The effect of primary care on potentially avoidable hospitalizations in France: a cross-sectional study

Abstract

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.

Factors associated with hospital admission and 30-day readmission for children less than 18 years of age in 2018 in France: a one-year nationwide observational study

“…The reasons reported for unplanned SSH and readmissions are organizational, In particular out-of-hospital primary care (transition between primary care and hospital, continuity of scheduled care), the adequacy of treatment, disease progression, and the recurrence and complications of pathologies and treatments, as well as specific concerns for children with medically complex conditions [ 12 , 34 – 37 ]. Individual characteristics have also been found to be associated with unplanned SSH and readmission: lower age, being male, insurance coverage, ethnicity, low income, and living in a social deprivation area, with or without an ED in the municipality, in a rural zone, mostly as in our study [ 13 , 14 , 38 – 44 ]. Girls were less often admitted than boys, in particular, for hospitalizations < 1 night, or readmitted.…”

Costs and its drivers for diabetes mellitus type 2 patients in France and Germany: a systematic review of economic studies

“…Lastly, while some studies analysed the total costs, other studies focused on single parts of the care or specific patients’ groups. Nevertheless, the different approaches in providing healthcare underline the importance to involve both healthcare provider characteristics [ 82 ] and patients perspective [ 83 ] in developing an effective value proposition to tackle type 2 diabetes management.…”

Impact of nutritional status on heart failure mortality: a retrospective cohort study

“…Hospital activity and funding is estimated from PMSI data, thus ensuring the exhaustivity of this database. These hospital data have been used in medical research for about 20 years, and their quality has been confirmed in recent studies [19][20][21][22][23]. This study was approved by the National Committee for Data Protection (declaration of conformity to the methodology of reference 05 obtained on 7/08/2018 under the number 2,204,633 v0) and was conducted in accordance with the Declaration of Helsinki.…”