Underutilized and undertheorized: the use of hospitalization for ambulatory care sensitive conditions for assessing the extent to which primary healthcare services are meeting needs in British Columbia First Nation communities

Abstract

BackgroundSince the 1960s, the federal government has been providing or funding a selection of community-based primary healthcare (PHC) programs on First Nations reserves. A key question is whether local access to PHC can help address health inequities in First Nations on-reserve communities in British Columbia (BC).ObjectivesThis paper examines whether hospitalization for Ambulatory Care Sensitive Conditions (1) can be used as a proxy measure for the organization of PHC in First Nations reserve areas; and (2) is associated with premature mortality rates.MethodsIn this descriptive correlational study, we used administrative data available through Population Data BC, including demographic and ecological information (i.e. geo-codes indicating location of residence). We used two different measures of hospitalization: rates of episodic hospital care and rates of length of stay. We correlated hospitalization rates with premature mortality rates and the level of care available in First Nations communities, which depends on a federal funding formula based upon community size and, more specifically, the level of isolation from a provincial point of care.ResultsFirst Nations communities in BC that have local 24/7 access to PHC services have similar rates of hospitalization for ACSC to those living in urban centres. This is demonstrated by the similarities in the strengths of the correlation between premature mortality rates and rates of avoidable hospitalization for conditions treatable in a PHC setting. This is not the case for communities served by a Health Centre (weaker correlation) and for communities serviced by a Health Station or with no on-reserve point of care (no correlation).ConclusionsImproving access to PHC services in First Nations communities can be associated with a significant reduction in avoidable hospitalization and premature mortality rates. The method we tested is an important tool that could serve health care planning decisions in small communities.

Admissions for ambulatory care sensitive conditions on rural islands and their association with patient experience: a multicentred prospective cohort study

“…Fourth, though data related to the reasons for referral and the severity of illnesses are essential for assessing the association between admissions for ACSCs and PX, we could not gather this information. Moreover, although a premature mortality rate and length of stay in a hospital are more relevant outcomes for patients,22 54 55 we could not collect the information on them due to lack of the data in the primary care clinic-based database. As a next step, an assessment of the severity/appropriateness of referrals, a premature mortality rate and length of stay may be required.…”

Inequalities in avoidable hospitalisation in large urban areas: retrospective observational study in the metropolitan area of Milan

“…23 Although patients with higher morbidity are routinely found to be at greater risk of being hospitalised for ACSC, 24 25 there is evidence of an independent effect of better access to ambulatory care on rates of hospitalisation for ACSC. 26 27 After adjustments for different measures of health status, most studies support the conclusion that although hospital discharges for ACSC may reflect morbidity and health-seeking behaviours, there is international evidence in support of hospitalisations for ACSC as a measure of access to timely and effective ambulatory care in Australia, 28 Canada, 29 England, 30 France, 18 Italy [31][32][33] and many other countries.…”

First Nations’ hospital readmission ending in death: a potential sentinel indicator of inequity?

“…In this paper, we analyse hospital readmission for conditions treatable in primary healthcare (PHC). Hospitalisation for Ambulatory Care-Sensitive Conditions (ACSC) has been used in a number of studies around the world as an indicator of the accessibility, adequacy and responsiveness of PHC services [7][8][9][10][11][12]. ACSC is defined as diseases or conditions that are less likely to lead to hospitalisation if managed in a timely and effective manner through PHC services [9,[13][14][15].…”