Hospitalization for Ambulatory Care Sensitive Conditions (ACSH) is an accepted indicator of access to health care and avoidable morbidity. Accessible care of reasonable quality should reduce ACSH. Little research has examined the indicator's external validity. We calculated standardized ACSH rates for 32 areas of Victoria, Australia (population 4.4 million). A representative survey measured access, disease prevalence, propensity to seek care, disease burden, social determinants of health services use, and behavioral risk factors. Regression analyses compared self-rated access with ACSH rates. Independent of prevalence, propensity to seek care, disease burden, and physician supply, better access was associated with lower ACSH rates. Results provide support for the ACSH indicator. When rural residence was considered, the covariate measuring access was not significant. However, rural residence also may contribute importantly to access. Results suggest both the complexity of the meaning of access and the desirability of further research to validate the ACSH indicator.

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.

The purpose of this review is to introduce health services researchers, especially in the area of primary health care, to the meaning and concept of ambulatory care sensitive conditions (ACSCs). More specifically, this review explores the validity of ACSC admissions as proxy indicators of access to primary health care, provides a description of the factors that cause variations in ACSC admission rates, and presents a discussion of the potential usefulness and policy implications of these indicators for primary health care. Critical Interpretive Synthesis (CIS) methodology was used to review the literature on ACSC admissions indicators. Medline and Australasian Medical Index were searched for English language articles published between 1970 and August 2005. The results were supplemented by an internet search of the World Wide Web, further augmented by manual scans of material from deeper levels within the sites. Main finding from the review indicates that ACSC admissions are valid proxy indicators of access to primary health care. Socioeconomic factors are most important in explaining variations in ACSC admissions. Several uses and policy implications of ACSC admission indicators are discussed, including their potential for identifying gaps in the primary health care system and providing opportunities for targeted public health and health services interventions.