HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland.
Epidemiology and Biostatistics, University of Georgia, Athens, Georgia, USA.
BMJ Open. 2021 May 5;11(5):e042779. doi: 10.1136/bmjopen-2020-042779.
Ambulatory care sensitive (ACS) conditions are those for which intensified primary care management could potentially prevent emergency admissions. This study aimed to quantify geographical variation in emergency admissions with ACS conditions in older adults and explore factors influencing variation.
Repeated cross-sectional study.
34 public hospitals in the Ireland.
Adults aged ≥65 years hospitalised for seven ACS conditions between 2012 and 2016 (chronic obstructive pulmonary disease, congestive heart failure (CHF), diabetes, angina, pyelonephritis/urinary tract infections (UTIs), dehydration and pneumonia).
Age and sex standardised emergency admission rates (SARs) per 1000 older adults.
Age and sex SARs were calculated for 21 geographical areas. Extremal quotients and systematic components of variance (SCV) quantified variation. Spatial regression analyses was conducted for SARs with unemployment, urban population proportion, hospital turnover, supply of general practitioners (GPs), and supply of hospital-based specialists as explanatory variables.
Over time, an increase in UTI/pyelonephritis SARs was seen while SARs for angina and CHF decreased. Geographic variation was moderate overall and high for dehydration and angina (SCV=11.7-50.0). For all conditions combined, multivariable analysis showed lower urban population (adjusted coefficient: -2.2 (-3.4 to -0.9, p<0.01)), lower GP supply (adjusted coefficient: -5.5 (-8.2 to -2.9, p<0.01)) and higher geriatrician supply (adjusted coefficient: 3.7 (0.5 to 6.9, p=0.02)) were associated with higher SARs.
Future research should evaluate methods of preventing admissions for ACS conditions among older adults, including how resources are allocated at a local level.
门诊医疗敏感（ACS）病症是指通过强化初级保健管理可能预防急诊入院的病症。本研究旨在定量分析老年人群中与 ACS 相关的急诊入院的地理差异，并探讨影响这种差异的因素。
重复横断面研究。
爱尔兰的 34 家公立医院。
2012 年至 2016 年期间因七种 ACS 病症（慢性阻塞性肺疾病、充血性心力衰竭（CHF）、糖尿病、心绞痛、肾盂肾炎/尿路感染（UTI）、脱水和肺炎）住院的年龄≥65 岁的成年人。
每 1000 名老年人的年龄和性别标准化急诊入院率（SAR）。
为 21 个地理区域计算了年龄和性别 SAR。极值比和系统方差分量（SCV）量化了变异性。对 SAR 进行了空间回归分析，解释变量为失业率、城市人口比例、医院周转率、全科医生（GP）供应量和医院专科医生供应量。
随着时间的推移，UTI/肾盂肾炎 SAR 增加，而心绞痛和 CHF 的 SAR 则下降。总体而言，地理变异性中等，脱水和心绞痛的变异性较高（SCV=11.7-50.0）。对于所有合并病症，多变量分析表明城市人口比例较低（调整系数：-2.2（-3.4 至-0.9，p<0.01））、GP 供应量较低（调整系数：-5.5（-8.2 至-2.9，p<0.01））和老年病医生供应量较高（调整系数：3.7（0.5 至 6.9，p=0.02））与 SAR 较高相关。
未来的研究应评估针对老年人群中 ACS 病症的预防入院方法，包括如何在地方层面分配资源。
