[To identify primary care interventions that reduce hospitalisation of people over 65 due to ambulatory care sensitive conditions].
OBJECTIVE
To study how primary care (PC) professionals perceive the pathologies that tend to cause hospitalisation of people over 65 most frequently, and to study their consistency with the list of ACSCs (Ambulatory Care Sensitive Conditions). To identify prior PC interventions that could reduce or prevent hospitalisation due to those pathologies.


METHODS
A Delphi study with PC experts from 7 health care centres in Granada, Spain, during 2005. A descriptive analysis of the consensus obtained via self-administered questionnaires.


RESULTS
The diseases that cause the bulk of admissions in people over 65 are: acute COPD, non-compensated cardiac failure, cerebro-vascular accident, and falls-traumas. The pathologies analysed form part of the list of ACSCs, with the exception of falls, listed as the fourth cause, and cancer processes, listed as the sixth cause. The hospitalisation rates that could be avoided with prompt and effective PC varies between 20% for cancer processes to 70% for non-compensated diabetes. The rate is over 50% in COPD, digestive haemorrhages, and diabetes. The key interventions for reducing hospitalisations are primary prevention care, early diagnosis, and correct treatment. Effectiveness and feasibility vary widely for each particular intervention.


CONCLUSIONS
The principal causes of hospitalisation in people over 65 are included as ACSC. Priority actions to reduce avoidable hospitalisations from PC are multi-modal interventions, the majority of which are over 50% effective and feasible.
Valenzuela López
M Isabel
MI
Medicina de Familia, Centro de Salud Almanjayar, Granada, España. isavallop@hotmail.com
Gastón Morata
José Luis
JL
Melguizo Jiménez
Miguel
M
Valenzuela López
M Mar
MM
Bueno Cavanillas
Aurora
A
D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D003697:Delphi Technique; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care