HCPLive Network

Primary Care Providers Deem Significant Share of Hospitalizations Avoidable

Primary care physicians rate more than 40 percent of hospitalizations resulting from ambulatory care-sensitive conditions (ACSCs) as avoidable with effective preventive care and disease management, according to new research published in the July/August 2013 issue of the Annals of Family Medicine.
For their “Strategies for Reducing Potentially Avoidable Hospitalizations for Ambulatory Care-Sensitive Conditions” study, Tobias Freund, MD, from the general practice and health services research department of University Hospital Heidelberg in Germany, and UK researchers from the University of Warwick and the University of Manchester interviewed 12 primary care physicians from 10 German clinics, exploring 104 hospitalizations for 81 patients with ACSCs identified through insurance claims data for hospital admissions.
During the interviews, the physicians rated each hospitalization for ACSCs based on whether it could have been avoided and then suggested the causes that resulted in each hospitalization. Examining the data from those interviews, the investigators determined that the physicians rated 43 of the 104 ACSC hospitalizations — or 41 percent of the cases — to be potentially avoidable.

Explanations and causes of those avoidable ambulatory care-sensitive hospitalizations were identified at the system, physician, medical, patient, and social levels, and on average, the physicians attributed 2.5 causes to each hospitalization. Medical- and patient-related causes — such as major somatic or psychiatric comorbidity and patient fearfulness — were the most frequent pairing, though other factors included after-hours absence of the treating physician, inadequate patient monitoring, lack of social support, treatment errors, and medication nonadherence. (Table) Among the 61 ACSC hospitalizations rated as unavoidable, medical emergencies and comorbidities were frequently cited as the causes. 

Although their research mainly calls attention to the need for “a number of interventions … to take up the challenge of potentially avoidable hospitalizations in primary care practice”, the authors also noted that the results “highlight the importance of a more differentiated view of hospitalizations for ACSC as an indicator for the quality of primary care by combining data from insurance claims and comprehensive case audits with treating physicians who are aware of the complex causality of potentially avoidable hospitalization.”
“From the perspective of the physicians in our study — and based on avoidability ratings — some causes of hospitalizations for ACSC are under the direct control of primary care more than others,” the authors concluded. Thus, the researchers suggested several implications for primary care practice teams, which included high-risk patient recognition; regular medication review and symptom monitoring; self-management training for patients and caregivers; and health technology systems implementation.

Further Reading
In this segment, Dr. Peter Salgo asks Dr. Alfred Deluca to "talk about some of the assurances about Ebola we’ve heard from public health officials, versus some of the truths as you see it."
In this segment, Dr. Peter Salgo talks about the potential for an Ebola vaccine to be developed in the near future, and Dr. Alfred Deluca discusses ongoing efforts to increase awareness and preparedness among hospital staff.
By some estimates, the number of cases of Ebola in an area can double as quickly as every 2 weeks.
Turning to the topic of Ebola risk in the United States, Dr. Peter Salgo says that people here are obviously concerned, especially those in the health care field.
Ebola has been the subject of a constant drumbeat on every television station, every radio station, and every newspaper in America. How effective has the news media been in conveying the reality of Ebola vs. the terror of Ebola?
In this final segment of "HCPLive Practice Brief: A Focus on Ebola for Practitioners," Dr. Peter Salgo and Dr. Alfred Deluca talk about "damping down the panic" surrounding Ebola while also communicating the potential severity of this disease.
One specific criticism leveled at the CDC is that it did not ask fast enough after the first Ebola case appeared in Dallas. Are we now taking adequate measures to defend the public health, or should we taking additional preventive action, like banning travel from affected nations in Africa?
More Reading