The impact of quality and accessibility of primary care on emergency admissions for a range of chronic ambulatory care sensitive conditions (ACSCs) in Scotland: longitudinal analysis
Abstract Background Hospital admissions for Ambulatory Care Sensitive Conditions (ACSC) are those that could potentially be prevented by timely and effective disease management within primary care. ACSC admissions are increasingly used as performance indicators. However, key questions remain about t...
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| Format: | Article |
| Language: | English |
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BMC
2019-02-01
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| Series: | BMC Family Practice |
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| Online Access: | http://link.springer.com/article/10.1186/s12875-019-0921-z |
| _version_ | 1811227490869313536 |
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| author | Marjon van der Pol Damilola Olajide Mark Dusheiko Robert Elliott Bruce Guthrie Louisa Jorm Alastair H. Leyland |
| author_facet | Marjon van der Pol Damilola Olajide Mark Dusheiko Robert Elliott Bruce Guthrie Louisa Jorm Alastair H. Leyland |
| author_sort | Marjon van der Pol |
| collection | DOAJ |
| description | Abstract Background Hospital admissions for Ambulatory Care Sensitive Conditions (ACSC) are those that could potentially be prevented by timely and effective disease management within primary care. ACSC admissions are increasingly used as performance indicators. However, key questions remain about the validity of these measures. The evidence to date has been inconclusive and limited to specific conditions. The aim of this study was to test the robustness of ACSC admissions as indicators of the quality of primary care. It is the first study to examine a wide range of ACSCs using longitudinal data which enables us to control for unmeasured characteristics which differ by practice but which are constant over time. Methods Using longitudinal data at the practice level, from 907 Scottish practices for the time period 1/4/2005 to 31/32012, we explored the relationships between the quality of primary care, and hospital admissions for multiple ACSCs controlling for a wide range of covariates including characteristics of GP practices, characteristics of the practice population, hospital effects and year effects. We examined the impact of two dimensions of quality of care: clinical quality of and access to daytime general practice. Generalised Estimating Equations taking the form of Negative Binomial regression models with the practice population included as the exposure term were estimated. Results We found that higher achievement on some clinical quality measures of primary care was associated with reduced ACSC emergency admissions. We also show that access to primary care was associated with ACSC emergency admissions. However, the effects were small and inconsistent and ACSC emergency admissions were associated with several confounding factors such as deprivation, rurality and distance to the hospital. Conclusions The results suggest caution in the use of crude ACSC admission rates as a performance indicator of quality of primary care. |
| first_indexed | 2024-04-12T09:43:05Z |
| format | Article |
| id | doaj.art-7bf86e4f17494267a583123ba2da3592 |
| institution | Directory Open Access Journal |
| issn | 1471-2296 |
| language | English |
| last_indexed | 2024-04-12T09:43:05Z |
| publishDate | 2019-02-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Family Practice |
| spelling | doaj.art-7bf86e4f17494267a583123ba2da35922022-12-22T03:38:01ZengBMCBMC Family Practice1471-22962019-02-0120111010.1186/s12875-019-0921-zThe impact of quality and accessibility of primary care on emergency admissions for a range of chronic ambulatory care sensitive conditions (ACSCs) in Scotland: longitudinal analysisMarjon van der Pol0Damilola Olajide1Mark Dusheiko2Robert Elliott3Bruce Guthrie4Louisa Jorm5Alastair H. Leyland6Health Economics Research Unit, University of AberdeenHealth Economics Research Unit, University of AberdeenUniversity of LausanneHealth Economics Research Unit, University of AberdeenUniversity of DundeeUNSW AustraliaUniversity of GlasgowAbstract Background Hospital admissions for Ambulatory Care Sensitive Conditions (ACSC) are those that could potentially be prevented by timely and effective disease management within primary care. ACSC admissions are increasingly used as performance indicators. However, key questions remain about the validity of these measures. The evidence to date has been inconclusive and limited to specific conditions. The aim of this study was to test the robustness of ACSC admissions as indicators of the quality of primary care. It is the first study to examine a wide range of ACSCs using longitudinal data which enables us to control for unmeasured characteristics which differ by practice but which are constant over time. Methods Using longitudinal data at the practice level, from 907 Scottish practices for the time period 1/4/2005 to 31/32012, we explored the relationships between the quality of primary care, and hospital admissions for multiple ACSCs controlling for a wide range of covariates including characteristics of GP practices, characteristics of the practice population, hospital effects and year effects. We examined the impact of two dimensions of quality of care: clinical quality of and access to daytime general practice. Generalised Estimating Equations taking the form of Negative Binomial regression models with the practice population included as the exposure term were estimated. Results We found that higher achievement on some clinical quality measures of primary care was associated with reduced ACSC emergency admissions. We also show that access to primary care was associated with ACSC emergency admissions. However, the effects were small and inconsistent and ACSC emergency admissions were associated with several confounding factors such as deprivation, rurality and distance to the hospital. Conclusions The results suggest caution in the use of crude ACSC admission rates as a performance indicator of quality of primary care.http://link.springer.com/article/10.1186/s12875-019-0921-zEmergency admissionsPrimary careAmbulatory care sensitive conditions |
| spellingShingle | Marjon van der Pol Damilola Olajide Mark Dusheiko Robert Elliott Bruce Guthrie Louisa Jorm Alastair H. Leyland The impact of quality and accessibility of primary care on emergency admissions for a range of chronic ambulatory care sensitive conditions (ACSCs) in Scotland: longitudinal analysis BMC Family Practice Emergency admissions Primary care Ambulatory care sensitive conditions |
| title | The impact of quality and accessibility of primary care on emergency admissions for a range of chronic ambulatory care sensitive conditions (ACSCs) in Scotland: longitudinal analysis |
| title_full | The impact of quality and accessibility of primary care on emergency admissions for a range of chronic ambulatory care sensitive conditions (ACSCs) in Scotland: longitudinal analysis |
| title_fullStr | The impact of quality and accessibility of primary care on emergency admissions for a range of chronic ambulatory care sensitive conditions (ACSCs) in Scotland: longitudinal analysis |
| title_full_unstemmed | The impact of quality and accessibility of primary care on emergency admissions for a range of chronic ambulatory care sensitive conditions (ACSCs) in Scotland: longitudinal analysis |
| title_short | The impact of quality and accessibility of primary care on emergency admissions for a range of chronic ambulatory care sensitive conditions (ACSCs) in Scotland: longitudinal analysis |
| title_sort | impact of quality and accessibility of primary care on emergency admissions for a range of chronic ambulatory care sensitive conditions acscs in scotland longitudinal analysis |
| topic | Emergency admissions Primary care Ambulatory care sensitive conditions |
| url | http://link.springer.com/article/10.1186/s12875-019-0921-z |
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