Access to Health Care and Hospitalization for Ambulatory Care Sensitive Conditions

Abstract

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.

Preventable Hospitalization Rates and Neighborhood Poverty among New York City Residents, 2008–2013

“…Our finding that very high neighborhood poverty is associated with higher preventable hospitalization rates builds on Billings and colleagues' analysis of New York City hospitalizations 20 years ago (1982 to 1993), although they found the disparity between low-income and high-income neighborhoods increased during that time period. 1 Studies in countries with universal health coverage have also found that preventable hospitalizations are higher for low-income populations and residents living in lowincome neighborhoods, 37,38 suggesting that quality and availability of primary care may be an issue for people living in high poverty neighborhoods regardless of insurance status. In New York City, every very high poverty neighborhood also qualifies as a federally designed Health Professional Shortage Area or Medically Underserved Area in whole or in part, indicating that these areas or populations have a shortage of primary medical care.…”

Modelagem hierárquica de determinantes associados a internações por condições sensíveis à atenção primária no Espírito Santo, Brasil

“…Quanto a isso, Macinko 19 menciona que um dos entraves da sua utilização é o fato de que pode levar anos para que sejam estabelecidas tendências, assim como detecção de problemas em áreas pequenas e em mudanças pontuais. Outros estudos que demonstraram uma associação negativa da oferta de serviços de atenção básica e das internações sensíveis o fizeram por meio de análise de série temporal, enquanto, nesta pesquisa, considerou-se apenas o ano de 2010 2,11 .…”

“…Estudos têm documentado a relação inversa entre as medidas de acesso aos cuidados primá-rios de saúde e as ICSAP 2,6 . Por outro lado, o uso desse indicador vem sendo criticado por alguns pesquisadores que argumentam existirem outros elementos determinantes da hospitalização que estão fora do escopo de atuação da atenção primária à saúde, tais como as características inerentes ao paciente, fatores socioeconômicos e demográficos, a variabilidade da prática clíni-ca hospitalar e as políticas de admissão nesses serviços 7,8,9 .…”

Hospitalization due to conditions sensitive to primary care and expansion of the Family Health Program in Brazil: an ecological study

“…Besides, it is known that elderly people 32 , with low income and schooling 33 , are hospitalized more often, so this indicator increases in States in which the proportion of elder is higher.…”