title: Strategies for reducing potentially avoidable hospitalizations for ambulatory care-sensitive conditions.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany. tobias.freund@med.uni-heidelberg.de
authors.forename: Tobias
authors.initials: T
authors.lastname: Freund
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Campbell
authors.forename: Stefan
authors.initials: S
authors.lastname: Geissler
authors.forename: Cornelia U
authors.initials: CU
authors.lastname: Kunz
authors.forename: Cornelia
authors.initials: C
authors.lastname: Mahler
authors.forename: Frank
authors.initials: F
authors.lastname: Peters-Klimm
authors.forename: Joachim
authors.initials: J
authors.lastname: Szecsenyi
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000458:organization & administration*; D001291:Attitude of Health Personnel; D005260:Female; D005858:Germany; D006300:Health Services Misuse / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000458:organization & administration*; D011369:Professional-Patient Relations; D011787:Quality of Health Care / Q000458:organization & administration
keywords: ambulatory care-sensitive conditions; avoidable hospitalizations; hospitalization; multimorbidity; primary health care; quality of health care