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Strategies for reducing potentially avoidable hospitalizations for ambulatory care-sensitive conditions

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Strategies for reducing potentially avoidable hospitalizations for ambulatory care-sensitive conditions. / Freund, Tobias; Campbell, Stephen M.; Geissler, Stefan et al.
In: Annals of Family Medicine, Vol. 11, No. 4, 10.07.2013, p. 363-370.

Research output: Contribution to Journal/MagazineJournal articlepeer-review

Harvard

Freund, T, Campbell, SM, Geissler, S, Kunz, CU, Mahler, C, Peters-Klimm, F & Szecsenyi, J 2013, 'Strategies for reducing potentially avoidable hospitalizations for ambulatory care-sensitive conditions', Annals of Family Medicine, vol. 11, no. 4, pp. 363-370. https://doi.org/10.1370/afm.1498

APA

Freund, T., Campbell, S. M., Geissler, S., Kunz, C. U., Mahler, C., Peters-Klimm, F., & Szecsenyi, J. (2013). Strategies for reducing potentially avoidable hospitalizations for ambulatory care-sensitive conditions. Annals of Family Medicine, 11(4), 363-370. https://doi.org/10.1370/afm.1498

Vancouver

Freund T, Campbell SM, Geissler S, Kunz CU, Mahler C, Peters-Klimm F et al. Strategies for reducing potentially avoidable hospitalizations for ambulatory care-sensitive conditions. Annals of Family Medicine. 2013 Jul 10;11(4):363-370. doi: 10.1370/afm.1498

Author

Freund, Tobias ; Campbell, Stephen M. ; Geissler, Stefan et al. / Strategies for reducing potentially avoidable hospitalizations for ambulatory care-sensitive conditions. In: Annals of Family Medicine. 2013 ; Vol. 11, No. 4. pp. 363-370.

Bibtex

@article{7a15f21becad46909f60844baf2fefe9,
title = "Strategies for reducing potentially avoidable hospitalizations for ambulatory care-sensitive conditions",
abstract = "PURPOSE: Hospitalizations for ambulatory care-sensitive conditions (ACSCs) are seen as potentially avoidable with optimal primary care. Little is known, however, about how primary care physicians rate these hospitalizations and whether and how they could be avoided. This study explores the complex causality of such hospitalizations from the perspective of primary care physicians.METHODS: We conducted semistructured interviews with 12 primary care physicians from 10 primary care clinics in Germany regarding 104 hospitalizations of 81 patients with ACSCs at high risk of rehospitalization.RESULTS: Participating physicians rated 43 (41%) of the 104 hospitalizations to be potentially avoidable. During the interviews the cause of hospitalization fell into 5 principal categories: system related (eg, unavailability of ambulatory services), physician related (eg, suboptimal monitoring), medical (eg, medication side effects), patient related (eg, delayed help-seeking), and social (eg, lack of social support). Subcategories frequently associated with physicians' rating of hospitalizations for ACSCs as potentially avoidable were after-hours absence of the treating physician, failure to use ambulatory services, suboptimal monitoring, patients' fearfulness, cultural background and insufficient language skills of patients, medication errors, medication nonadherence, and overprotective caregivers. Comorbidities and medical emergencies were frequent causes attributed to ACSC-based hospitalizations that were rated as being unavoidable.CONCLUSIONS: Primary care physicians rated a significant proportion of hospitalizations for ACSCs to be potentially avoidable. Strategies to avoid these hospitalizations may target after-hours care, optimal use of ambulatory services, intensified monitoring of high-risk patients, and initiatives to improve patients' willingness and ability to seek timely help, as well as patients' medication adherence.",
keywords = "Adult, Aged, Ambulatory Care, Attitude of Health Personnel, Female, Germany, Health Services Misuse, Hospitalization, Humans, Male, Middle Aged, Primary Health Care, Professional-Patient Relations, Quality of Health Care",
author = "Tobias Freund and Campbell, {Stephen M.} and Stefan Geissler and Kunz, {Cornelia U.} and Cornelia Mahler and Frank Peters-Klimm and Joachim Szecsenyi",
year = "2013",
month = jul,
day = "10",
doi = "10.1370/afm.1498",
language = "English",
volume = "11",
pages = "363--370",
journal = "Annals of Family Medicine",
issn = "1544-1717",
publisher = "Annals of Family Medicine, Inc",
number = "4",

}

RIS

TY - JOUR

T1 - Strategies for reducing potentially avoidable hospitalizations for ambulatory care-sensitive conditions

AU - Freund, Tobias

AU - Campbell, Stephen M.

AU - Geissler, Stefan

AU - Kunz, Cornelia U.

AU - Mahler, Cornelia

AU - Peters-Klimm, Frank

AU - Szecsenyi, Joachim

PY - 2013/7/10

Y1 - 2013/7/10

N2 - PURPOSE: Hospitalizations for ambulatory care-sensitive conditions (ACSCs) are seen as potentially avoidable with optimal primary care. Little is known, however, about how primary care physicians rate these hospitalizations and whether and how they could be avoided. This study explores the complex causality of such hospitalizations from the perspective of primary care physicians.METHODS: We conducted semistructured interviews with 12 primary care physicians from 10 primary care clinics in Germany regarding 104 hospitalizations of 81 patients with ACSCs at high risk of rehospitalization.RESULTS: Participating physicians rated 43 (41%) of the 104 hospitalizations to be potentially avoidable. During the interviews the cause of hospitalization fell into 5 principal categories: system related (eg, unavailability of ambulatory services), physician related (eg, suboptimal monitoring), medical (eg, medication side effects), patient related (eg, delayed help-seeking), and social (eg, lack of social support). Subcategories frequently associated with physicians' rating of hospitalizations for ACSCs as potentially avoidable were after-hours absence of the treating physician, failure to use ambulatory services, suboptimal monitoring, patients' fearfulness, cultural background and insufficient language skills of patients, medication errors, medication nonadherence, and overprotective caregivers. Comorbidities and medical emergencies were frequent causes attributed to ACSC-based hospitalizations that were rated as being unavoidable.CONCLUSIONS: Primary care physicians rated a significant proportion of hospitalizations for ACSCs to be potentially avoidable. Strategies to avoid these hospitalizations may target after-hours care, optimal use of ambulatory services, intensified monitoring of high-risk patients, and initiatives to improve patients' willingness and ability to seek timely help, as well as patients' medication adherence.

AB - PURPOSE: Hospitalizations for ambulatory care-sensitive conditions (ACSCs) are seen as potentially avoidable with optimal primary care. Little is known, however, about how primary care physicians rate these hospitalizations and whether and how they could be avoided. This study explores the complex causality of such hospitalizations from the perspective of primary care physicians.METHODS: We conducted semistructured interviews with 12 primary care physicians from 10 primary care clinics in Germany regarding 104 hospitalizations of 81 patients with ACSCs at high risk of rehospitalization.RESULTS: Participating physicians rated 43 (41%) of the 104 hospitalizations to be potentially avoidable. During the interviews the cause of hospitalization fell into 5 principal categories: system related (eg, unavailability of ambulatory services), physician related (eg, suboptimal monitoring), medical (eg, medication side effects), patient related (eg, delayed help-seeking), and social (eg, lack of social support). Subcategories frequently associated with physicians' rating of hospitalizations for ACSCs as potentially avoidable were after-hours absence of the treating physician, failure to use ambulatory services, suboptimal monitoring, patients' fearfulness, cultural background and insufficient language skills of patients, medication errors, medication nonadherence, and overprotective caregivers. Comorbidities and medical emergencies were frequent causes attributed to ACSC-based hospitalizations that were rated as being unavoidable.CONCLUSIONS: Primary care physicians rated a significant proportion of hospitalizations for ACSCs to be potentially avoidable. Strategies to avoid these hospitalizations may target after-hours care, optimal use of ambulatory services, intensified monitoring of high-risk patients, and initiatives to improve patients' willingness and ability to seek timely help, as well as patients' medication adherence.

KW - Adult

KW - Aged

KW - Ambulatory Care

KW - Attitude of Health Personnel

KW - Female

KW - Germany

KW - Health Services Misuse

KW - Hospitalization

KW - Humans

KW - Male

KW - Middle Aged

KW - Primary Health Care

KW - Professional-Patient Relations

KW - Quality of Health Care

U2 - 10.1370/afm.1498

DO - 10.1370/afm.1498

M3 - Journal article

C2 - 23835823

VL - 11

SP - 363

EP - 370

JO - Annals of Family Medicine

JF - Annals of Family Medicine

SN - 1544-1717

IS - 4

ER -