Primary care docs rate many hospitalizations as avoidable

(HealthDay)—Physicians acknowledge that a considerable proportion of hospitalizations for ambulatory care-sensitive conditions (ACSCs) are avoidable, according to a study published in the July/August issue of the Annals of Family Medicine.

Tobias Freund, M.D., from the University Hospital Heidelberg in Germany, and colleagues conducted semistructured interviews with 12 primary care physicians from 10 clinics in Germany. The interviews focused on 104 hospitalizations of 81 patients with ACSCs, considered to be at high risk of rehospitalization.

The researchers found that participating physicians rated 41 percent of the hospitalizations as potentially avoidable. The causes of hospitalization were classified into five main categories: system related (e.g., ambulatory services were unavailable), physician related (e.g., suboptimal monitoring), medical (e.g., side effects of medications), patient related (e.g., delayed help-seeking), and social (e.g., lack of social support). Potentially avoidable hospitalizations were often associated with subcategories, including after-hours absence of the treating physician; failure to utilize ambulatory services; inadequate monitoring; patients' fearfulness; cultural background and insufficient language skills of patients; medication errors and nonadherence; and overprotective caregivers. ACSC-based hospitalizations that were rated as unavoidable were frequently attributed to comorbidities and medical emergencies.

"A number of interventions, including patient education, proactive monitoring of symptoms, improving medication adherence, and promoting continuity of care, may help to take up the challenge of potentially avoidable hospitalizations in primary care practice," the authors write. "Reducing the number of avoidable hospitalizations will contribute to both increased quality of care and reduced health care expenditures."

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