The impact of quality and accessibility of primary care on emergency admissions for a range of chronic ambulatory care sensitive conditions (ACSCs) in Scotland: longitudinal analysis.

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License: CC BY 4.0
Serval ID
serval:BIB_342E4AA3135F
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
The impact of quality and accessibility of primary care on emergency admissions for a range of chronic ambulatory care sensitive conditions (ACSCs) in Scotland: longitudinal analysis.
Journal
BMC family practice
Author(s)
van der Pol M., Olajide D., Dusheiko M., Elliott R., Guthrie B., Jorm L., Leyland A.H.
ISSN
1471-2296 (Electronic)
ISSN-L
1471-2296
Publication state
Published
Issued date
22/02/2019
Peer-reviewed
Oui
Volume
20
Number
1
Pages
32
Language
english
Notes
Publication types: Journal Article ; Research Support, Non-U.S. Gov't
Publication Status: epublish
Abstract
Hospital admissions for Ambulatory Care Sensitive Conditions (ACSC) are those that could potentially be prevented by timely and effective disease management within primary care. ACSC admissions are increasingly used as performance indicators. However, key questions remain about the validity of these measures. The evidence to date has been inconclusive and limited to specific conditions. The aim of this study was to test the robustness of ACSC admissions as indicators of the quality of primary care. It is the first study to examine a wide range of ACSCs using longitudinal data which enables us to control for unmeasured characteristics which differ by practice but which are constant over time.
Using longitudinal data at the practice level, from 907 Scottish practices for the time period 1/4/2005 to 31/32012, we explored the relationships between the quality of primary care, and hospital admissions for multiple ACSCs controlling for a wide range of covariates including characteristics of GP practices, characteristics of the practice population, hospital effects and year effects. We examined the impact of two dimensions of quality of care: clinical quality of and access to daytime general practice. Generalised Estimating Equations taking the form of Negative Binomial regression models with the practice population included as the exposure term were estimated.
We found that higher achievement on some clinical quality measures of primary care was associated with reduced ACSC emergency admissions. We also show that access to primary care was associated with ACSC emergency admissions. However, the effects were small and inconsistent and ACSC emergency admissions were associated with several confounding factors such as deprivation, rurality and distance to the hospital.
The results suggest caution in the use of crude ACSC admission rates as a performance indicator of quality of primary care.
Keywords
Ambulatory Care, Angina Pectoris/therapy, Asthma/therapy, Chronic Disease, Diabetes Mellitus/therapy, Emergencies, Epilepsy/therapy, Health Services Accessibility, Hospitalization/statistics & numerical data, Humans, Hypertension/therapy, Longitudinal Studies, Primary Health Care, Pulmonary Disease, Chronic Obstructive/therapy, Quality of Health Care, Retrospective Studies, Scotland, Stroke/therapy, Ambulatory care sensitive conditions, Emergency admissions, Primary care
Pubmed
Web of science
Open Access
Yes
Create date
12/03/2019 9:26
Last modification date
18/02/2020 6:20
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