Patient characteristics associated with hospitalisations for ambulatory care sensitive conditions in Victoria, Australia

Abstract

BackgroundAmbulatory Care Sensitive Conditions (ACSCs) are those for which hospitalisation is thought to be avoidable with the application of preventive care and early disease management, usually delivered in a primary care setting. ACSCs are used extensively as indicators of accessibility and effectiveness of primary health care. We examined the association between patient characteristics and hospitalisation for ACSCs in the adult and paediatric population in Victoria, Australia, 2003/04.MethodsHospital admissions data were merged with two area-level socioeconomic indexes: Index of Socio-Economic Disadvantage (IRSED) and Accessibility/Remoteness Index of Australia (ARIA). Univariate and multiple logistic regressions were performed for both adult (age 18+ years) and paediatric (age <18 years) groups, reporting odds ratios (OR) and 95% confidence intervals (CI) for a number of predictors of ACSCs admissions compared to non-ACSCs admissions.ResultsPredictors were much more strongly associated with ACSCs admissions compared to non-ACSCs admissions in the adult group than for the paediatric group with the exception of rurality. Significant adjusted ORs in the adult group were 1.06, 1.15, 1.13, 1.06 and 1.11 for sex, rurality, age, IRSED and ARIA variables, and 1.34, 1.04 and 1.09 in the paediatric group for rurality, IRSED and ARIA, respectively.ConclusionsDisadvantaged paediatric and adult population experience more need of hospital care for ACSCs. Access barriers to primary care are plausible causes for the observed disparities. Understanding the characteristics of individuals experiencing access barriers to primary care will be useful for developing targeted interventions meeting the unique ambulatory needs of the population.

Social determinants of hospitalizations for ambulatory care sensitive conditions in Guarulhos, São Paulo

“…It is worth highlighting the difficulty comparing results with international studies, as they use different lists of ACSC; however, the diagnoses given are in line with foreign studies (10,15) .…”

“…It is worth highlighting that some authors have found some associations in the results of ACSC when they considered variables related to gender (female), age group (children and the elderly), poor socioeconomic conditions and low incomes, demographic situation (rural areas), ethnic and racial differences (non-Latin and afro descendents) (5,(9)(10)15) , as well as determinants such as worldview (idealist) and understanding of the health-disease process (pluricausal) by the players involved in the execution of health policies (17) .…”

“…This measure was initially developed in the United States at the end of the 1980s, and has since been applied as an assessment and monitoring tool in PHC, in areas of different sizes (9)(10)(11)(12)(13)(14) .…”

“…On the international scene, different lists of diagnoses considered to be avoidable by utilization of PHC are chosen as performance markers for primary health care (10,15) . As for Brazil, a national list of ACSC was made by a group of researchers and managers of the SUS, following an American model, that was applied in Spanish studies and adapted to the Brazilian reality (8) .…”

Hospital admissions due to ambulatory care sensitive conditions among children by age group and health region

“…ACSC admissions can be avoided by preventative care and the early diagnosis and treatment of diseases, and are used to measure access to health services and the effectiveness of primary care (7) . The list of ACSCs in Brazil is organised in 19 groups and based on the International Classification of Diseases (ICD-10) (8) .…”