Admissions for ambulatory care sensitive conditions: a national observational study in the general and COPD population

Eur J Public Health. 2019 Apr 1;29(2):213-219. doi: 10.1093/eurpub/cky182.


Background: Hospital admissions for ambulatory care sensitive conditions (ACSCs) may be prevented by effective ambulatory management and treatment. ACSC admissions is used as indicator for primary care quality and accessibility. However, debate continues to which extent these admissions are truly preventable. The aim of this study was to provide more objective insight into the preventability of ACSC admissions.

Methods: Observational study using 2012-15 health insurer claim data of 13 182 602 Dutch insured inhabitants. Logistic multilevel regression analyses were conducted to investigate factors (ambulatory care and characteristics of inhabitants) possibly associated with ACSC admissions. Prior ambulatory care use was examined for patients with an ACSC contributing to the highest number of ACSC admissions: chronic obstructive pulmonary disease (COPD).

Results: In 2014, 89.8 hospital admissions for ACSCs per 10 000 insured inhabitants were claimed. Percentage of inhabitants with ACSC admissions varied between general practices from 0.58-0.84%. ASCS admissions were hardly associated with ambulatory care. One month prior to admission, 97% of admitted COPD patients had at least one ambulatory care contact.

Conclusions: Variation in ACSC admissions between general practitioners was observed, indicating that certain hospital admissions may be prevented. However, we found no indication that ACSC admissions were preventable, as no link was found with the provision of ambulatory care and ACSC admissions. This may indicate that this indicator is country and health care system specific. Before including ACSC admission as quality indicator of primary care in the Netherlands, more insight into the causes of variation is required.

Publication types

  • Observational Study

MeSH terms

  • Adrenal Cortex Hormones / administration & dosage
  • After-Hours Care / statistics & numerical data
  • Aged
  • Aged, 80 and over
  • Ambulatory Care / statistics & numerical data*
  • Anti-Bacterial Agents / administration & dosage
  • Bronchodilator Agents / administration & dosage
  • Comorbidity
  • Female
  • General Practice / statistics & numerical data*
  • Hospitalization / statistics & numerical data*
  • Humans
  • Insurance Claim Review
  • Male
  • Netherlands
  • Pulmonary Disease, Chronic Obstructive / epidemiology*
  • Pulmonary Disease, Chronic Obstructive / therapy
  • Quality of Health Care
  • Regression Analysis
  • Respiratory Therapy / statistics & numerical data
  • Socioeconomic Factors


  • Adrenal Cortex Hormones
  • Anti-Bacterial Agents
  • Bronchodilator Agents