Admissions for ambulatory care sensitive conditions on rural islands and their association with patient experience: a multicentred prospective cohort study

ObjectivesThe rate of admissions for ambulatory care sensitive conditions (ACSCs) is a key outcome indicator for primary care, and patient experience (PX) is a crucial process indicator. Studies have reported higher rates of admission for ACSCs in rural areas than in urban areas. Whether there is an association between admissions for ACSCs and PX in rural areas has not been examined. This study aimed to document admissions for ACSCs on Japanese rural islands, and assess whether there was an association between the rate of admissions for ACSCs and PX.DesignMulticentred, prospective, cohort studySettingThis study was conducted on five rural islands in Okinawa, Japan.ParticipantsThe study participants were all island inhabitants aged 65 years or older.Primary outcome measuresThis study examined the association between ACSCs and PX assessed by a questionnaire, the Japanese Version of Primary Care Assessment Tool. ACSCs were classified using the International Classification of Diseases, Tenth Revision, and the rate of admissions for ACSCs in 1 year.ResultsOf 1258 residents, 740 completed the questionnaire. This study documented 38 admissions for ACSCs (29 patients, males/females: 15/14, median age 81.9) that included congestive heart failure (11), pneumonia (7) and influenza (5). After adjusting for covariates and geographical clustering, admissions for ACSCs had a significant positive association with each patient’s PX scores (OR per 1 SD increase=1.62, 95% CI 1.02–2.61).ConclusionsPhysicians serving rural areas need to stress the importance of preventive interventions for heart failure, pneumonia and influenza to reduce the number of admissions for ACSCs. Contrary to previous studies, our findings might be explained by close patient–doctor relationships on the rural islands.

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Effect of Patient Experience on Bypassing a Primary Care Gatekeeper: a Multicenter Prospective Cohort Study in Japan

Journal of General Internal Medicine ◽

10.1007/s11606-017-4245-1 ◽

2018 ◽

Vol 33 (5) ◽

pp. 722-728 ◽

Cited By ~ 8

Author(s):

Takuya Aoki ◽

Yosuke Yamamoto ◽

Tatsuyoshi Ikenoue ◽

Makoto Kaneko ◽

Morito Kise ◽

...

Keyword(s):

Primary Care ◽

Cohort Study ◽

Patient Experience ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Multicenter Prospective Cohort Study ◽

Multicenter Prospective Cohort

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Associations of Patient Experience in Primary Care With Hospitalizations and Emergency Department Visits on Isolated Islands: A Prospective Cohort Study

The Journal of Rural Health ◽

10.1111/jrh.12342 ◽

2018 ◽

Vol 35 (4) ◽

pp. 498-505

Author(s):

Makoto Kaneko ◽

Takuya Aoki ◽

Hideki Mori ◽

Ryuichi Ohta ◽

Hiroki Matsuzawa ◽

...

Keyword(s):

Primary Care ◽

Emergency Department ◽

Cohort Study ◽

Patient Experience ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Emergency Department Visits

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Do hospitalisations for ambulatory care sensitive conditions reflect low access to primary care? An observational cohort study of primary care usage prior to hospitalisation

BMJ Open ◽

10.1136/bmjopen-2016-015704 ◽

2017 ◽

Vol 7 (8) ◽

pp. e015704 ◽

Cited By ~ 10

Author(s):

Sabine I Vuik ◽

Gianluca Fontana ◽

Erik Mayer ◽

Ara Darzi

Keyword(s):

Primary Care ◽

Cohort Study ◽

Ambulatory Care ◽

Observational Cohort Study ◽

Ambulatory Care Sensitive Conditions ◽

Observational Cohort ◽

Gp Services ◽

Access To Primary Care ◽

Ambulatory Care Sensitive ◽

Sensitive Conditions

ObjectivesTo explore whether hospitalisations for ambulatory care sensitive conditions (ACSCs) are associated with low access to primary care.DesignObservational cohort study over 2008 to 2012 using the Clinical Practice Research Datalink (CPRD) and Hospital Episode Statistics (HES) databases.SettingEnglish primary and secondary care.ParticipantsA random sample of 300 000 patients.Main outcome measuresEmergency hospitalisation for an ACSC.ResultsOver the long term, patients with ACSC hospitalisations had on average 2.33 (2.17 to 2.49) more general practice contacts per 6 months than patients with similar conditions who did not require hospitalisation. When accounting for the number of diagnosed ACSCs, age, gender and GP practice through a nested case–control method, the difference was smaller (0.64 contacts), but still significant (p<0.001).In the short-term analysis, measured over the 6 months prior to hospitalisation, patients used more GP services than on average over the 5 years. Cases had significantly (p<0.001) more primary care contacts in the 6 months before ACSC hospitalisations (7.12, 95% CI 6.95 to 7.30) than their controls during the same 6 months (5.57, 95% CI 5.43 to 5.72). The use of GP services increased closer to the time of hospitalisation, with a peak of 1.79 (1.74 to 1.83) contacts in the last 30 days before hospitalisation.ConclusionsThis study found no evidence to support the hypothesis that low access to primary care is the main driver of ACSC hospitalisations. Other causes should also be explored to understand how to use ACSC admission rates as quality metrics, and to develop the appropriate interventions.

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Faculty Opinions recommendation of Effect of antibiotic prescribing on antibiotic resistance in individual children in primary care: prospective cohort study.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1090146.543362 ◽

2007 ◽

Author(s):

Marilyn Roberts

Keyword(s):

Primary Care ◽

Antibiotic Resistance ◽

Cohort Study ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Antibiotic Prescribing

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Faculty Opinions recommendation of Contrast echocardiography for assessing left ventricular vortex strength in heart failure: a prospective cohort study.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718250477.793490113 ◽

2014 ◽

Author(s):

Gerald Maurer ◽

Georg Goliasch

Keyword(s):

Heart Failure ◽

Cohort Study ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Contrast Echocardiography ◽

Left Ventricular ◽

Vortex Strength

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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 ◽

10.1136/bmjopen-2018-028744 ◽

2019 ◽

Vol 9 (11) ◽

pp. e028744 ◽

Cited By ~ 1

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.

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