconomic position (SEP) and health status than factors related to primary care. While most earlier studies have been cross-sectional, this study aims to observe if these associations change over time. Finland offers a good possibility for this due to its extensive registers and unexplained over time convergence of geographic variation in ACSC. Methods This observational study obtained ACSCs in 2011-2017 from the Finnish Hospital Discharge Register and divided them into subgroups of acute, chronic and vaccine-preventable causes. In these subgroups we analysed geographic variations with a three-level multilevel logistic regression model - individuals, health centre areas (HC) and hospital districts (HD) - and estimated the proportion of the variance at each level explained by individual SEP and comorbidities, as well as both primary care and hospital supply and spatial access at three time points. Results In the preliminary results of the baseline geographic variation in total ACSCs in 2011-2013 - the model with age and sex - the variance between HDs was nearly twice that between HCs. Individual SEP and comorbidities explained 46% of the variance between HDs and 29% between HCs; and area-level proportion of ACSC periods in primary care inpatient wards a further 12% and 5%. This evened out the unexplained variance between HDs and HCs. Conclusions Geographic variation in ACSCs was more pronounced in hospital districts than in the smaller health centre areas. The excess variance between HDs was explained by individual SEP and health status as well as by use of primary care inpatient wards. Our findings suggest that not only hospital bed supply, but also the national structure of hospital services affects ACSCs. This challenges international ACSC comparisons. Key messages Geographic variation in ACSCs concentrated in larger areas with differing population characteristics. The national structure of hospital services, such as use of primary care inpatient wards, affects ACSCs.

Hospitalizations for Ambulatory Care Sensitive Conditions and Quality of Primary Care

Medical Care ◽  
2011 ◽  
Vol 49 (1) ◽  
pp. 17-23 ◽  
Author(s):  
Purificación Magán ◽  
Ángel Alberquilla ◽  
Ángel Otero ◽  
José Manuel Ribera
Keyword(s):  
Primary Care ◽  
Ambulatory Care ◽  
Ambulatory Care Sensitive Conditions ◽  
Quality Of Primary Care ◽  
Ambulatory Care Sensitive ◽  
Sensitive Conditions
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