Hospitalisation of ambulatory care sensitive conditions and access to primary care in Portugal

Abstract

Objectives: Our aim is to study the relationship between the incidence of hospitalisations of ambulatory care sensitive conditions (ACSCs) in small geographic areas and characteristics of the primary care delivery system that are associated with access to care such as travel time to the provider, volume of resources and patient-doctor ties. We try to assess the relative importance of access barriers and draw useful implications for healthcare planning policy.

Study design: This work combines the approach of ACSC rates by Billings et al. (1993) and the Penchansky and Thomas (1981) framework of access, building a tool for analysing variations in small areas and assessing barriers to access for primary health care. We explicitly address and describe some of those barriers through an empirical test of the relevance on ACSC hospitalisation rates of factors that can be grouped in the access dimensions of that framework.

Methods: We examine data of hospitalisations in public hospitals and characteristics of the public primary care delivery system in small areas of Portugal in 2014, estimating two models by ordinary least squares: one with variables that capture specific aspects of access and one without such variables. We then compared the predictive power of the two models.

Results: Although data on specific access barriers are scarce, results show that a model with access variables explains 70% of the variation in ACSC hospitalisation rates, 11 percentage points more than a model without such variables.

Conclusions: Our results suggest that increasing resources do not seem to necessarily enhance patient access to care. Other factors, such as reduced travel time and long-term patient-doctor ties, arise as more important in reducing unnecessary hospitalisations. Thus, the solution for increasing the access to primary health care and reducing disparities among small areas seems to lie more in organisational changes than in allocation of resources.

Keywords: Access; Ambulatory care sensitive conditions; Primary care.