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BMC Health Services Research
Published in: BMC Health Services Research 1/2019

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

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

Authors: Josée G. Lavoie, Sabrina T. Wong, Naser Ibrahim, John D. O’Neil, Michael Green, Amanda Ward

Published in: BMC Health Services Research | Issue 1/2019

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Abstract

Background

Since 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).

Objectives

This 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.

Methods

In 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.

Results

First 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).

Conclusions

Improving 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.
Literature
1.
2.
3.
Bradshaw J, Kemp P, Baldwin S, Rowe A. The drivers of social exclusion: review of the literature for the social exclusion unit in the breaking the cycle series. London: University of York; 2004.
4.
Lavoie JG, Forget EL, Prakash T, Dahl M, Martens PJ, O'Neil JD. Have investments in on-reserve health services and initiatives promoting community control improved First Nations’ health in Manitoba? Soc Sci Med. 2010;71(4):717–24.CrossRef
5.
6.
Greenwood M, de Leeuw S, Lindsay NM, Reading C. Determinants of Indigenous Peoples’ health in Canada: beyond the social. Toronto: Canadian Scholars’ Press; 2015.
7.
Lavoie JG, Kaufert JM, Browne AJ, Mah S, O'Neil JD. Negotiating barriers, navigating the maze: First Nation peoples’ experience of medical relocation. Canadian Public Administration. 2015;58(2):295–314.CrossRef
8.
Lavoie JG, Kaufert JM, Browne AJ, O'Neil JD. Managing Matajoosh : determinants of First Nations’ cancer care decisions. BMC Health Serv Res. 2016;16(402):1–12.
9.
10.
11.
12.
Lavoie JG. Medicare and the Care of First Nations, Métis and Inuit. J Health Economics, Policy and Law. 2017;13(3–4):280–98.
13.
Lavoie JG, O’Neil JD, Sanderson L, Elias B, Mignone J, Bartlett J, Forget E, Burton R, Schmeichel C, MacNeil D. The evaluation of the First Nations and Inuit health transfer policy. Winnipeg: Centre for Aboriginal Health Research; 2005.
14.
Lavoie JG, Kornelsen D, Boyer Y, Wylie L. Lost in maps: regionalization and Indigenous health services. HealthcarePapers. 2016;16(1):63–73.CrossRef
15.
Wong ST, Browne AJ, Varcoe C, Lavoie J, Fridkin A, Smye V, Godwin O, Tu D. Development of health equity indicators in primary health care organizations using a modified Delphi. PLoS One. 2014;9(12):e114563.CrossRef
16.
Weissman JS, Gatsonis C, Epstein AM. Rates of avoidable hospitalization by insurance status in Massachusetts and Maryland. JAMA. 1992;268(17):2388–94.CrossRef
17.
Billings J, Zeital L, Lukomnik J, Carey T, Blank A, Newman L. Impact of socio-economic status on hospital use in new York City. Health Aff. 1993;12:162–73.CrossRef
18.
Rosano A, Loha CA, Falvo R, van der Zee J, Ricciardi W, Guasticchi G, de Belvis AG. The relationship between avoidable hospitalization and accessibility to primary care: a systematic review. Eur J Pub Health. 2013;23(3):356–60.CrossRef
19.
Purdy S, Griffin T, Salisbury C, Sharp D. Ambulatory care sensitive conditions: terminology and disease coding need to be more specific to aid policy makers and clinicians. Public Health. 2009;123(2):169–73.CrossRef
20.
Passey ME, Longman JM, Johnston JJ, Jorm L, Ewald D, Morgan GG, Rolfe M, Chalker B. Diagnosing potentially preventable Hospitalisations (DaPPHne): protocol for a mixed-methods data-linkage study. BMJ Open. 2015;5(11):e009879.CrossRef
21.
Nedel FB, Facchini LA, Bastos JL, Martin-Mateo M. Conceptual and methodological aspects in the study of hospitalizations for ambulatory care sensitive conditions. Cien Saude Colet. 2011;16(Suppl 1):1145–54.CrossRef
22.
Gibbons DC, Bindman AB, Soljak MA, Millett C, Majeed A. Defining primary care sensitive conditions: a necessity for effective primary care delivery? J R Soc Med. 2012;105(10):422–8.CrossRef
23.
Caminal J, Starfield B, Sanchez E, Casanova C, Morales M. The role of primary care in preventing ambulatory care sensitive conditions. EurJPublic Health. 2004;14(3):246–51.
24.
Sundmacher L, Fischbach D, Schuettig W, Naumann C, Augustin U, Faisst C. Which hospitalisations are ambulatory care-sensitive, to what degree, and how could the rates be reduced? Results of a group consensus study in Germany. Health Policy. 2015;119(11):1415–23.CrossRef
25.
Longman JM, Passey ME, Ewald DP, Rix E, Morgan GG. Admissions for chronic ambulatory care sensitive conditions - a useful measure of potentially preventable admission? BMC Health Serv Res. 2015;15:472.CrossRef
26.
Gibson OR, Segal L, McDermott RA. A systematic review of evidence on the association between hospitalisation for chronic disease related ambulatory care sensitive conditions and primary health care resourcing. BMC Health Serv Res. 2013;13:336.CrossRef
27.
Korenbrot C, Kao C, Crouch JA. Funding of tribal health programs linked to lower rates of hospitalization for conditions sensitive to ambulatory care. Med Care. 2009;47(1):88–96.CrossRef
28.
Van Loenen T, van den Berg MJ, Westert GP, Faber MJ. Organizational aspects of primary care related to avoidable hospitalization: a systematic review. Fam Pract. 2014;31(5):502–16.CrossRef
29.
Van Loenen T, Faber MJ, Westert GP, Van den Berg MJ. The impact of primary care organization on avoidable hospital admissions for diabetes in 23 countries. Scand J Prim Health Care. 2016;34(1):5–12.CrossRef
30.
Weeks WB, Ventelou B, Paraponaris A. Rates of admission for ambulatory care sensitive conditions in France in 2009-2010: trends, geographic variation, costs, and an international comparison. Eur J Health Econ. 2016;17(4):453–70.CrossRef
31.
Lavoie JG, Forget EL, Dahl M, Martens PJ, O'Neil JD. Is it worthwhile to invest in home care? Healthcare policy = Politiques de sante. 2011;6(4):35–48.CrossRef
32.
Hossain MM, Laditka JN. Using hospitalization for ambulatory care sensitive conditions to measure access to primary health care: an application of spatial structural equation modeling. Int J Health Geogr. 2009;8:51.CrossRef
33.
Ansari Z, Rowe S, Ansari H, Sindall C. Small area analysis of ambulatory care sensitive conditions in Victoria, Australia. Popul Health Manag. 2013;16(3):190–200.CrossRef
34.
Busby J, Purdy S, Hollingworth W. A systematic review of the magnitude and cause of geographic variation in unplanned hospital admission rates and length of stay for ambulatory care sensitive conditions. BMC Health Serv Res. 2015;15:324.CrossRef
35.
Laditka JN, Laditka SB, Probst JC. Health care access in rural areas: evidence that hospitalization for ambulatory care-sensitive conditions in the United States may increase with the level of rurality. Health Place. 2009;15(3):731–40.CrossRef
36.
Saha S, Solotaroff R, Oster A, Bindman AB. Are preventable hospitalizations sensitive to changes in access to primary care? The case of the Oregon Health Plan Med Care. 2007;45(8):712–9.PubMed
37.
Stamp KM, Duckett SJ, Fisher DA. Hospital use for potentially preventable conditions in Aboriginal and Torres Strait Islander and other Australian populations. Aust N Z J Public Health. 1998;22(6):673–8.CrossRef
38.
Browne AJ. Discourses influencing nurses’ perceptions of First Nations patients. Can J Nurs Res. 2005;37(4):62–87.PubMed
39.
Browne AJ. Clinical encounters between nurses and First Nations women in a Western Canadian hospital. Soc Sci Med. 2007;64(10):2165–76.CrossRef
40.
Paradies Y, Harris R, Anderson I. The impact of racism on Indigenous health in Australia and Aotearoa: towards a research agenda. Casuarina, N.T. Cooperative Research Centre for Aboriginal Health; 2008.
41.
Shahid S, Finn LD, Thompson SC. Barriers to participation of Aboriginal people in cancer care: communication in the hospital setting. Med J Aust. 2009;190(10):574–9.PubMed
42.
Lavoie JG, Dwyer J. Implementing Indigenous community control in health care: lessons from Canada. Australian health review: a publication of the Australian Hospital Association. 2016;40:453–8.CrossRef
43.
Statistics Canada. British Columbia. Aboriginal identity (3), registered Indian status (3), age groups (12), sex (3) and area of residence (6) for the population of Canada, provinces and territories, 2006 census - 20% sample data. In: Statistics Canada; 2006.
44.
Canadian Institute for Health Information. Pan-Canadian primary health care indicators: report 1, Volume 1. Ottawa: Pan-Canadian primary health care indicator development project; 2006.
45.
Victorian Government Department of Human Resources Division. The Victorian ambulatory care sensitive conditions study: opportunities for targeting public health and health services intervention. Victoria: Public Health Division; 2001.
46.
Martens PJ, Sanderson D, Jebamani LS. Health services use of Manitoba First Nations people: is it related to underlying need? CanJPublic Health. 2005;96(Suppl 1):S39–44.
47.
Shah BR, Gunraj N, Hux JE. Markers of access to and quality of primary care for Aboriginal people in Ontario, Canada. Am J Public Health. 2003;93(5):798–802.CrossRef
48.
49.
50.
British Columbia Ministry of Health. Consolidation File (MSP Registration & Premium Billing). V2. Population Data BC. Data Extract. In. Edited by BC PD. Victoria, BC; 2012.
51.
Canadian Institute for Health Information. Discharge abstract database (hospital separations). V2. . In. Edited by BC PD. Victoria BC; 2012.
52.
Lavoie JG, O’Neil J, Sanderson L, Elias B, Mignone J, Bartlett J, et al. The evaluation of the First Nations and Inuit health transfer policy. Manitoba First Nations Centre for Aboriginal Health Research: Winnipeg; 2005.
53.
Natural Resources Canada. First Nations and Inuit Health Branch Facilities. Ottawa: Natural Resources Canada; 2004.
54.
O’Neil JD, Gallagher J, Wylie L, Bingham B, Lavoie JG, Alcock D, Johnson H. Transforming First Nations’ health governance in British Columbia. Int J of Health Governance. 2016;21(4):229–44.CrossRef
55.
Browne AJ, Varcoe CM, Wong ST, Smye VL, Lavoie J, Littlejohn D, Tu D, Godwin O, Krause M, Khan KB, et al. Closing the health equity gap: evidence-based strategies for primary health care organizations. IntJEquity Health. 2012;11(1):59.
56.
Browne AJ, Varcoe C, Lavoie JG, Smye V, Wong ST, Krause M, Tu D, Godwin O, Khan K, Fridkin A. Enhancing health care equity with Indigenous populations: evidence-based strategies from an ethnographic study. BMC Health Serv Res 2016;16,544:16.
Metadata
Title
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
Authors
Josée G. Lavoie
Sabrina T. Wong
Naser Ibrahim
John D. O’Neil
Michael Green
Amanda Ward
Publication date
01-12-2019
Publisher
BioMed Central
Keyword
Care
Published in
BMC Health Services Research / Issue 1/2019
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-018-3850-y

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