There are nine such health problems, called Ambulatory Care Sensitive (ACS) conditions. Because outpatient care for ACSs could prevent the onset of an illness, control problems that arise during an episode, or manage a chronic disease, researchers use these conditions to assess whether patients are getting access to the kinds of care which may both reduce their disease burden and reduce the overall costs of their treatment.
This paper challenges the paradigm that frequent visits for ACS conditions should be assumed to be associated with lower rates of hospitalization. This was not true in Manitoba-- especially for patients coming from different socioeconomic levels even within a setting designed to promote equal access. The study specifically looked at the hospitalizations, same-day surgery, and outpatient visits to the provider [that is, 'ambulatory care'] for people with ACS conditions from urban areas of Manitoba during 1998-2001. "All conditions showed a socioeconomic gradient with residents of the lowest-income neighborhoods having both more ambulatory care and more hospitalizations than their counterparts in higher income areas," author Leslie Roos states. For six of the nine conditions, individuals living in the lowest income neighborhoods had significantly more ambulatory visits before hospitalization than those living in wealthier neighborhoods-- so poorer access to ambulatory care is not the obvious explanation. Instead, the poor in urban Manitoba had more frequent contact with general practitioners; socioeconomic groups differed little in contact with specialists. Policies and research that tries to assess the "timeliness" and "quality of care" of care received by measuring access to outpatient care for Ambulatory Care Sensitive Conditions need to be further examined in the light of these findings.
This study is publishing in the June issue of Health Services Research. Media wishing to receive a PDF, please contact journalnews@bos.blackwellpublishing.net
Health Services Research (HSR) provides those engaged in research, public policy formulation, and health services management with the latest findings, methods, and thinking on important policy and practice issues. HSR is now Online Early meaning complete, peer reviewed, web-functional articles will post online up to several months in advance of the printed issue. HSR is published by the Health Research and Educational Trust in cooperation with AcademyHealth.
Leslie L. Roos is a Professor in the Department of Community Health Sciences, Faculty of Medicine, University of Manitoba. He was Director of the Population Health Research Repository at the Manitoba Centre for Health Policy from 1990 to 2004. Dr. Roos was a National Health Research Scholar and Scientist for over twenty years.
Dr. Roos is available for questions and interviews.
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