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The relationship between avoidable hospitalization and accessibility to primary care: a systematic review
Aldo Rosano1, Christian Abo Loha, Roberto Falvo
1Agency for Public Health, Lazio Region, Rome, Italy. rosano@asplazio.it
European Journal of Public Health
|May 31, 2012
Summary
Greater accessibility to primary health care (PHC) is linked to fewer avoidable hospitalizations (AH). This suggests AH can indicate PHC quality, but requires careful interpretation.
Area of Science:
- Health Services Research
- Public Health Policy
- Primary Care Medicine
Background:
- Avoidable hospitalization (AH) is a potential metric for primary health care (PHC) performance.
- Existing research on the link between PHC quality/efficiency and AH yields inconsistent findings.
- This study investigates factors influencing the relationship between AH and PHC accessibility globally.
Purpose of the Study:
- To explore the association between primary health care accessibility and avoidable hospitalizations.
- To identify factors influencing this relationship across different countries.
Main Methods:
- Systematic literature review of peer-reviewed studies.
- Searched databases for studies published between 1990 and October 2010.
- Included studies in English, German, French, Italian, or Spanish.
Main Results:
- Analysis included 51 papers, with 72.5% showing a significant inverse relationship between PHC accessibility and AH rates.
- Individual-level PHC indicators produced more varied results regarding AH, quality, and accessibility.
- Higher PHC accessibility correlated with lower hospitalization rates for ambulatory care sensitive conditions (ACSCs).
Conclusions:
- The findings support the use of AH for ambulatory care sensitive conditions (ACSCs) as a primary care quality indicator.
- A strong association exists between PHC accessibility and lower rates of hospitalization for ACSCs.
- Appropriate adjustment factors are necessary when using ACSC hospitalizations to assess primary care quality.
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