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BMC Primary Care
Published in: BMC Primary Care 1/2019

Open Access 01-12-2019 | Care | Research article

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

Authors: Marjon van der Pol, Damilola Olajide, Mark Dusheiko, Robert Elliott, Bruce Guthrie, Louisa Jorm, Alastair H. Leyland

Published in: BMC Primary Care | Issue 1/2019

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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.
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Metadata
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
Authors
Marjon van der Pol
Damilola Olajide
Mark Dusheiko
Robert Elliott
Bruce Guthrie
Louisa Jorm
Alastair H. Leyland
Publication date
01-12-2019
Publisher
BioMed Central
Keyword
Care
Published in
BMC Primary Care / Issue 1/2019
Electronic ISSN: 2731-4553
DOI
https://doi.org/10.1186/s12875-019-0921-z

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