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Spycher J, Morisod K, Moschetti K, Le Pogam MA, Peytremann-Bridevaux I, Bodenmann P, Cookson R, Rodwin V, Marti J. Potentially avoidable hospitalizations and socioeconomic status in Switzerland: A small area-level analysis. Health Policy 2024; 139:104948. [PMID: 38096621 DOI: 10.1016/j.healthpol.2023.104948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 10/13/2023] [Accepted: 11/24/2023] [Indexed: 12/31/2023]
Abstract
The Swiss healthcare system is well known for the quality of its healthcare and population health but also for its high cost, particularly regarding out-of-pocket expenses. We conduct the first national study on the association between socioeconomic status and access to community-based ambulatory care (CBAC). We analyze administrative and hospital discharge data at the small area level over a four-year time period (2014 - 2017). We develop a socioeconomic deprivation indicator and rely on a well-accepted indicator of potentially avoidable hospitalizations as a measure of access to CBAC. We estimate socioeconomic gradients at the national and cantonal levels with mixed effects models pooled over four years. We compare gradient estimates among specifications without control variables and those that include control variables for area geography and physician availability. We find that the most deprived area is associated with an excess of 2.80 potentially avoidable hospitalizations per 1,000 population (3.01 with control variables) compared to the least deprived area. We also find significant gradient variation across cantons with a difference of 5.40 (5.54 with control variables) between the smallest and largest canton gradients. Addressing broader social determinants of health, financial barriers to access, and strengthening CBAC services in targeted areas would likely reduce the observed gap.
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Affiliation(s)
- Jacques Spycher
- Department of epidemiology and health systems, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.
| | - Kevin Morisod
- Department of vulnerable populations and social medicine, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Karine Moschetti
- Department of epidemiology and health systems, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Marie-Annick Le Pogam
- Department of epidemiology and health systems, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Isabelle Peytremann-Bridevaux
- Department of epidemiology and health systems, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Patrick Bodenmann
- Department of vulnerable populations and social medicine, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland; Faculty of Biology and Medicine, Deanship, University of Lausanne, Lausanne, Switzerland
| | | | - Victor Rodwin
- Robert Wagner School of Public Service, New York University, New York, NY, United States
| | - Joachim Marti
- Department of epidemiology and health systems, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
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Natali I, Dewatripont M, Ginsburgh V, Goldman M, Legros P. Prescription opioids and economic hardship in France. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2023; 24:1473-1504. [PMID: 36710287 PMCID: PMC9884604 DOI: 10.1007/s10198-022-01557-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 12/01/2022] [Indexed: 06/18/2023]
Abstract
This paper studies how opioid analgesic sales are empirically related to socioeconomic disparities in France, with a focus on poverty. This analysis is made possible using the OpenHealth database, which provides retail sales data for opioid analgesics available on the French market. We exploit firm-level data for each of the 94 departments in Metropolitan France between 2008 and 2017. We show that increases in the poverty rate are associated with increases in sales: a one percentage point increase in poverty is associated with approximately a 5% increase in mild opioid sales. Our analysis further shows that opioid sales are positively related to the share of middle-aged people and individuals with basic education only, while they are negatively related to population density. The granularity and longitudinal nature of these data allow us to control for a large pool of potential confounding factors. Our results suggest that additional interventions should be more intensively addressed toward the most deprived areas. We conclude that a combination of policies aimed at improving economic prospects and strictly monitoring access to opioid medications would be beneficial for reducing opioid-related harm.
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Affiliation(s)
- Ilaria Natali
- Université Libre de Bruxelles, Avenue F. D. Roosevelt, 50, 1050, Brussels, Belgium.
- European Center for Advanced Research in Economics and Statistics (ECARES), Université Libre de Bruxelles, Brussels, Belgium.
- Institute for Interdisciplinary Innovation in Healthcare (I3h), Université Libre de Bruxelles, Brussels, Belgium.
- Toulouse School of Economics (TSE), Université Toulouse 1 Capitole, Toulouse, France.
| | - Mathias Dewatripont
- European Center for Advanced Research in Economics and Statistics (ECARES), Université Libre de Bruxelles, Brussels, Belgium
- Institute for Interdisciplinary Innovation in Healthcare (I3h), Université Libre de Bruxelles, Brussels, Belgium
| | - Victor Ginsburgh
- European Center for Advanced Research in Economics and Statistics (ECARES), Université Libre de Bruxelles, Brussels, Belgium
- Institute for Interdisciplinary Innovation in Healthcare (I3h), Université Libre de Bruxelles, Brussels, Belgium
| | - Michel Goldman
- Institute for Interdisciplinary Innovation in Healthcare (I3h), Université Libre de Bruxelles, Brussels, Belgium
| | - Patrick Legros
- European Center for Advanced Research in Economics and Statistics (ECARES), Université Libre de Bruxelles, Brussels, Belgium
- Institute for Interdisciplinary Innovation in Healthcare (I3h), Université Libre de Bruxelles, Brussels, Belgium
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Satokangas M, Arffman M, Agerholm J, Thielen K, Hougaard CØ, Andersen I, Burström B, Keskimäki I. Performing up to Nordic principles? Geographic and socioeconomic equity in ambulatory care sensitive conditions among older adults in capital areas of Denmark, Finland and Sweden in 2000-2015. BMC Health Serv Res 2023; 23:835. [PMID: 37550672 PMCID: PMC10405465 DOI: 10.1186/s12913-023-09855-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 07/27/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Denmark, Finland and Sweden pursue equity in health for their citizens through universal health care. However, it is unclear if these services reach the older adult population equally across different socioeconomic positions or living areas. Thus, we assessed geographic and socioeconomic equity in primary health care (PHC) performance among the older adults in the capital areas of Denmark (Copenhagen), Finland (Helsinki) and Sweden (Stockholm) in 2000-2015. Hospitalisations for ambulatory care sensitive conditions (ACSC) were applied as a proxy for PHC performance. METHODS We acquired individual level ACSCs for those aged ≥ 45 in 2000-2015 from national hospitalisation registers. To identify whether the disparities varied by age, we applied three age groups (those aged 45-64, 65-75 and ≥ 75). Socioeconomic disparities in ACSCs were described with incidence rate ratios (IRR) and annual rates by education, income and living-alone; and then analysed with biennial concentration indices by income. Geographic disparities were described with biennial ACSC rates by small areas and analysed with two-level Poisson multilevel models. These models provided small area estimates of IRRs of ACSCs in 2000 and their slopes for development over time, between which Pearson correlations were calculated within each capital area. Finally, these models were adjusted for income to distinguish between geographic and socioeconomic disparities. RESULTS Copenhagen had the highest IRR of ACSCs among those aged 45-64, and Helsinki among those aged ≥ 75. Over time IRRs decreased among those aged ≥ 45, but only in Helsinki among those aged ≥ 75. All concentration indices slightly favoured the affluent population but in Stockholm were mainly non-significant. Among those aged ≥ 75, Pearson correlations were low in Copenhagen (-0.14; p = 0.424) but high in both Helsinki (-0.74; < 0.001) and Stockholm (-0.62; < 0.001) - with only little change when adjusted for income. Among those aged ≥ 45 the respective correlations were rather similar, except for a strong correlation in Copenhagen (-0.51, 0.001) after income adjustment. CONCLUSIONS While socioeconomic disparities in PHC performance persisted among older adults in the three Nordic capital areas, geographic disparities narrowed in both Helsinki and Stockholm but persisted in Copenhagen. Our findings suggest that the Danish PHC incorporated the negative effects of socio-economic segregation to a lesser degree.
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Affiliation(s)
- Markku Satokangas
- Health Economics and Equity in Health Care, Finnish Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland.
- Network of Academic Health Centres and Department of General Practice and Primary Health Care, University of Helsinki, P.O. Box 20, 00014, Helsinki, Finland.
| | - Martti Arffman
- Health Economics and Equity in Health Care, Finnish Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland
| | - Janne Agerholm
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Karsten Thielen
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Charlotte Ørsted Hougaard
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Ingelise Andersen
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Bo Burström
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Ilmo Keskimäki
- Health Economics and Equity in Health Care, Finnish Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland
- Faculty of Social Sciences, Tampere University, 33014, Tampere, Finland
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Iba A, Tomio J, Abe K, Sugiyama T, Kobayashi Y. Hospitalizations for Ambulatory Care Sensitive Conditions in a Large City of Japan: a Descriptive Analysis Using Claims Data. J Gen Intern Med 2022; 37:3917-3924. [PMID: 35829872 PMCID: PMC9640483 DOI: 10.1007/s11606-022-07713-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 06/17/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hospitalization for ambulatory care sensitive conditions (ACSCs) is an indicator of the quality of primary care in different health systems. In Japan, where patients can choose any healthcare facility with universal health coverage (UHC), data on these admissions are unknown. OBJECTIVE To describe the current situation of ACSC admissions in a city of Japan. DESIGN Retrospective observational study using claims data. PARTICIPANTS Beneficiaries aged 0-74 years of the National Health Insurance (NHI) program in a large city in the Greater Tokyo Area. We extracted ACSC admissions from all inpatient claims between April 2013 and March 2017. MAIN MEASURES We calculated age- and sex-specific annual ACSC admission rates for three categories: acute, chronic, and vaccine-preventable. We estimated the age-adjusted admission rates by ACSC category according to administrative districts and rate ratios using Poisson regression models. We also estimated medical expenditures and lengths of stay for ACSC admissions. KEY RESULTS Of 91,350 hospitalization episodes, we identified 7666 (8.4%) that were ACSC admissions. Males had higher annual ACSC admission rates than females (p < 0.001), especially for chronic ACSCs. Admission rates were lowest in those aged 15-39 years and higher in the youngest (0-4 years) and oldest (70-74 years) age groups. Age-adjusted chronic ACSC admission rates were lower in a newly developed area (rate ratio [RR]: 0.79, 95% confidence interval [CI]: 0.71-0.87) and higher in a residential area (RR: 1.14, 95% CI: 1.04-1.24) than in the center of the city. Total medical expenditures for all ACSC admissions accounted for 5.8% of the total inpatient expenditures of NHI in the city. CONCLUSIONS ACSC admission rates in Japan were higher for males than for females and showed a U-shaped trend in terms of age, as in other countries with UHC, and deferred by region. This study provided possible factors to reduce ACSC admissions.
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Affiliation(s)
- Arisa Iba
- Department of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
- Institute for Global Health Policy Research, Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan.
| | - Jun Tomio
- Department of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Health Crisis Management, National Institute of Public Health, Saitama, Japan
| | - Kazuhiro Abe
- Department of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Takemi Program in International Health, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Takehiro Sugiyama
- Institute for Global Health Policy Research, Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan
- Diabetes and Metabolism Information Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yasuki Kobayashi
- Department of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Silwal PR, Exeter D, Tenbensel T, Lee A. Understanding geographical variations in health system performance: a population-based study on preventable childhood hospitalisations. BMJ Open 2022; 12:e052209. [PMID: 35649589 PMCID: PMC9161092 DOI: 10.1136/bmjopen-2021-052209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To investigate interdistrict variations in childhood ambulatory sensitive hospitalisation (ASH) over the years. DESIGN Observational population-based study over 2008-2018 using the Primary Health Organisation Enrolment Collection (PHO) and the National Minimum Dataset hospital events databases. SETTING New Zealand primary and secondary care. PARTICIPANTS All children aged 0-4 years enrolled in the PHO Enrolment Collection from 2008 to 2018. MAIN OUTCOME MEASURE ASH. RESULTS Only 1.4% of the variability in the risk of having childhood ASH (intracluster correlation coefficient=0.014) is explained at the level of District Health Board (DHB), with the median OR of 1.23. No consistent time trend was observed for the adjusted childhood ASH at the national level, but the DHBs demonstrated different trajectories over the years. Ethnicity (being a Pacific child) followed by deprivation demonstrated stronger relationships with childhood ASH than the geography and the health system input variables. CONCLUSION The variation in childhood ASH is explained only minimal at the DHB level. The sociodemographic variables also only partly explained the variations. Unlike the general ASH measure, the childhood ASH used in this analysis provides insights into the acute conditions sensitive to primary care services. However, further information would be required to conclude this as the DHB-level performance variations.
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Affiliation(s)
- Pushkar Raj Silwal
- Health Systems Department, The University of Auckland, Auckland, New Zealand
| | - Daniel Exeter
- Section of Epidemiology and Biostatistics, The University of Auckland, Auckland, New Zealand
| | - Tim Tenbensel
- Health Systems Department, The University of Auckland, Auckland, New Zealand
| | - Arier Lee
- Section of Epidemiology and Biostatistics, The University of Auckland, Auckland, New Zealand
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Rocha JVM, Santana R, Tello JE. Hospitalization for ambulatory care sensitive conditions: What conditions make inter-country comparisons possible? HEALTH POLICY OPEN 2021; 2:100030. [PMID: 37383514 PMCID: PMC10297774 DOI: 10.1016/j.hpopen.2021.100030] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 11/23/2020] [Accepted: 12/30/2020] [Indexed: 11/20/2022] Open
Abstract
Hospitalizations for ambulatory care sensitive conditions have been extensively used in health services research to assess access, quality and performance of primary health care. Inter-country comparisons can assist policy-makers in pursuing better health outcomes by contrasting policy design, implementation and evaluation. The objective of this study is to identify the conceptual, methodological, contextual and policy dimensions and factors that need to be accounted for when comparing these types of hospitalizations across countries. A conceptual framework for inter-country comparisons was drawn based on a review of 18 studies with inter-country comparison of ambulatory care sensitive conditions hospitalizations. The dimensions include methodological choices; population's demographic, epidemiologic and socio-economic profiles and features of the health services and system. Main factors include access and quality of primary health care, availability of health workforce and health facilities, health interventions and inequalities. The proposed framework can assist in designing studies and interpreting findings of inter-country comparisons of ambulatory care sensitive conditions hospitalizations, accelerating learning and progress towards universal health coverage.
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Affiliation(s)
- João Victor Muniz Rocha
- Escola Nacional de Saúde Pública, Comprehensive Health Research Centre, Universidade NOVA de Lisboa, Portugal
| | - Rui Santana
- Escola Nacional de Saúde Pública, Comprehensive Health Research Centre, Universidade NOVA de Lisboa, Portugal
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Barrenetxea J, Tan KB, Tong R, Chua K, Feng Q, Koh WP, Chen C. Emergency hospital admissions among older adults living alone in the community. BMC Health Serv Res 2021; 21:1192. [PMID: 34732180 PMCID: PMC8567640 DOI: 10.1186/s12913-021-07216-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 10/14/2021] [Indexed: 11/29/2022] Open
Abstract
Background Among older adults, living alone is often associated with higher risk of Emergency Department (ED) admissions. However, older adults living alone are very heterogeneous in terms of health. As more older adults choose to live independently, it remains unclear if the association between living alone and ED admissions is moderated by health status. We studied the association between living alone and ED admission outcomes (number of admissions, inpatient days and inpatient costs) among older adults with and without multimorbidity. Methods We used data from 16,785 individuals of the third follow-up of the Singapore Chinese Health Study, a population-based cohort of older Singapore Chinese (mean age: 73(61-96) years). Participants were interviewed face-to-face from 2014 to 2016 for sociodemographic/health factors and followed-up for one year on ED admission outcomes using Singapore Ministry of Health’s Mediclaim Database. We first applied multivariable logistic regression and two-part models to test if living alone is a risk factor for ED admission outcomes. We then ran stratified and joint effect analysis to examine if the associations between living alone and ED admission outcomes were moderated by multimorbidity. Results Compared to living with others, living alone was associated with higher odds of ED admission [Odds Ratio (OR) 1.28, 95 % Confidence Interval(CI) 1.08-1.51)], longer inpatient days (+0.61, 95 %CI 0.25-0.97) and higher inpatient costs (+322 USD, 95 %CI 54-591). The interaction effects of living arrangement and multimorbidity on ED admissions and inpatient costs were not statistically different, whereas the interaction between living arrangements and multimorbidity on inpatient days was borderline significant (p-value for interaction=0.050). Compared to those living with others and without multimorbidity, the relative mean increase was 1.13 inpatient days (95 %CI 0.39-1.86) for those living alone without multimorbidity, and 0.73 inpatient days ( 95 %CI 0.29-1.17) for those living alone with multimorbidity. Conclusions Older adults living alone were at higher risk of ED admission and higher inpatient costs regardless of multimorbidity, while those living alone without multimorbidity had the longest average inpatient days. To enable aging in place while avoiding ED admissions, interventions could provide instrumental support and regular health monitoring to older adults living alone, regardless of their health status.
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Affiliation(s)
- Jon Barrenetxea
- Health Services and Systems Research, Duke-NUS Medical School Singapore, Singapore, Singapore
| | - Kelvin Bryan Tan
- Ministry of Health, Singapore, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, 117549, Singapore, Singapore
| | | | - Kevin Chua
- Integrative Sciences and Engineering Programme, NUS Graduate School, National University of Singapore, SG, Singapore, Singapore
| | - Qiushi Feng
- Department of Sociology & Centre for Family and Population Research, National University of Singapore, Singapore, Singapore
| | - Woon-Puay Koh
- Health Services and Systems Research, Duke-NUS Medical School Singapore, Singapore, Singapore. .,Healthy Longevity Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, 5 Science Drive 2, 117545, Singapore, Singapore. .,Singapore Institute for Clinical Sciences, Agency for Science Technology and Research, Singapore, Singapore.
| | - Cynthia Chen
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, 117549, Singapore, Singapore.
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Gygli N, Zúñiga F, Simon M. Regional variation of potentially avoidable hospitalisations in Switzerland: an observational study. BMC Health Serv Res 2021; 21:849. [PMID: 34419031 PMCID: PMC8380390 DOI: 10.1186/s12913-021-06876-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 08/12/2021] [Indexed: 01/17/2023] Open
Abstract
Background Primary health care is subject to regional variation, which may be due to unequal and inefficient distribution of services. One key measure of such variation are potentially avoidable hospitalisations, i.e., hospitalisations for conditions that could have been dealt with in situ by sufficient primary health care provision. Particularly, potentially avoidable hospitalisations for ambulatory care-sensitive conditions (ACSCs) are a substantial and growing burden for health care systems that require targeting in health care policy. Aims Using data from the Swiss Federal Statistical Office (SFSO) from 2017, we applied small area analysis to visualize regional variation to comprehensively map potentially avoidable hospitalisations for five ACSCs from Swiss nursing homes, home care organisations and the general population. Methods This retrospective observational study used data on all Swiss hospitalisations in 2017 to assess regional variations of potentially avoidable hospitalisations for angina pectoris, congestive heart failure, chronic obstructive pulmonary disease, diabetes complications and hypertension. We used small areas, utilisation-based hospital service areas (HSAs), and administrative districts (Cantons) as geographic zones. The outcomes of interest were age and sex standardised rates of potentially avoidable hospitalisations for ACSCs in adults (> 15 years). Our inferential analyses used linear mixed models with Gaussian distribution. Results We identified 46,479 hospitalisations for ACSC, or 4.3% of all hospitalisations. Most of these occurred in the elderly population for congestive heart failure and COPD. The median rate of potentially avoidable hospitalisation for ACSC was 527 (IQR 432–620) per 100.000 inhabitants. We found substantial regional variation for HSAs and administrative districts as well as disease-specific regional patterns. Conclusions Differences in continuity of care might be key drivers for regional variation of potentially avoidable hospitalisations for ACSCs. These results provide a new perspective on the functioning of primary care structures in Switzerland and call for novel approaches in effective primary care delivery. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06876-5.
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Affiliation(s)
- Niklaus Gygli
- Faculty of Medicine, Department of Public Health, Institute of Nursing Science, University of Basel, Bernoullistr. 28, CH-4056, Basel, Switzerland.,Department of Nursing, University Hospital Basel, Spitalstrasse 21, CH-4031, Basel, Switzerland
| | - Franziska Zúñiga
- Faculty of Medicine, Department of Public Health, Institute of Nursing Science, University of Basel, Bernoullistr. 28, CH-4056, Basel, Switzerland
| | - Michael Simon
- Faculty of Medicine, Department of Public Health, Institute of Nursing Science, University of Basel, Bernoullistr. 28, CH-4056, Basel, Switzerland. .,Nursing and Midwifery Research Unit, Department of Nursing, University Hospital Bern, Freiburgstrasse 18, CH-3010, Bern, Switzerland.
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Silva SDS, Pinheiro LC, Loyola Filho AID. Spatial Analysis of Factors Associated with Hospitalizations for Ambulatory Care Sensitive Conditions among Old Adults in Minas Gerais State. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2021; 24:e210037. [PMID: 34133703 DOI: 10.1590/1980-549720210037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 01/20/2021] [Indexed: 11/22/2022] Open
Abstract
AIM To investigate the geographical variability and factors associated with hospitalizations for ambulatory care sensitive conditions (ACSC) among older adults living in the state of Minas Gerais. METHODOLOGY This is an ecological study, based on data from the National Hospital Information System (SIH-SUS). Municipal rates of hospitalization for ACSC were compared to the state's average rate, and analysis of associated factors included sociodemographic characteristics, supply of health services and primary health care (PHC) activities. Data analysis was based on Bayesian spatial modeling. RESULTS Most municipalities in Minas Gerais (479 or 56.2%) had a rate of hospitalization for ACSC below the state average. After multivariate analysis, income (β = -0,0008; 95%CI: -0.0014 - -0,0002) and the Family Health Strategy coverage (β = -0.4269; 95%CI: -0.7988 - -0.1116) were negatively associated with the risk of hospitalization for ACSC, while the availability of hospital beds (β = 0.0271; 95%CI 0.0211 - 0.0331) was positively associated. The characteristics of PHC did not show any association with the rate of hospitalization for ACSC. CONCLUSION the rates of hospitalization for ACSC in the elderly population were influenced by the PHC coverage, but also by external factors such as income and structure and provision of health services, indicating that the meeting of population health demands passes through actions that go beyond the health sector, including investment in the reduction of poverty and inequality and expansion of access to PHC.
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Affiliation(s)
- Sara de Souza Silva
- Programa de Pós-Graduação em Saúde Coletiva, Instituto René Rachou, Fundação Oswaldo Cruz - Belo Horizonte (MG), Brasil
| | - Letícia Cavalari Pinheiro
- Núcleo de Estudos em Saúde Pública e Envelhecimento, Instituto René Rachou, Fundação Oswaldo Cruz - Belo Horizonte (MG), Brasil
| | - Antônio Ignácio de Loyola Filho
- Núcleo de Estudos em Saúde Pública e Envelhecimento, Instituto René Rachou, Fundação Oswaldo Cruz - Belo Horizonte (MG), Brasil.,Escola de Enfermagem, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brasil
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10
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Gottlieb DJ, Watts BV, Peltzman T, Riblet NBV, Cornelius S, Forehand JA, Shiner B. Small Area Analysis of Veterans Affairs Mental Health Services Data. Psychiatr Serv 2021; 72:384-390. [PMID: 33530729 DOI: 10.1176/appi.ps.202000130] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To identify geographic variation in mental health service use in the Department of Veterans Affairs (VA), the authors constructed utilization-based VA mental health service areas (MHSAs) for outpatient treatment and mental health referral regions (MHRRs) for residential and acute inpatient treatment. METHODS MHSAs are empirically derived geographic groupings of one or more counties containing one or more VA outpatient mental health clinics. For each county within an MHSA, patients received most of their VA-provided outpatient mental health care within that MHSA. MHSAs were aggregated into MHRRs according to where VA users in each MHSA received most of their residential and acute inpatient mental health care. Attribution loyalty was evaluated with the localization index-the fraction of VA users living in each geographic area who used their designated MHSA and MHRR facility. Variation in outpatient mental health visits and in acute inpatient and residential mental health stays was determined for the 2008-2018 period. RESULTS A total of 441 MHSAs were aggregated to 115 MHRRs (representing 3,909,080 patients with 52,372,303 outpatient mental health visits). The mean±SD localization index was 59.3%±16.4% for MHSAs and 67.8%±12.7% for MHRRs. Adjusted outpatient mental health visits varied from a mean of 0.88 per year in the lowest quintile of MHSAs to 3.14 in the highest. Combined residential and acute inpatient days varied from 0.29 to 1.79 between the lowest and highest quintiles. CONCLUSIONS MHSAs and MHRRs validly represented mental health utilization patterns in the VA and displayed considerable variation in mental health service provision across different locations.
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Affiliation(s)
- Daniel J Gottlieb
- Department of Veterans Affairs (VA) Medical Center, White River Junction, Vermont
| | - Bradley V Watts
- Department of Veterans Affairs (VA) Medical Center, White River Junction, Vermont
| | - Talya Peltzman
- Department of Veterans Affairs (VA) Medical Center, White River Junction, Vermont
| | - Natalie B V Riblet
- Department of Veterans Affairs (VA) Medical Center, White River Junction, Vermont
| | - Sarah Cornelius
- Department of Veterans Affairs (VA) Medical Center, White River Junction, Vermont
| | - Jenna A Forehand
- Department of Veterans Affairs (VA) Medical Center, White River Junction, Vermont
| | - Brian Shiner
- Department of Veterans Affairs (VA) Medical Center, White River Junction, Vermont
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Satokangas M, Arffman M, Antikainen H, Leyland AH, Keskimäki I. Individual and Area-level Factors Contributing to the Geographic Variation in Ambulatory Care Sensitive Conditions in Finland: A Register-based Study. Med Care 2021; 59:123-130. [PMID: 33201086 PMCID: PMC7899221 DOI: 10.1097/mlr.0000000000001454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Measuring primary health care (PHC) performance through hospitalizations for ambulatory care sensitive conditions (ACSCs) remains controversial-recent cross-sectional research claims that its geographic variation associates more with individual socioeconomic position (SEP) and health status than PHC supply. OBJECTIVES To clarify the usage of ACSCs as a PHC performance indicator by quantifying how disease burden, both PHC and hospital supply and spatial access contribute over time to geographic variation in Finland when individual SEP and comorbidities were adjusted for. METHODS The Finnish Care Register for Health Care provided hospitalizations for ACSCs (divided further into subgroups of acute, chronic, and vaccine-preventable causes) in 2011-2017. With 3-level nested multilevel Poisson models-individuals, PHC authorities, and hospital authorities-we estimated the proportion of the variance in ACSCs explained by selected factors at 3 time periods. RESULTS In age-adjusted and sex-adjusted analysis of total ACSCs the variances between hospital authorities was nearly twice that between PHC authorities. Individual SEP and comorbidities explained 19%-30% of the variance between PHC authorities and 25%-36% between hospital authorities; and area-level disease burden and arrangement and usage of hospital care a further 14%-16% and 32%-33%-evening out the unexplained variances between PHC and hospital authorities. CONCLUSIONS Alongside individual factors, areas' disease burden and factors related to hospital care explained the excess variances in ACSCs captured by hospital authorities. Our consistent findings over time suggest that the local strain on health care and the regional arrangement of hospital services affect ACSCs-necessitating caution when comparing areas' PHC performance through ACSCs.
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Affiliation(s)
- Markku Satokangas
- Department of General Practice and Primary Health Care, Network of Academic Health Centres, University of Helsinki
- Service System Research Unit, Finnish Institute for Health and Welfare, Helsinki
| | - Martti Arffman
- Service System Research Unit, Finnish Institute for Health and Welfare, Helsinki
| | | | - Alastair H. Leyland
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, Scotland
| | - Ilmo Keskimäki
- Service System Research Unit, Finnish Institute for Health and Welfare, Helsinki
- Faculty of Social Sciences, Tampere University, Tampere, Finland
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12
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Kontsevaya AV, Doludin YV, Khudyakov MB, Drapkina OM. Regional Characteristics of Hospital Admissions and Outpatients Visits with Arterial Hypertension from the Point of the WHO Concept of Ambulatory Care Sensitive Conditions. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2020. [DOI: 10.20996/1819-6446-2020-12-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Aim. To analyze hospital admission and ambulatory care of the patients with arterial hypertension (AH) in federal districts and regions from the perspective of the WHO concept of diseases, which can be treated in ambulatory settings (ambulatory care sensitive conditions, ACSC).Material and methods. For analysis we used data from annual forms of federal statistical monitoring (12 and 14), which includes data on hospital admissions with hypertension in federal districts and separate regions in 2017. Hypertension included diseases characterized by raised blood pressure, ICD10: I10-I13.Results. We performed the analysis of 12 and 14 forms per districts and regions of the Russian Federation. Regions with increased hospitalization rates and an increased ratio of the hospitalizations to number to outpatients visits were identified. High variability of these indicators was observed both among both between regions and federal districts. The values of the ratio indicator vary from 0.0131 in the Nizhny Novgorod Region to 0.0234 in the Chechen Republic. The average value of the ratio in the federal district varies from 0.032 in the Volga Federal District to 0.119 in the North Caucasus Federal District. In the North Caucasus and Far East Federal District the value of the indicator is significantly higher than in other districts.Conclusion. Assessing diseases which can be treated in ambulatory setting scan be one of the tools for evaluating the quality of medical care in primary care facilities. However, before including ACSC as an indicator of the quality of health care delivery, a deeper understanding of the reasons that can impact its rates is required.
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Affiliation(s)
- A. V. Kontsevaya
- National Medical Research Center for Therapy and Preventive Medicine
| | - Yu. V. Doludin
- National Medical Research Center for Therapy and Preventive Medicine
| | - M. B. Khudyakov
- National Medical Research Center for Therapy and Preventive Medicine
| | - O. M. Drapkina
- National Medical Research Center for Therapy and Preventive Medicine
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Pongiglione B, Torbica A, Gusmano MK. Inequalities in avoidable hospitalisation in large urban areas: retrospective observational study in the metropolitan area of Milan. BMJ Open 2020; 10:e042424. [PMID: 33372079 PMCID: PMC7772299 DOI: 10.1136/bmjopen-2020-042424] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Significant inequalities in access to healthcare system exist between residents of world megacities, even if they have different healthcare systems. The aim of this study was to estimate avoidable hospitalisations in the metropolitan area of Milan (Italy) and explore inequalities in access to healthcare between patients and across their areas of residence. DESIGN Retrospective observational study. SETTING Public and accredited private hospitals in the metropolitan area of Milan. Data obtained from the hospital discharge database of the Italian Health Ministry. PARTICIPANTS 472 579 patients hospitalised for ambulatory care sensitive conditions and resident in the metropolitan area of Milan from 2005 to 2016. OUTCOME MEASURE Age-adjusted rates of avoidable hospitalisations; OR for hospital admissions with ambulatory care sensitive conditions. METHODS Age-adjusted rates of avoidable hospitalisations in the metropolitan area of Milan were estimated from 2005 to 2016 using direct standardisation. For the hospitalised population, multilevel logistic regression model with patient random effects was used to identify patients, hospitals and municipalities' characteristics associated with risk of avoidable hospitalisation in the period 2012-2016. RESULTS The rate of avoidable hospitalisation in Milan fell steadily between 2005 and 2016 from 16.6 to 10.5 per 1000. Among the hospitalised population, the odds of being hospitalised with an ambulatory care sensitive condition was higher for male (OR 1.42, 95% CI 1.36 to 1.48), older (OR 1.012, 95% CI 1.01 to 1.014), low-educated (elementary school vs degree OR 4.23, 95% CI 3.72 to 4.81) and single (vs married OR 2.08, 95% CI 2.01 to 2.16) patients with comorbidities (OR 1.47, 95% CI 1.38 to 1.56); avoidable admissions were more frequent in public non-teaching hospitals while municipality's characteristics did not appear to be correlated with hospitalisation for ambulatory care sensitive conditions. CONCLUSIONS The health system in metropolitan Milan has experienced a reduction in avoidable hospitalisations between 2005 and 2016, quite homogeneously across its 134 municipalities. The study design allowed to explore inequalities among the hospitalised population for which we found specific sociodemographic disadvantages.
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Affiliation(s)
- Benedetta Pongiglione
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Bocconi University, Milan, Italy
| | - Aleksandra Torbica
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Bocconi University, Milan, Italy
| | - Michael K Gusmano
- Department of Health Behavior, Society, and Policy, Rutgers University, New Brunswick, New Jersey, USA
- The Hastings Center, Garrison, New York, USA
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14
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Georgescu V, Green A, Jensen PB, Möller S, Renard E, Mercier G. Primary care visits can reduce the risk of potentially avoidable hospitalizations among persons with diabetes in France. Eur J Public Health 2020; 30:1056-1061. [PMID: 32851398 DOI: 10.1093/eurpub/ckaa137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Diabetes is a frequent chronic condition, which can lead to costly complications if not managed well in the primary care setting. Potentially avoidable hospitalizations (PAH) are considered as an indirect measure of primary care. However, the association between primary care use and PAH in diabetic patients has not been investigated in France. METHODS We investigate the association between primary care indicators and PAH at an individual level among persons with diabetes in a population-based cohort study on the French national health insurance database (EGB sample). PAH occurrence in 2013 was modeled as a function of primary care use and access, health status and socio-economic indicators over the exposure period 2011-12 using a cause-specific hazards model with death as a competing event. RESULTS We included 25 293 diabetics in our cohort, among which 385 (1.5%) experienced at least 1 PAH in 2013. After adjustment on health status indicators, primary care use had a protective effect against PAH. Diabetic patients who had seen a general practitioner (GP) 10-14 times had a reduced hazard of PAH compared to less frequent encounters (HR=0.49, P<0.001). The effect size decreased when the number of encounters increased, suggesting a remaining confounding effect of health status. CONCLUSIONS For the first time in France, this study shows a protective effect of the number of GP encounters against PAH at an individual level and highlights the importance of a frequent monitoring of diabetic patients in the primary care setting to prevent PAH occurrence.
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Affiliation(s)
- Vera Georgescu
- Health Services Research Unit, Public Health Department (DIM), CHU Montpellier, Montpellier, France
| | - Anders Green
- Odense Patient data Exploratory Network (OPEN), Odense, Denmark.,Department of Clinical Research, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Peter B Jensen
- Odense Patient data Exploratory Network (OPEN), Odense, Denmark.,Department of Clinical Research, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Sören Möller
- Odense Patient data Exploratory Network (OPEN), Odense, Denmark.,Department of Clinical Research, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Eric Renard
- Department of Endocrinology, Diabetes, Nutrition, CHU Montpellier, Montpellier, France.,Institute of Functional Genomics, University of Montpellier, Montpellier, France
| | - Gregoire Mercier
- Health Services Research Unit, Public Health Department (DIM), CHU Montpellier, Montpellier, France.,UMR CNRS CEPEL, Political Science and Sociology, UMR 5112, Montpellier, France
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15
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Pinto A, Santos JV, Souza J, Viana J, Costa Santos C, Lobo M, Freitas A. Comparison and Impact of Four Different Methodologies for Identification of Ambulatory Care Sensitive Conditions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8121. [PMID: 33153171 PMCID: PMC7662634 DOI: 10.3390/ijerph17218121] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 10/29/2020] [Accepted: 10/30/2020] [Indexed: 11/30/2022]
Abstract
Ambulatory care sensitive conditions (ACSCs) are conditions for which hospitalizations are thought to be avoidable if effective and accessible primary health care is available. However, to define which conditions are considered ACSCs, there is a considerable number of different lists. Our aim was to compare the impact of using different ACSC lists considering mainland Portugal hospitalizations. A retrospective study with inpatient data from Portuguese public hospital discharges between 2011 and 2015 was conducted. Four ACSC list sources were considered: Agency for Healthcare Research and Quality (AHRQ), Canadian Institute for Health Information (CIHI), the Victorian Ambulatory Care Sensitive Conditions study, and Sarmento et al. Age-sex-adjusted rates of ACSCs were calculated by district (hospitalizations per 100,000 inhabitants). Spearman's rho, the intraclass correlation coefficient (ICC), the information-based measure of disagreement (IBMD), and Bland and Altman plots were computed. Results showed that by applying the four lists, different age-sex-adjusted rates are obtained. However, the lists that seemed to demonstrate greater agreement and consistency were the list proposed by Sarmento et al. compared to AHRQ and the AHRQ method compared to the Victorian list. It is important to state that we should compare comparable indicators and ACSC lists cannot be used interchangeably.
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Affiliation(s)
- Andreia Pinto
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal; (J.V.S.); (J.S.); (J.V.); (C.C.S.); (M.L.); (A.F.)
- CINTESIS–Center for Health Technology and Services Research, 4200-450 Porto, Portugal
| | - João Vasco Santos
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal; (J.V.S.); (J.S.); (J.V.); (C.C.S.); (M.L.); (A.F.)
- CINTESIS–Center for Health Technology and Services Research, 4200-450 Porto, Portugal
- Public Health Unit, ACES Grande Porto VIII–Espinho/Gaia, 4500-330 Porto, Portugal
| | - Júlio Souza
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal; (J.V.S.); (J.S.); (J.V.); (C.C.S.); (M.L.); (A.F.)
- CINTESIS–Center for Health Technology and Services Research, 4200-450 Porto, Portugal
| | - João Viana
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal; (J.V.S.); (J.S.); (J.V.); (C.C.S.); (M.L.); (A.F.)
- CINTESIS–Center for Health Technology and Services Research, 4200-450 Porto, Portugal
| | - Cristina Costa Santos
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal; (J.V.S.); (J.S.); (J.V.); (C.C.S.); (M.L.); (A.F.)
- CINTESIS–Center for Health Technology and Services Research, 4200-450 Porto, Portugal
| | - Mariana Lobo
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal; (J.V.S.); (J.S.); (J.V.); (C.C.S.); (M.L.); (A.F.)
- CINTESIS–Center for Health Technology and Services Research, 4200-450 Porto, Portugal
| | - Alberto Freitas
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal; (J.V.S.); (J.S.); (J.V.); (C.C.S.); (M.L.); (A.F.)
- CINTESIS–Center for Health Technology and Services Research, 4200-450 Porto, Portugal
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16
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Sarmento J, Rocha JVM, Santana R. Defining ambulatory care sensitive conditions for adults in Portugal. BMC Health Serv Res 2020; 20:754. [PMID: 32799880 PMCID: PMC7429814 DOI: 10.1186/s12913-020-05620-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 08/03/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Ambulatory Care Sensitive Conditions (ACSCs) are health conditions for which adequate management, treatment and interventions delivered in the ambulatory care setting could potentially prevent hospitalization. Which conditions are sensitive to ambulatory care varies according to the scope of health care services and the context in which the indicator is used. The need for a country-specific validated list for Portugal has already been identified, but currently no national list exists. The objective of this study was to develop a list of Ambulatory Care Sensitive Conditions for Portugal. METHODS A modified web-based Delphi panel approach was designed, in order to determine which conditions can be considered ACSCs in the Portuguese adult population. The selected experts were general practitioners and internal medicine physicians identified by the most relevant Portuguese scientific societies. Experts were presented with previously identified ACSC and asked to select which could be accepted in the Portuguese context. They were also asked to identify other conditions they considered relevant. We estimated the number and cost of ACSC hospitalizations in 2017 in Portugal according to the identified conditions. RESULTS After three rounds the experts agreed on 34 of the 45 initially proposed items. Fourteen new conditions were proposed and four achieved consensus, namely uterine cervical cancer, colorectal cancer, thromboembolic venous disease and voluntary termination of pregnancy. In 2017 133,427 hospitalizations were for ACSC (15.7% of all hospitalizations). This represents a rate of 1685 per 100,000 adults. The most frequent diagnosis were pneumonia, heart failure, chronic obstructive pulmonary disease/chronic bronchitis, urinary tract infection, colorectal cancer, hypertensive disease atrial fibrillation and complications of diabetes mellitus. CONCLUSIONS New ACSC were identified. It is expected that this list could be used henceforward by epidemiologic studies, health services research and for healthcare management purposes. ACSC lists should be updated frequently. Further research is necessary to increase the specificity of ACSC hospitalizations as an indicator of healthcare performance.
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Affiliation(s)
- João Sarmento
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Av. Padre Cruz, 1600-560, Lisbon, Portugal.
| | - João Victor Muniz Rocha
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Av. Padre Cruz, 1600-560, Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Rui Santana
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Av. Padre Cruz, 1600-560, Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
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17
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Kembou Nzale S, Weeks WB, Ouafik L, Rouquette I, Beau-Faller M, Lemoine A, Bringuier PP, Le Coroller Soriano AG, Barlesi F, Ventelou B. Inequity in access to personalized medicine in France: Evidences from analysis of geo variations in the access to molecular profiling among advanced non-small-cell lung cancer patients: Results from the IFCT Biomarkers France Study. PLoS One 2020; 15:e0234387. [PMID: 32609781 PMCID: PMC7329126 DOI: 10.1371/journal.pone.0234387] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 05/26/2020] [Indexed: 11/19/2022] Open
Abstract
In this article, we studied geographic variation in the use of personalized genetic testing for advanced non-small cell lung cancer (NSCLC) and we evaluated the relationship between genetic testing rates and local socioeconomic and ecological variables. We used data on all advanced NSCLC patients who had a genetic test between April 2012 and April 2013 in France in the frame of the IFCT Biomarqueurs-France study (n = 15814). We computed four established measures of geographic variation of the sex-adjusted rates of genetic testing utilization at the "départment" (the French territory is divided into 94 administrative units called 'départements') level. We also performed a spatial regression model to determine the relationship between département-level sex-adjusted rates of genetic testing utilization and economic and ecological variables. Our results are the following: (i) Overall, 46.87% lung cancer admission patients obtained genetic testing for NSCLC; département-level utilization rates varied over 3.2-fold. Measures of geographic variation indicated a relatively high degree of geographic variation. (ii) there was a statistically significant relationship between genetic testing rates and per capita supply of general practitioners, radiotherapists and surgeons (negative correlation for the latter); lower genetic testing rates were also associated with higher local poverty rates. French policymakers should pursue effort toward deprived areas to obtain equal access to personalized medicine for advanced NSCLC patients.
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Affiliation(s)
- Samuel Kembou Nzale
- Aix-Marseille Univ., CNRS, EHESS, Centrale Marseille, AMSE, Marseille, France
| | - William B. Weeks
- The Dartmouth Institute for Health Policy and Clinical Practice, Williamson Translational Building, DHMC, Lebanon, NH, United States of America
| | - L’Houcine Ouafik
- Assistance Publique Hôpitaux de Marseille, Service de Transfert d'Oncologie Biologique, Aix-Marseille Univ, Marseille, France
| | - Isabelle Rouquette
- Institut Universitaire du Cancer de Toulouse, Oncopôle, Service d'Anatomie Pathologique, Toulouse, France
| | - Michèle Beau-Faller
- Centre Hospitalier Universitaire de Hautepierre, Laboratoire de Biochimie et de Biologie Moléculaire & Plate-forme de Génomique des Cancers, Strasbourg, France
| | - Antoinette Lemoine
- Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier des Hôpitaux Universitaires Paris-Sud, Service d'Oncogénétique- Oncomolpath, Université Paris 11, Villejuif, France
| | - Pierre-Paul Bringuier
- Hôpital Edouard Herriot, Service d'Anatomie et de Cytologie Pathologique, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon Cancer Research Center, UMR 1057 INSERM, Lyon, France
| | - Anne-Gaëlle Le Coroller Soriano
- Mixed Research Unit 912, Institute of Research and Development, National Institute of Health and Medical Research, Paoli Calmettes Institute, Aix-Marseille University, Marseille, France
- * E-mail:
| | - Fabrice Barlesi
- Assistance Publique Hôpitaux de Marseille, Multidisciplinary Oncology and Therapeutic Innovations Department, Aix-Marseille Univ, Centre d'Investigation Clinique, Marseille, France
| | - Bruno Ventelou
- Aix-Marseille Univ., CNRS, EHESS, Centrale Marseille, AMSE, Marseille, France
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18
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Sevilla-Dedieu C, Billaudeau N, Paraponaris A. Healthcare consumption after a change in health insurance coverage: a French quasi-natural experiment. HEALTH ECONOMICS REVIEW 2020; 10:17. [PMID: 32529529 PMCID: PMC7291705 DOI: 10.1186/s13561-020-00275-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 05/29/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Compared with the number of studies performed in the United States, few studies have been conducted on the link between health insurance and healthcare consumption in Europe, likely because most European countries have compulsory national health insurance (NHI) or a national health service (NHS). Recently, a major French private insurer, offering voluntary complementary coverage in addition to the compulsory NHI, replaced its single standard package with a range of offers from basic coverage (BC) to extended coverage (EC), providing a quasi-natural experiment to test theoretical assumptions about consumption patterns. METHODS Reimbursement claim data from 85,541 insurees were analysed from 2009 to 2018. Insurees who opted for EC were matched to those still covered by BC with similar characteristics. Difference-in-differences (DiD) models were used to compare both the monetary value and physical quantities of healthcare consumption before and after the change in coverage. RESULTS As expected, the DiD models revealed a strongly significant, though transitory (mainly during the first year), increase after the change in coverage for EC insurees, particularly for costly care such as dental prostheses and spectacles. Surprisingly, consumption seemed to precede the change in coverage, suggesting that one possible determinant of opting for more coverage may be previous unplanned expenses. CONCLUSION Both catching-up behaviour and moral hazard are likely to play a role in the observed increase in healthcare consumption.
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Affiliation(s)
| | | | - Alain Paraponaris
- Aix-Marseille Univ, CNRS, EHESS, Centrale Marseille, AMSE, Marseille, France
- ORS PACA, South-Eastern Health Observatory, Marseille, France
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19
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Wilk P, Ali S, Anderson KK, Clark AF, Cooke M, Frisbee SJ, Gilliland J, Haan M, Harris S, Kiarasi S, Maltby A, Norozi K, Petrella R, Sarma S, Singh SS, Stranges S, Thind A. Geographic variation in preventable hospitalisations across Canada: a cross-sectional study. BMJ Open 2020; 10:e037195. [PMID: 32414831 PMCID: PMC7232620 DOI: 10.1136/bmjopen-2020-037195] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE The objective of this study is to examine the magnitude and pattern of small-area geographic variation in rates of preventable hospitalisations for ambulatory care-sensitive conditions (ACSC) across Canada (excluding Québec). DESIGN AND SETTING A cross-sectional study conducted in Canada (excluding Québec) using data from the 2006 Canadian Census Health and Environment Cohort (CanCHEC) linked prospectively to hospitalisation records from the Discharge Abstract Database (DAD) for the three fiscal years: 2006-2007, 2007-2008 and 2008-2009. PRIMARY OUTCOME MEASURE Preventable hospitalisations (ACSC). PARTICIPANTS The 2006 CanCHEC represents a population of 22 562 120 individuals in Canada (excluding Québec). Of this number, 2 940 150 (13.03%) individuals were estimated to be hospitalised at least once during the 2006-2009 fiscal years. METHODS Age-standardised annualised ACSC hospitalisation rates per 100 000 population were computed for each of the 190 Census Divisions. To assess the magnitude of Census Division-level geographic variation in rates of preventable hospitalisations, the global Moran's I statistic was computed. 'Hot spot' analysis was used to identify the pattern of geographic variation. RESULTS Of all the hospitalisation events reported in Canada during the 2006-2009 fiscal years, 337 995 (7.10%) events were ACSC-related hospitalisations. The Moran's I statistic (Moran's I=0.355) suggests non-randomness in the spatial distribution of preventable hospitalisations. The findings from the 'hot spot' analysis indicate a cluster of Census Divisions located in predominantly rural and remote parts of Ontario, Manitoba and Saskatchewan and in eastern and northern parts of Nunavut with significantly higher than average rates of preventable hospitalisation. CONCLUSION The knowledge generated on the small-area geographic variation in preventable hospitalisations can inform regional, provincial and national decision makers on planning, allocation of resources and monitoring performance of health service providers.
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Affiliation(s)
- Piotr Wilk
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Shehzad Ali
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Kelly K Anderson
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Andrew F Clark
- Department of Geography, Western University, London, Ontario, Canada
| | - Martin Cooke
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Stephanie J Frisbee
- Department of Pathology and Laboratory Medicine, Western University, London, Ontario, Canada
| | - Jason Gilliland
- Department of Geography, Western University, London, Ontario, Canada
| | - Michael Haan
- Department of Sociology, Western University, London, Ontario, Canada
| | - Stewart Harris
- Department of Family Medicine, Western University, London, Ontario, Canada
| | - Soushyant Kiarasi
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Alana Maltby
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Kambiz Norozi
- Department of Paediatrics, Western University, London, Ontario, Canada
| | - Robert Petrella
- Department of Family Medicine, Western University, London, Ontario, Canada
| | - Sisira Sarma
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Sarah S Singh
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Saverio Stranges
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Amardeep Thind
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
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Wallar LE, De Prophetis E, Rosella LC. Socioeconomic inequalities in hospitalizations for chronic ambulatory care sensitive conditions: a systematic review of peer-reviewed literature, 1990-2018. Int J Equity Health 2020; 19:60. [PMID: 32366253 PMCID: PMC7197160 DOI: 10.1186/s12939-020-01160-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 03/09/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Hospitalizations for chronic ambulatory care sensitive conditions are an important indicator of health system equity and performance. Chronic ambulatory care sensitive conditions refer to chronic diseases that can be managed in primary care settings, including angina, asthma, and diabetes, with hospitalizations for these conditions considered potentially avoidable with adequate primary care interventions. Socioeconomic inequities in the risk of hospitalization have been observed in several health systems globally. While there are multiple studies examining the association between socioeconomic status and hospitalizations for chronic ambulatory care sensitive conditions, these studies have not been systematically reviewed. The objective of this study is to systematically identify and describe socioeconomic inequalities in hospitalizations for chronic ambulatory care sensitive conditions amongst adult populations in economically developed countries reported in high-quality observational studies published in the peer-reviewed literature. METHODS Peer-reviewed literature was searched in six health and social science databases: MEDLINE, EMBASE, PsycInfo, CINAHL, ASSIA, and IBSS using search terms for hospitalization, socioeconomic status, and chronic ambulatory care sensitive conditions. Study titles and abstracts were first screened followed by full-text review according to the following eligibility criteria: 1) Study outcome is hospitalization for selected chronic ambulatory care sensitive conditions; 2) Primary exposure is individual- or area-level socioeconomic status; 3) Study population has a mean age ± 1 SD < 75 years of age; 4) Study setting is economically developed countries; and 5) Study type is observational. Relevant data was then extracted, and studies were critically appraised using appropriate tools from The Joanna Briggs Institute. Results were narratively synthesized according to socioeconomic constructs and type of adjustment (minimally versus fully adjusted). RESULTS Of the 15,857 unique peer-reviewed studies identified, 31 studies met the eligibility criteria and were of sufficient quality for inclusion. Socioeconomic constructs and hospitalization outcomes varied across studies. However, despite this heterogeneity, a robust and consistent association between lower levels of socioeconomic status and higher risk of hospitalizations for chronic ambulatory care sensitive conditions was observed. CONCLUSIONS This systematic review is the first to comprehensively identify and analyze literature on the relationship between SES and hospitalizations for chronic ambulatory care sensitive conditions, considering both aggregate and condition-specific outcomes that are common to several international health systems. The evidence consistently demonstrates that lower socioeconomic status is a risk factor for hospitalization across global settings. Effective health and social interventions are needed to reduce these inequities and ensure fair and adequate care across socioeconomic groups. TRIAL REGISTRATION PROSPERO CRD42018088727.
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Affiliation(s)
- Lauren E Wallar
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, M5T 3M7, Canada
| | - Eric De Prophetis
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, M5T 3M7, Canada
| | - Laura C Rosella
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, M5T 3M7, Canada.
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21
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Weeks WB, Weinstein JN. Medicare's per-Beneficiary Potentially Avoidable Admission Measures Mask True Performance. J Gen Intern Med 2020; 35:1348-1351. [PMID: 31637656 PMCID: PMC7174531 DOI: 10.1007/s11606-019-05354-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 09/11/2019] [Indexed: 11/24/2022]
Affiliation(s)
| | - James N Weinstein
- Microsoft Healthcare NExT, Redmond, WA, USA.,The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA
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22
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Mercier G, Georgescu V, Plancque E, Duflos C, Le Pape A, Quantin C. The effect of primary care on potentially avoidable hospitalizations in France: a cross-sectional study. BMC Health Serv Res 2020; 20:268. [PMID: 32234078 PMCID: PMC7106616 DOI: 10.1186/s12913-020-05132-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Accepted: 03/20/2020] [Indexed: 11/21/2022] Open
Abstract
Background Potentially avoidable hospitalizations are an indirect measure of access to primary care. However, the role and quality of primary care might vary by geographical location. The main objective was to assess the impact of primary care on geographic variations of potentially avoidable hospitalizations in Occitanie, France. Methods We conducted a retrospective analysis of claims and socio-economic data for the French Occitanie region in 2014. In order to account for spatial heterogeneity, the region was split into two zones based on socio-economic traits: median pre-tax income and unemployment rate. Age- and sex-adjusted hospital discharge potentially avoidable hospitalization rates were calculated at the ZIP-code level. Demographic, socio-economic, and epidemiological determinants were retrieved, as well as data on supply of, access to and utilization of primary care. Results 72% of PAH are attributable to two chronic conditions: chronic obstructive pulmonary disease and heart failure. In Zone 1, the potentially avoidable hospitalization rate was positively associated with premature mortality and with the number of specialist encounters by patients. It was negatively associated with the density of nurses. In Zone 2, the potentially avoidable hospitalization rate was positively associated with premature mortality, with access to general practitioners, and with the number of nurse encounters by patients. It was negatively associated with the proportion of the population having at least one general practitioner encounter and with the density of nurses. Conclusions This study suggests that the role of primary care in potentially avoidable hospitalizations might be geography dependent.
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Affiliation(s)
- Gregoire Mercier
- Health Services Research Unit, DIM, CHU de Montpellier, Montpellier, France. .,UMR CNRS CEPEL, Montpellier, France. .,DIM, Hopital La Colombiere, 39 avenue Charles Flahault, 34295, Montpellier, France.
| | - Vera Georgescu
- Health Services Research Unit, DIM, CHU de Montpellier, Montpellier, France.,DIM, Hopital La Colombiere, 39 avenue Charles Flahault, 34295, Montpellier, France
| | - Elodie Plancque
- Agence Regionale de Sante Occitanie, 1025 Rue Henri Becquerel, 34067, Montpellier, France
| | - Claire Duflos
- Health Services Research Unit, DIM, CHU de Montpellier, Montpellier, France.,DIM, Hopital La Colombiere, 39 avenue Charles Flahault, 34295, Montpellier, France
| | - Annick Le Pape
- Agence Regionale de Sante Occitanie, 1025 Rue Henri Becquerel, 34067, Montpellier, France
| | - Catherine Quantin
- CHU de Dijon, 2 Boulevard du Maréchal de Lattre de Tassigny, 21000, Dijon, France
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23
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Rocha JVM, Marques AP, Moita B, Santana R. Direct and lost productivity costs associated with avoidable hospital admissions. BMC Health Serv Res 2020; 20:210. [PMID: 32164697 PMCID: PMC7069007 DOI: 10.1186/s12913-020-5071-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 03/04/2020] [Indexed: 12/14/2022] Open
Abstract
Background Hospitalizations for ambulatory care sensitive conditions are commonly used to evaluate primary health care performance, as the hospital admission could be avoided if care was timely and adequate. Previous evidence indicates that avoidable hospitalizations carry a substantial direct financial burden in some countries. However, no attention has been given to the economic burden on society they represent. The aim of this study is to estimate the direct and lost productivity costs of avoidable hospital admissions in Portugal. Methods Hospitalizations occurring in Portugal in 2015 were analyzed. Avoidable hospitalizations were defined and their associated costs and years of potential life lost were calculated. Direct costs were obtained using official hospitalization prices. For lost productivity, there were estimated costs for absenteeism and premature death. Costs were analyzed by components, by conditions and by variations on estimation parameters. Results The total estimated cost associated with avoidable hospital admissions was €250 million (€2515 per hospitalization), corresponding to 6% of the total budget of public hospitals in Portugal. These hospitalizations led to 109,641 years of potential life lost. Bacterial pneumonia, congestive heart failure and urinary tract infection accounted for 77% of the overall costs. Nearly 82% of avoidable hospitalizations were in patients aged 65 years or older, therefore did not account for the lost productivity costs. Nearly 84% of the total cost comes from the direct cost of the hospitalization. Lost productivity costs are estimated to be around €40 million. Conclusion The age distribution of avoidable hospitalizations had a significant effect on costs components. Not only did hospital admissions have a substantial direct economic impact, they also imposed a considerable economic burden on society. Substantial financial resources could potentially be saved if the country reduced avoidable hospitalizations.
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Affiliation(s)
- João Victor Muniz Rocha
- Universidade Nova de Lisboa Escola Nacional de Saúde Publica Lisboa, Avenida Padre Cruz, 1600-560, Lisboa, Portugal. .,Universidade Nova de Lisboa Centro de Investigação em Saúde Publica Lisboa, Lisboa, Portugal.
| | - Ana Patrícia Marques
- Universidade Nova de Lisboa Escola Nacional de Saúde Publica Lisboa, Avenida Padre Cruz, 1600-560, Lisboa, Portugal.,Universidade Nova de Lisboa Centro de Investigação em Saúde Publica Lisboa, Lisboa, Portugal
| | - Bruno Moita
- Universidade Nova de Lisboa Escola Nacional de Saúde Publica Lisboa, Avenida Padre Cruz, 1600-560, Lisboa, Portugal.,Centro Hospitalar Universitário do Algarve, E.P.E Faro, PT. Universidade Nova de Lisboa Escola Nacional de Saúde Publica Lisboa, Rua Leão Penedo, 8000-386, Faro, Portugal
| | - Rui Santana
- Universidade Nova de Lisboa Escola Nacional de Saúde Publica Lisboa, Avenida Padre Cruz, 1600-560, Lisboa, Portugal.,Universidade Nova de Lisboa Centro de Investigação em Saúde Publica Lisboa, Lisboa, Portugal
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24
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Renner AT. Inefficiencies in a healthcare system with a regulatory split of power: a spatial panel data analysis of avoidable hospitalisations in Austria. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2020; 21:85-104. [PMID: 31501973 PMCID: PMC7058618 DOI: 10.1007/s10198-019-01113-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 08/27/2019] [Indexed: 06/10/2023]
Abstract
Despite generous universal social health insurance with little formal restrictions of outpatient utilisation, Austria exhibits high rates of avoidable hospitalisations, which indicate the inefficient provision of primary healthcare and might be a consequence of the strict regulatory split between the Austrian inpatient and outpatient sector. This paper exploits the considerable regional variations in acute and chronic avoidable hospitalisations in Austria to investigate whether those inefficiencies in primary care are rather related to regional healthcare supply or to population characteristics. To explicitly account for inter-regional dependencies, spatial panel data methods are applied to a comprehensive administrative dataset of all hospitalisations from 2008 to 2013 in the 117 Austrian districts. The initial selection of relevant covariates is based on Bayesian model averaging. The results of the analysis show that supply-side variables, such as the number of general practitioners, are significantly associated with decreased chronic and acute avoidable hospitalisations, whereas characteristics of the regional population, such as the share of population with university education or long-term unemployed, are less relevant. Furthermore, the spatial error term indicates that there are significant spatial dependencies between unobserved characteristics, such as practice style or patients' utilization behaviour. Not accounting for those would result in omitted variable bias.
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Affiliation(s)
- Anna-Theresa Renner
- Health Economics and Policy Group, Vienna University of Economics and Business (WU), Welthandelsplatz 1, Building D4, 1020, Vienna, Austria.
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25
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Amaral JV, Araujo Filho ACAD, Da Rocha SS. Hospitalizações infantis por condições sensíveis à atenção primária em cidade brasileira. AVANCES EN ENFERMERÍA 2020. [DOI: 10.15446/av.enferm.v38n1.79093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Objetivo: analisar a evolução temporal das hospitalizações, de crianças menores de cinco anos, por condições sensíveis à atenção primária em Teresina-PI, Brasil, de 2003 a 2012.Métodos: trata-se de estudo retrospectivo, descritivo e quantitativo, realizado a partir de dados secundários extraídos da Rede Interagencial de Informações para a Saúde, disponíveis no sítio eletrônico do Departamento de Informática do Sistema Único de Saúde. As hospitalizações foram analisadas em dois grupos etários: crianças menores de um ano de idade e crianças entre um e quatro anos de idade.Resultados: apesar das flutuações no período analisado, a taxa de hospitalizações teve um decréscimo de 71,88 %. Em crianças menores de um ano, o declínio foi de 71,49 % e, com idade entre um e quatro anos, a redução foi de 72,30 %. A maioria das hospitalizações ocorreu no sexo masculino, e as causas que predominaram foram gastroenterites infecciosas e pneumonias bacterianas.Conclusões: as hospitalizações por condições sensíveis à atenção primária tiveram um declínio ao longo da década analisada, entretanto houve um predomínio de condições sensíveis que poderiam ser evitadas ou até mesmo solucionadas se fossem aplicadas as medidas disponíveis e de baixo custo nos serviços primários de saúde.
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26
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Seringa J, Marques AP, Moita B, Gaspar C, Raposo JF, Santana R. The impact of diabetes on multiple avoidable admissions: a cross-sectional study. BMC Health Serv Res 2019; 19:1002. [PMID: 31881962 PMCID: PMC6935195 DOI: 10.1186/s12913-019-4840-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 12/16/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Multiple admissions for ambulatory care sensitive conditions (ACSC) are responsible for an important proportion of health care expenditures. Diabetes is one of the conditions consensually classified as an ACSC being considered a major public health concern. The aim of this study was to analyse the impact of diabetes on the occurrence of multiple admissions for ACSC. METHODS We analysed inpatient data of all public Portuguese NHS hospitals from 2013 to 2015 on multiple admissions for ACSC among adults aged 18 or older. Multiple ACSC users were identified if they had two or more admissions for any ACSC during the period of analysis. Two logistic regression models were computed. A baseline model where a logistic regression was performed to assess the association between multiple admissions and the presence of diabetes, adjusting for age and sex. A full model to test if diabetes had no constant association with multiple admissions by any ACSC across age groups. RESULTS Among 301,334 ACSC admissions, 144,209 (47.9%) were classified as multiple admissions and from those, 59,436 had diabetes diagnosis, which corresponded to 23,692 patients. Patients with diabetes were 1.49 times (p < 0,001) more likely to be admitted multiple times for any ACSC than patients without diabetes. Younger adults with diabetes (18-39 years old) were more likely to become multiple users. CONCLUSION Diabetes increases the risk of multiple admissions for ACSC, especially in younger adults. Diabetes presence is associated with a higher resource utilization, which highlights the need for the implementation of adequate management of chronic diseases policies.
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Affiliation(s)
- Joana Seringa
- NOVA National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal.
| | - Ana Patrícia Marques
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Center (CHRC), Lisbon, Portugal
| | - Bruno Moita
- NOVA National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal
- Algarve University Hospital Center, Faro, Portugal
| | - Cátia Gaspar
- NOVA National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - João Filipe Raposo
- NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
- Associação Protectora dos Diabéticos de Portugal, Lisbon, Portugal
| | - Rui Santana
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Center (CHRC), Lisbon, Portugal
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27
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Zucco R, Pileggi C, Vancheri M, Papadopoli R, Nobile CGA, Pavia M. Preventable pediatric hospitalizations and access to primary health care in Italy. PLoS One 2019; 14:e0221852. [PMID: 31644581 PMCID: PMC6808327 DOI: 10.1371/journal.pone.0221852] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 08/18/2019] [Indexed: 12/02/2022] Open
Abstract
The aim of this study was to quantify the burden of avoidable pediatric hospital admissions for Ambulatory care-sensitive conditions (ACSC) and to identify factors related to these preventable hospitalizations. The study was conducted by retrospectively reviewing all medical records of children admitted in a non-teaching 474-bed acute care hospital located in Catanzaro (Italy) for an avoidable hospitalization diagnosis. Two control clinical records involving children hospitalized for clinical conditions not classified as ACSC were randomly selected for each clinical record that included an ACSC. Among the 4293 pediatric hospitalizations, 451 (10.5%) were judged to be preventable. Of these, the most frequent discharge diagnoses were: dehydration (29.7%), pneumonia (17.7%), seizures (15.7%) and chronic obstructive pulmonary disease (12.9%).Children admitted for a preventable hospitalization were more likely to be females, to be younger, to be residents in the same province as the hospital and less likely to have had at least one Community-Based Pediatrician (CBP) access in the previous year and to have used the district health service. The burden of pediatric preventable hospitalizations found in this study is quite high, and the results show that there is still work that lies ahead on the way to improve interaction between hospital and community-based services.
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Affiliation(s)
- Rossella Zucco
- Department of Health Sciences, University of Catanzaro "Magna Græcia", Catanzaro, Italy
| | - Claudia Pileggi
- Department of Health Sciences, University of Catanzaro "Magna Græcia", Catanzaro, Italy
| | - Martina Vancheri
- Department of Health Sciences, University of Catanzaro "Magna Græcia", Catanzaro, Italy
| | - Rosa Papadopoli
- Department of Health Sciences, University of Catanzaro "Magna Græcia", Catanzaro, Italy
| | | | - Maria Pavia
- Department of Health Sciences, University of Catanzaro "Magna Græcia", Catanzaro, Italy
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Satokangas M, Lumme S, Arffman M, Keskimäki I. Trajectory modelling of ambulatory care sensitive conditions in Finland in 1996-2013: assessing the development of equity in primary health care through clustering of geographic areas - an observational retrospective study. BMC Health Serv Res 2019; 19:629. [PMID: 31484530 PMCID: PMC6727548 DOI: 10.1186/s12913-019-4449-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 08/20/2019] [Indexed: 02/02/2023] Open
Abstract
Background Due to stagnating resources and an increase in staff workload, the quality of Finnish primary health care (PHC) is claimed to have deteriorated slowly. With a decentralised PHC organisation and lack of national stewardship, it is likely that municipalities have adopted different coping strategies, predisposing them to geographic disparities. To assess whether these disparities emerge, we analysed health centre area trajectories in hospitalisations due to ambulatory care sensitive conditions (ACSCs). Methods ACSCs, a proxy for PHC quality, comprises conditions in which hospitalisation could be avoided by timely care. We obtained ACSCs of the total Finnish population aged ≥20 for the years 1996–2013 from the Finnish Hospital Discharge Register, and divided them into subgroups of acute, chronic and vaccine-preventable causes, and calculated annual age-standardised ACSC rates by gender in health centre areas. Using these rates, we conducted trajectory analyses for identifying health centre area clusters using group-based trajectory modelling. Further, we applied area-level factors to describe the distribution of health centre areas on these trajectories. Results Three trajectories – and thus separate clusters of health centre areas – emerged with different levels and trends of ACSC rates. During the study period, chronic ACSC rates decreased (40–63%) within each of the clusters, acute ACSC rates remained stable and vaccine-preventable ACSC rates increased (1–41%). While disparities in rate differences in chronic ACSC rates between trajectories narrowed, in the two other ACSC subgroups they increased. Disparities in standardised rate ratios increased in vaccine-preventable and acute ACSC rates between northern cluster and the two other clusters. Compared to the south-western cluster, 13–16% of health centre areas, in rural northern cluster, had 47–92% higher ACSC rates – but also the highest level of morbidity, most limitations on activities of daily living and highest PHC inpatient ward usage as well as the lowest education levels and private health and dental care usage. Conclusions We identified three differing trajectories of time trends for ACSC rates, suggesting that the quality of care, particularly in northern Finland health centre areas, may have lagged behind the general improvements. This calls for further investments to strengthen rural area PHC. Electronic supplementary material The online version of this article (10.1186/s12913-019-4449-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Markku Satokangas
- Social and Health Systems Research Unit, National Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland. .,Department of General Practice and Primary Health Care, Network of Academic Health Centres, University of Helsinki, Helsinki, Finland. .,Health Stations, Department of Social Services and Health Care, City of Helsinki, Finland.
| | - Sonja Lumme
- Social and Health Systems Research Unit, National Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland
| | - Martti Arffman
- Social and Health Systems Research Unit, National Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland
| | - Ilmo Keskimäki
- Social and Health Systems Research Unit, National Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland.,Faculty of Social Sciences, Tampere University, Tampere, Finland
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Rocha JVM, Sarmento J, Moita B, Marques AP, Santana R. Comparative research aspects on hospitalizations for ambulatory care sensitive conditions: the case of Brazil and Portugal. CIENCIA & SAUDE COLETIVA 2019; 25:1375-1388. [PMID: 32267439 DOI: 10.1590/1413-81232020254.13502019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 08/23/2019] [Indexed: 11/22/2022] Open
Abstract
Hospitalizations for ambulatory care sensitive conditions have been used to measure access, quality and performance of the primary health care delivery system, as timely and adequate care could potentially avoid the need of hospitalization. Comparative research provides the opportunity for cross-country learning process. Brazil and Portugal have reformed their primary health care services in the last years, with similar organizational characteristics. We used hospitalization data of Brazil and Portugal for the year 2015 to compare hospitalizations for ambulatory care sensitive conditions between the two countries, and discussed conceptual and methodological aspects to be taken into consideration in the comparative approach. Brazil and Portugal presented similarities in causes and standardized rates of hospitalizations for ambulatory care sensitive conditions. There was great sensitivity on rates according to the methodology employed to define conditions. Hospitalizations for ambulatory care sensitive conditions are important sources of pressure for both Brazil and Portugal, and there are conceptual and methodological aspects that are critical to render the country-comparison approach useful.
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Affiliation(s)
- João Victor Muniz Rocha
- National School of Public Health, NOVA University of Lisbon. Av. Padre Cruz, 1600-560. Lisbon Portugal.
| | - João Sarmento
- National School of Public Health, NOVA University of Lisbon. Av. Padre Cruz, 1600-560. Lisbon Portugal.
| | - Bruno Moita
- National School of Public Health, NOVA University of Lisbon. Av. Padre Cruz, 1600-560. Lisbon Portugal.
| | - Ana Patrícia Marques
- National School of Public Health, NOVA University of Lisbon. Av. Padre Cruz, 1600-560. Lisbon Portugal.
| | - Rui Santana
- National School of Public Health, NOVA University of Lisbon. Av. Padre Cruz, 1600-560. Lisbon Portugal.
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Manderbacka K, Arffman M, Satokangas M, Keskimäki I. Regional variation of avoidable hospitalisations in a universal health care system: a register-based cohort study from Finland 1996-2013. BMJ Open 2019; 9:e029592. [PMID: 31324684 PMCID: PMC6661699 DOI: 10.1136/bmjopen-2019-029592] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 05/21/2019] [Accepted: 06/28/2019] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES A persistent finding in research concerning healthcare and hospital use in Western countries has been regional variation in the medical practices. The aim of the current study was to examine trends in the regional variation of avoidable hospitalisations, that is, hospitalisations due to conditions treatable in ambulatory care in Finland in 1996-2013 and the influence of different healthcare levels on them. SETTING Use of hospital inpatient care in 1996-2013 among the total population in Finland. PARTICIPANTS Altogether 1 931 012 hospital inpatient care episodes among all persons residing in Finland identified from administrative registers in Finland in 1996-2013 and alive in 1 January 1996. OUTCOME MEASURES We examined hospitalisations due to avoidable causes including vaccine-preventable hospitalisations, hospitalisations due to complications of chronic conditions and acute conditions treatable in ambulatory care. We calculated annual age-adjusted rates per 10 000 person-years. Multilevel models were used for studying time trends in regional variation. RESULTS There was a steep decline in avoidable hospitalisation rates during the study period. The decline occurred almost exclusively in hospitalisations due to chronic conditions, which diminished by about 60%. The overall correlation between hospital district intercepts and slopes in time was -0.46 (p<0.05) among men and -0.20 (ns) among women. Statistically highly significant diminishing variation was found in hospitalisations due to chronic conditions among both men (-0.90) and women (-0.91). The variation was mainly distributed to the hospital district level. CONCLUSIONS The results suggest that chronic conditions are managed better in primary care in the whole country than before. Further research is needed on whether this is the case or whether this has more to do with supply of hospital care.
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Affiliation(s)
- Kristiina Manderbacka
- Service System Research, National Institute for Health and Welfare (THL), Helsinki, Finland
| | - Martti Arffman
- Service System Research, National Institute for Health and Welfare (THL), Helsinki, Finland
| | - Markku Satokangas
- Service System Research, National Institute for Health and Welfare (THL), Helsinki, Finland
- Network of Academic Health Centres and Department of General Practice and Primary Health Care, Helsingin Yliopisto, Helsinki, Finland
| | - Ilmo Keskimäki
- Service System Research, National Institute for Health and Welfare (THL), Helsinki, Finland
- Department of Social Sciences, Tampereen Yliopisto, Tampere, Finland
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Rocha JVM, Nunes C, Santana R. Avoidable hospitalizations in Brazil and Portugal: Identifying and comparing critical areas through spatial analysis. PLoS One 2019; 14:e0219262. [PMID: 31299045 PMCID: PMC6625697 DOI: 10.1371/journal.pone.0219262] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 06/19/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Hospitalizations for ambulatory care sensitive conditions have been used to assess the performance of primary health care. Few studies have compared geographic variation in rates of avoidable hospitalizations and characteristics of high-risk areas within and between countries. The aim of this study was to identify and compare critical areas of avoidable hospitalizations in Brazil and Portugal, because these countries have reformed their primary health care systems in recent years and have similar organizational characteristics. METHODS An ecological study on hospitalizations for ambulatory care sensitive conditions produced in Brazil and Portugal in 2015 was used. Geographic variation of rates were analyzed and compared at the municipal level. A spatial scan statistic was employed to identify clusters with higher risk of hospitalizations for acute and chronic conditions in each country separately. Socioeconomic and primary health care characteristics of critical areas were compared to non-critical areas. RESULTS There were high variations in rates of avoidable hospitalizations within and between Brazil and Portugal, with higher variations found in Brazil. A more evident pattern of rates was found in Portugal. Rates and cluster distribution of acute and chronic conditions had significant agreement for both countries. The differences in primary health care and socioeconomic characteristics between areas identified as high risk clusters and non-clusters varied between category of conditions and between countries. CONCLUSION Brazil and Portugal presented expressive regional differences with respect to rates of avoidable hospitalizations, indicating that there is room to improve by reducing such events in both countries. Different areas presented distinct interactions between primary health care, socioeconomic characteristics, and avoidable hospitalizations. Results indicate that the primary health care reforms, with similar organizational characteristics in different contexts, did not produce similar results either between or within countries. Possible actions to reduce these events should be defined at a local level.
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Affiliation(s)
- João Victor Muniz Rocha
- Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisbon, Portugal
- Centro de Investigação em Saúde Pública, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Carla Nunes
- Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisbon, Portugal
- Centro de Investigação em Saúde Pública, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Rui Santana
- Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisbon, Portugal
- Centro de Investigação em Saúde Pública, Universidade NOVA de Lisboa, Lisbon, Portugal
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Kim J, Kang HY, Lee KS, Min S, Shin E. A Spatial Analysis of Preventable Hospitalization for Ambulatory Care Sensitive Conditions and Regional Characteristics in South Korea. Asia Pac J Public Health 2019; 31:422-432. [DOI: 10.1177/1010539519858452] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Hospitalization rates for ambulatory care sensitive conditions (ACSCs) can indicate the accessibility of a community’s primary care. We examined regional variation in ACSC hospitalization rates and identified associated factors. ACSC hospitalization rates in the 232 districts in 2013 ranged from 4.08 to 101.53 per 1000 adults. Spatial analysis showed that none of the 24 highest rate districts were located near Seoul, whereas 80% of the 45 lowest rate districts were, suggesting health care inequality between people living near Seoul and in other areas. Regression analysis showed significantly higher ACSC hospitalization rates in districts with higher elderly (β = 0.94) and low-income populations (β = 2.25), more remote areas (β = 0.29), and more hospital beds (β = 0.03). The number of primary care clinics was negatively associated with ACSC hospitalization (β = −1.37). For these variables, geographically weighted regression analysis provided local regression coefficients, useful for developing region-specific strategies to reduce ACSC hospitalization.
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Affiliation(s)
| | | | | | | | - Euichul Shin
- The Catholic University of Korea, Seoul, South Korea
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Islam MK, Kjerstad E. Co-ordination of health care: the case of hospital emergency admissions. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2019; 20:525-541. [PMID: 30467690 PMCID: PMC6517355 DOI: 10.1007/s10198-018-1015-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 11/13/2018] [Indexed: 05/13/2023]
Abstract
The recognition that chronic care delivery is suboptimal has led many health authorities around the world to redesign it. In Norway, the Department of Health and Care Services implemented the Coordination Reform in January 2012. One policy instrument was to build emergency bed capacity (EBC) as an integrated part of primary care service provided by municipalities. The explicit aim was to reduce the rate of avoidable admissions to state-owned hospitals. Using five different sources of register data and a quasi-experimental framework-the "difference-in-differences" regression approach-we estimated the association between changes in EBC on changes in aggregate emergency hospital admissions for eight ambulatory care sensitive conditions (ACSC). The results show that EBC is negatively associated with changes in aggregate ACSC emergency admissions. The associations are largely consistent with alternative model specifications. We also estimated the relationship between changes in EBC on changes in each ACSC condition separately. Our results are mixed. EBC is negatively associated with emergency hospital admissions for asthma, angina and chronic obstructive pulmonary disease but not congestive heart failure and diabetes. The main implication of the study is that EBC within primary care is potentially a sensible way of redesigning chronic care.
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Abdulrahim S, Bousmah MAQ. Regional Inequalities in Maternal and Neonatal Health Services in Iraq and Syria From 2000 to 2011. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2019; 49:623-641. [PMID: 31126204 DOI: 10.1177/0020731419851659] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We analyze regional inequalities in access to maternal and neonatal health services in Iraq and Syria during the period 2000-2011, before the rise of the Islamic State in Iraq and Syria, ISIS. Utilizing nationally representative survey data (Iraq 2000, 2006, 2011; Syria 2006, 2009), we examine changes in the rate of babies weighed at birth and women delivering at home. We calculate 4 regional inequality indicators: (1) extremal quotient, (2) interquartile quotient, (3) coefficient of variation, and (4) systematic component of variation. Despite national improvements in both countries over time, indicators show increasing regional inequalities in access to maternal and neonatal health services, particularly in Syria between 2006 and 2009. Spatial regression results indicate that these inequalities associate with inequalities in maternal education, rurality, and wealth. Regions where women experienced deteriorating access over time, reflecting overall inequalities, are those that fell under the control of ISIS. Inequalities in access to basic services (education and health) deserve more attention in understanding social and political change in the Arab region.
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Affiliation(s)
- Sawsan Abdulrahim
- 1 Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Marwân-Al-Qays Bousmah
- 2 Aix Marseille Univ, INSERM, IRD, SESSTIM, Marseille, France.,3 ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France.,4 Aix-Marseille Univ, CNRS, EHESS, Centrale Marseille, AMSE, and IDEP, Marseille, France
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Kim AM, Park JH, Yoon TH, Kim Y. Hospitalizations for ambulatory care sensitive conditions as an indicator of access to primary care and excess of bed supply. BMC Health Serv Res 2019; 19:259. [PMID: 31029134 PMCID: PMC6487016 DOI: 10.1186/s12913-019-4098-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 04/12/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ambulatory care sensitive conditions (ACSC) hospitalization is a widely accepted measure of the access to primary care. However, given its discretionary characteristics, the ACSC hospitalization can be a measure reflecting the influence of hospital bed supply. In Korea, where the quality of primary care and oversupply of hospital beds are coexistent concerns, ACSC hospitalization can be used to examine the impact of both factors. This study was performed to investigate the ACSC hospitalization rate as a measure of the hospital bed supply as well as access to primary care. METHODS Data were obtained from the National Health Insurance Database for 2015. We calculated the age-sex standardized hospitalization rates for ACSC in the total population and crude rates of ACSC hospitalization for three different age groups in 252 districts in Korea. We calculated the variation statistics of ACSC hospitalization rates, and we estimated a linear regression model to investigate the factors for ACSC hospitalization. RESULTS There was a very high geographic variation in ACSC hospitalization rates. Higher density of primary care physicians was associated with a decreased ACSC hospitalization rate while a higher density of hospital beds in small to medium sized hospitals was associated with an increased rate. The deprivation index score had a strongly positive association with the ACSC hospitalization rates. CONCLUSION ACSC hospitalization, while being a negative index of primary care access, can also be a measure indicating the impact of the hospital bed supply, and it is still a valid measure of the disparity of health care, the original motivation for this topic.
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Affiliation(s)
- Agnus M. Kim
- Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jong Heon Park
- Big Data Steering Department, National Health Insurance Service, Wonju, Republic of Korea
| | - Tae Ho Yoon
- Department of Preventive & Occupational Medicine, School of Medicine, Pusan National University, Pusan, Republic of Korea
| | - Yoon Kim
- Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Republic of Korea
- Institute of Health Policy and Management, Medical Research Center, Seoul National University, Seoul, Republic of Korea
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Paul MC, Dik JWH, Hoekstra T, van Dijk CE. Admissions for ambulatory care sensitive conditions: a national observational study in the general and COPD population. Eur J Public Health 2019; 29:213-219. [PMID: 30212895 PMCID: PMC6426039 DOI: 10.1093/eurpub/cky182] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Hospital admissions for ambulatory care sensitive conditions (ACSCs) may be prevented by effective ambulatory management and treatment. ACSC admissions is used as indicator for primary care quality and accessibility. However, debate continues to which extent these admissions are truly preventable. The aim of this study was to provide more objective insight into the preventability of ACSC admissions. METHODS Observational study using 2012-15 health insurer claim data of 13 182 602 Dutch insured inhabitants. Logistic multilevel regression analyses were conducted to investigate factors (ambulatory care and characteristics of inhabitants) possibly associated with ACSC admissions. Prior ambulatory care use was examined for patients with an ACSC contributing to the highest number of ACSC admissions: chronic obstructive pulmonary disease (COPD). RESULTS In 2014, 89.8 hospital admissions for ACSCs per 10 000 insured inhabitants were claimed. Percentage of inhabitants with ACSC admissions varied between general practices from 0.58-0.84%. ASCS admissions were hardly associated with ambulatory care. One month prior to admission, 97% of admitted COPD patients had at least one ambulatory care contact. CONCLUSIONS Variation in ACSC admissions between general practitioners was observed, indicating that certain hospital admissions may be prevented. However, we found no indication that ACSC admissions were preventable, as no link was found with the provision of ambulatory care and ACSC admissions. This may indicate that this indicator is country and health care system specific. Before including ACSC admission as quality indicator of primary care in the Netherlands, more insight into the causes of variation is required.
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Affiliation(s)
- Marieke C Paul
- National Healthcare Institute, Diemen, The Netherlands
- Faculty of Science, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Trynke Hoekstra
- Faculty of Science, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Lavoie JG, Wong ST, Ibrahim N, O’Neil JD, Green M, Ward A. Underutilized and undertheorized: the use of hospitalization for ambulatory care sensitive conditions for assessing the extent to which primary healthcare services are meeting needs in British Columbia First Nation communities. BMC Health Serv Res 2019; 19:50. [PMID: 30658626 PMCID: PMC6339420 DOI: 10.1186/s12913-018-3850-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 12/19/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Since the 1960s, the federal government has been providing or funding a selection of community-based primary healthcare (PHC) programs on First Nations reserves. A key question is whether local access to PHC can help address health inequities in First Nations on-reserve communities in British Columbia (BC). OBJECTIVES This paper examines whether hospitalization for Ambulatory Care Sensitive Conditions (1) can be used as a proxy measure for the organization of PHC in First Nations reserve areas; and (2) is associated with premature mortality rates. METHODS In this descriptive correlational study, we used administrative data available through Population Data BC, including demographic and ecological information (i.e. geo-codes indicating location of residence). We used two different measures of hospitalization: rates of episodic hospital care and rates of length of stay. We correlated hospitalization rates with premature mortality rates and the level of care available in First Nations communities, which depends on a federal funding formula based upon community size and, more specifically, the level of isolation from a provincial point of care. RESULTS First Nations communities in BC that have local 24/7 access to PHC services have similar rates of hospitalization for ACSC to those living in urban centres. This is demonstrated by the similarities in the strengths of the correlation between premature mortality rates and rates of avoidable hospitalization for conditions treatable in a PHC setting. This is not the case for communities served by a Health Centre (weaker correlation) and for communities serviced by a Health Station or with no on-reserve point of care (no correlation). CONCLUSIONS Improving access to PHC services in First Nations communities can be associated with a significant reduction in avoidable hospitalization and premature mortality rates. The method we tested is an important tool that could serve health care planning decisions in small communities.
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Affiliation(s)
- Josée G. Lavoie
- Dept of Community Health Sciences, University of Manitoba, #715 – 727 McDermot Avenue, Winnipeg, MB R3E 3P4 Canada
- Ongomiizwin Research, University of Manitoba, Winnipeg, Canada
| | - Sabrina T. Wong
- School of Nursing, University of British Columbia, Vancouver, Canada
| | - Naser Ibrahim
- Ongomiizwin Research, University of Manitoba, Winnipeg, Canada
| | | | | | - Amanda Ward
- First Nation Health Authority, Vancouver, Canada
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Komwong D, Sriratanaban J. Associations between structures and resources of primary care at the district level and health outcomes: a case study of diabetes mellitus care in Thailand. Risk Manag Healthc Policy 2018; 11:199-208. [PMID: 30464660 PMCID: PMC6208489 DOI: 10.2147/rmhp.s177125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The structural factors of primary care potentially influence its performance and quality. This study investigated the association between structural factors, including available primary care resources and health outcomes, by using diabetes-related ambulatory care sensitive conditions hospitalizations under the Universal Coverage Scheme in Thailand. Methods A 2-year panel study used secondary data compiled at the district level. Administrative claim data from 838 districts during the 2014–2015 fiscal years from the National Health Security Office were used to analyze overall diabetes mellitus (DM) hospitalizations and its three subgroups: hospitalizations for uncontrolled diabetes, short-term complications, and long-term complications. Primary care structural data were obtained from the Ministry of Public Health. Generalized estimating equations were used to estimate the influence of structural factors on the age-standardized DM hospitalization ratio. Results A higher overall DM and uncontrolled diabetes hospitalization ratio was related to an increasing concentration of outpatient utilization (using the Herfindahl–Hirschman Index) (overall DM; beta [standard error, SE]=0.003 [0.001], 95% CI 0.000, 0.006) and decreasing physician density and bed supply (overall DM; beta [SE]=−1.350 [0.674], 95% CI −2.671, −0.028), beta [SE]=−0.023 [0.011], 95% CI −0.045, −0.001, respectively). Hospitalizations for short-term complications increased with a decrease in health care facility density, whereas hospitalizations for long-term complications increased as that density increased. Rurality was strongly associated with higher hospitalization ratios for all DM hospitalizations except short-term complications. Conclusions This study identified structural factors associated with health outcomes, many of which can be changed through reorganization at the district level.
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Affiliation(s)
- Daoroong Komwong
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand, .,Sirindhorn College of Public Health, Praboromarajchanok Institute of Health Workforce Development, Chon Buri, Thailand
| | - Jiruth Sriratanaban
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand, .,Thailand Research Center for Health Services System, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand,
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Longo F, Siciliani L, Gravelle H, Santos R. Do hospitals respond to rivals' quality and efficiency? A spatial panel econometric analysis. HEALTH ECONOMICS 2017; 26 Suppl 2:38-62. [PMID: 28940914 DOI: 10.1002/hec.3569] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 07/03/2017] [Accepted: 07/04/2017] [Indexed: 05/27/2023]
Abstract
We investigate whether hospitals in the English National Health Service change their quality or efficiency in response to changes in quality or efficiency of neighbouring hospitals. We first provide a theoretical model that predicts that a hospital will not respond to changes in the efficiency of its rivals but may change its quality or efficiency in response to changes in the quality of rivals, though the direction of the response is ambiguous. We use data on eight quality measures (including mortality, emergency readmissions, patient reported outcome, and patient satisfaction) and six efficiency measures (including bed occupancy, cancelled operations, and costs) for public hospitals between 2010/11 and 2013/14 to estimate both spatial cross-sectional and spatial fixed- and random-effects panel data models. We find that although quality and efficiency measures are unconditionally spatially correlated, the spatial regression models suggest that a hospital's quality or efficiency does not respond to its rivals' quality or efficiency, except for a hospital's overall mortality that is positively associated with that of its rivals. The results are robust to allowing for spatially correlated covariates and errors and to instrumenting rivals' quality and efficiency.
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Affiliation(s)
- Francesco Longo
- Department of Economic and Related Studies, University of York, York, UK
- Centre for Health Economics, University of York, York, UK
| | - Luigi Siciliani
- Department of Economic and Related Studies, University of York, York, UK
- Centre for Health Economics, University of York, York, UK
| | - Hugh Gravelle
- Centre for Health Economics, University of York, York, UK
| | - Rita Santos
- Centre for Health Economics, University of York, York, UK
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Araujo WRM, Queiroz RCDS, Rocha TAH, Silva NCD, Thumé E, Tomasi E, Facchini LA, Thomaz EBAF. Structure and work process in primary care and hospitalizations for sensitive conditions. Rev Saude Publica 2017; 51:75. [PMID: 28832757 PMCID: PMC5559214 DOI: 10.11606/s1518-8787.2017051007033] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 08/30/2016] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The objective of this study is to investigate whether the characteristics of the structure of primary health units and the work process of primary care teams are associated with the number of hospitalizations for primary care sensitive conditions. METHODS In this ecological study, we have analyzed data of Brazilian municipalities related to sociodemographic characteristics, coverage of care programs, structure of primary health units, and work process of primary care teams. We have obtained the data from the first cycle of the Brazilian Program for Improving Access and Quality of the Primary Care, of the Department of Information Technology of the Brazilian Unified Health System, the Brazilian Institute of Geography and Statistics, and the United Nations Development Programme. The associations have been estimated using negative binomial regression coefficients (β) and respective 95% confidence intervals, with a hierarchical approach in three levels (alpha = 5%). RESULTS In the adjusted analysis for the outcome in 2013, in the distal level, the coverage of the Bolsa Família Program (β = -0.001) and private insurance (β = -0.01) had a negative association, and the human development index (β = 1.13), the proportion of older adults (β = 0.05) and children under the age of five (β = 0.05), and the coverage of the Community Health Agent Strategy (β = 0.002) showed positive association with hospitalizations for primary care sensitive conditions. In the intermediate level, minimum hours (β = -0.14) and availability of vaccines (β = -0.16) showed a negative association, and availability of medications showed a positive association (β = 0.16). In the proximal level, only the variable of matrix support (β = 0.10) showed a positive association. The variables in the adjusted analysis of the number of hospitalizations for primary care sensitive conditions in 2014 presented the same association as in 2013. CONCLUSIONS The characteristics of the structure of primary health units and the work process of the primary care teams impact the number of hospitalizations for primary care sensitive conditions in Brazilian municipalities.
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Affiliation(s)
| | | | | | - Núbia Cristina da Silva
- Centro de Pós-Graduação e Pesquisa em Administração. Universidade Federal de Minas Gerais. Belo Horizonte, MG, Brasil
| | - Elaine Thumé
- Departamento de Medicina Social. Faculdade de Medicina da Universidade Federal de Pelotas. Pelotas, RS, Brasil
| | - Elaine Tomasi
- Departamento de Medicina Social. Faculdade de Medicina da Universidade Federal de Pelotas. Pelotas, RS, Brasil
| | - Luiz Augusto Facchini
- Departamento de Medicina Social. Faculdade de Medicina da Universidade Federal de Pelotas. Pelotas, RS, Brasil
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Cookson R, Asaria M, Ali S, Ferguson B, Fleetcroft R, Goddard M, Goldblatt P, Laudicella M, Raine R. Health Equity Indicators for the English NHS: a longitudinal whole-population study at the small-area level. HEALTH SERVICES AND DELIVERY RESEARCH 2016. [DOI: 10.3310/hsdr04260] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundInequalities in health-care access and outcomes raise concerns about quality of care and justice, and the NHS has a statutory duty to consider reducing them.ObjectivesThe objectives were to (1) develop indicators of socioeconomic inequality in health-care access and outcomes at different stages of the patient pathway; (2) develop methods for monitoring local NHS equity performance in tackling socioeconomic health-care inequalities; (3) track the evolution of socioeconomic health-care inequalities in the 2000s; and (4) develop ‘equity dashboards’ for communicating equity findings to decision-makers in a clear and concise format.DesignLongitudinal whole-population study at the small-area level.SettingEngland from 2001/2 to 2011/12.ParticipantsA total of 32,482 small-area neighbourhoods (lower-layer super output areas) of approximately 1500 people.Main outcome measuresSlope index of inequality gaps between the most and least deprived neighbourhoods in England, adjusted for need or risk, for (1) patients per family doctor, (2) primary care quality, (3) inpatient hospital waiting time, (4) emergency hospitalisation for chronic ambulatory care-sensitive conditions, (5) repeat emergency hospitalisation in the same year, (6) dying in hospital, (7) mortality amenable to health care and (8) overall mortality.Data sourcesPractice-level workforce data from the general practice census (indicator 1), practice-level Quality and Outcomes Framework data (indicator 2), inpatient hospital data from Hospital Episode Statistics (indicators 3–6) and mortality data from the Office for National Statistics (indicators 6–8).ResultsBetween 2004/5 and 2011/12, more deprived neighbourhoods gained larger absolute improvements on all indicators except waiting time, repeat hospitalisation and dying in hospital. In 2011/12, there was little measurable inequality in primary care supply and quality, but inequality was associated with 171,119 preventable hospitalisations and 41,123 deaths amenable to health care. In 2011/12, > 20% of Clinical Commissioning Groups performed statistically significantly better or worse than the England equity benchmark.LimitationsGeneral practitioner supply is a limited measure of primary care access, need in deprived neighbourhoods may be underestimated because of a lack of data on multimorbidity, and the quality and outcomes indicators capture only one aspect of primary care quality. Health-care outcomes are adjusted for age and sex but not for other risk factors that contribute to unequal health-care outcomes and may be outside the control of the NHS, so they overestimate the extent of inequality for which the NHS can reasonably be held responsible.ConclusionsNHS actions can have a measurable impact on socioeconomic inequality in both health-care access and outcomes. Reducing inequality in health-care outcomes is more challenging than reducing inequality of access to health care. Local health-care equity monitoring against a national benchmark can be performed using any administrative geography comprising ≥ 100,000 people.Future workExploration of quality improvement lessons from local areas performing well and badly on health-care equity, improved methods including better measures of need and risk and measures of health-care inequality over the life-course, and monitoring of other dimensions of equity. These indicators can also be used to evaluate the health-care equity impacts of interventions and make international health-care equity comparisons.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
| | - Miqdad Asaria
- Centre for Health Economics, University of York, York, UK
| | - Shehzad Ali
- Centre for Health Economics, University of York, York, UK
- Department of Health Sciences, University of York, York, UK
| | - Brian Ferguson
- Knowledge and Intelligence, Public Health England, York, UK
| | | | - Maria Goddard
- Centre for Health Economics, University of York, York, UK
| | - Peter Goldblatt
- Institute of Health Equity, University College London, London, UK
| | | | - Rosalind Raine
- Department of Applied Health Research, University College London, London, UK
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