Hospitalizations for ambulatory care sensitive conditions and quality of primary care: their relation with socioeconomic and health care variables in the Madrid regional health service (Spain).
BACKGROUND
Hospitalizations for ambulatory care sensitive conditions (ACSH) have been proposed as an indirect indicator of the effectiveness and quality of care provided by primary health care.


OBJECTIVE
To investigate the association of ACSH rates with population socioeconomic factors and with characteristics of primary health care.


METHODS
Cross-sectional, ecologic study. Using hospital discharge data, ACSH were selected from the list of conditions validated for Spain.


METHODS
All 34 health districts in the Region of Madrid, Spain.


METHODS
Individuals aged 65 years or older residing in the region of Madrid between 2001 and 2003, inclusive.


METHODS
Age- and gender-adjusted ACSH rates in each health district.


RESULTS
The adjusted ACSH rate per 1000 population was 35.37 in men and 20.45 in women. In the Poisson regression analysis, an inverse relation was seen between ACSH rates and the socioeconomic variables. Physician workload was the only health care variable with a statistically significant relation (rate ratio of 1.066 [95% CI; 1.041-1.091]). These results were similar in the analyses disaggregated by gender. In the multivariate analyses that included health care variables, none of the health care variables were statistically significant.


CONCLUSIONS
ACSH may be more closely related with socioeconomic variables than with characteristics of primary care activity. Therefore, other factors outside the health system must be considered to improve health outcomes in the population.
Epidemiología Clínica-Unidad Investigación, Hospital Universitario 12 de Octubre, Avda de Córdoba s/n, Madrid, Spain. pmagan@h12o.es
Purificación
P
Magán
Angel
A
Alberquilla
Angel
A
Otero
José Manuel
JM
Ribera
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000458:organization & administration / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D009026:Mortality; D010820:Physicians / Q000600:supply & distribution; D011320:Primary Health Care / Q000458:organization & administration* / Q000592:standards / Q000706:statistics & numerical data*; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data; D011787:Quality of Health Care / Q000458:organization & administration* / Q000592:standards; D012737:Sex Factors; D012959:Socioeconomic Factors; D013030:Spain; D013997:Time Factors; D014850:Waiting Lists; D016526:Workload / Q000706:statistics & numerical data