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 socioeconomic data for the French Occitanie region in 2014. In order to account for spatial heterogeneity, the region was split into two zones based on socioeconomic 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, socioeconomic , 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.

Analysis (MCDA) is a popular decision tool as it permits to summarize the benefits and the risks of a drug in a single utility score, accounting for the preferences of the decision-makers. However, the utility score is often derived using a linear model which might lead to counter-intuitive conclusions, for example drugs with no benefit or extreme risk could be recommended. Moreover, it assumes that the relative importance of benefits against risks is constant for all levels of benefit or risk, which might not hold for all drugs. Further methodological developments are required to overcome these issues. METHODS: . We propose Scale Loss Score (SLoS) as a new tool for the BR assessment, which offers the same advantages as MCDA but has, in addition, desirable properties permitting to avoid recommendations of non-effective or extremely unsafe treatments, and to tolerate larger increases in risk for a given increase in benefit when the amount of benefit is small than when it is high. RESULTS: . We present an application to a real case study on telithromycin in Community Acquired Pneumonia and Acute Bacterial Sinusitis, and we investigated the patterns of behavior of SLoS, as compared to MCDA, in a comprehensive simulation study. CONCLUSIONS: . Scale Loss Score (SLoS) is a novel, simple and valuable tool for BR assessment.