Defining primary care sensitive conditions: a necessity for effective primary care delivery?

Abstract

SummaryPrimary care is a major component of England's National Health Service (NHS), responsible for approximately 300 million consultations per year with GPs in England, which represents 70 -90% of all patient contacts with the NHS. In addition to providing healthcare to the registered population, GPs are charged with coordination and gatekeeping of access to services provided by secondary care, tertiary care and other allied healthcare providers. As GPs will be assuming a key role in commissioning health services in England, there is a clear opportunity to re-model care delivery to maximize outcomes, cost efficiency and patient access by focusing on diseases that are most amenable to management in primary care. It is essential that there is evidence to inform what conditions are most sensitive to management in primary care -commonly referred to as primary care sensitive conditions or ambulatory care sensitive conditions. Such definitions would aid resource planning, drafting of local management protocols and simplification of the interface between primary and secondary care for a number of chronic conditions. Indeed, inappropriate utilization of secondary care resources is likely to represent a significant opportunity cost to healthcare providers and may be less desirable for patients.Primary care is a major component of England's National Health Service (NHS), responsible for approximately 300 million consultations per year with general practitioners (GPs) in England, 1 which represents 70-90% of all patient contacts with the NHS.2 In addition to providing healthcare to the registered population, GPs are charged with coordination and gatekeeping of access to services provided by secondary care, tertiary care and other allied healthcare providers.While primary care has a role to play in the management of acute conditions, there are a number of alternative means by which individuals can directly access appropriate advice and care for acute problems via services such as NHS Direct, Walk-in Centres and Accident & Emergency Departments. In contrast, the management of chronic conditions generally lies within the remit of GPs, and patients are usually only able to obtain ongoing specialist care for their condition if referred to a specialist by their GP.Primary care consultation rates in England are rising year-on-year, 1 and the role of primary careThis is the second article in a series on health policy DECLARATIONS Competing interestsNone declared

“No Other Choice”: Reasons for Emergency Department Utilization Among Urban Adults With Acute Asthma

“…As health service researchers have pointed out, admissions for ambulatory care-sensitive conditions can only be an effective measure of quality if the scope of primary care is well understood. 36 The ability of primary care to influence a patient's behavior or alter the course of his or her disease may vary based on available resources and cultural context. Any limitations must be clearly delineated.…”

“…Any limitations must be clearly delineated. 36,37 The role of the outpatient practice in acute asthma care, for example, has not been unanimously defined.…”

Desigualdades intraurbanas de taxas de internações por condições sensíveis à atenção primária na região central do Brasil

“…This situation can be explained by differences in health service organization and provision and in levels of literacy and income among the local population [39][40][41] . Our findings concerning rates of admissions for ACSCs by groups of causes and age are consistent with the findings described in the literature.…”

Diminuição de internações por condições sensíveis à atenção primária em idosos no estado do Paraná

“…Assim, as chamadas Condições Sensíveis à Atenção Primária (CSAP) são um conjunto de problemas de saúde para os quais a efetiva ação da atenção primária diminuiria o risco de internações hospitalares. Um dos instrumentos utilizados para verificar o desempenho e a qualidade da Atenção Primária à Saúde (APS) é a análise do indicador dessas Internações por Condições Sensíveis à Atenção Primária (ICSAP) (8)(9)(10) . (11) .…”

“…(11) . O conhecimento das ICSAP é importante para o esclarecimento das causas mais sensíveis à gestão na APS, para que tais definições ajudem no planejamento de recursos, na elaboração de protocolos de manejo locais e na simplificação da interface entre cuidados primários e secundários para um número de condições crônicas (8) , sobretudo e inclusive o que diz respeito às ICSAP em idosos. (13) .…”