Relationship Between Primary Care Physician Visits and Hospital/Emergency Use for Uncomplicated Hypertension, an Ambulatory Care-Sensitive Condition

• Published in: Canadian journal of cardiology Vol. 30; no. 12; pp. 1640 - 1648
• Main Authors: Walker, Robin L., MSc, Chen, Guanmin, MD, PhD, McAlister, Finlay A., MD, MSc, Campbell, Norm R.C., MD, Hemmelgarn, Brenda R., MD, PhD, Dixon, Elijah, MD, MSc, Ghali, William, MD, MPH, Rabi, Doreen, MD, MSc, Tu, Karen, MD, MSc, Jette, Nathalie, MD, MSc, Quan, Hude, MD, PhD
• Format: Journal Article
• Language: English
• Published: England Elsevier Inc 01.12.2014
• Subjects: Adult; Aged; Alberta - epidemiology; Ambulatory Care - utilization; Cardiovascular; Emergency Service, Hospital - utilization; Female; Follow-Up Studies; Health Services Accessibility; Hospitalization - statistics & numerical data; Humans; Hypertension - epidemiology; Male; Middle Aged; Morbidity - trends; Physicians, Primary Care - utilization; Retrospective Studies; Socioeconomic Factors; Young Adult; Alberta
• ISSN: 0828-282X; 1916-7075
• DOI: 10.1016/j.cjca.2014.09.035

Abstract Background Hospitalizations for ambulatory care-sensitive conditions (ACSCs) represent an indirect measure of access and quality of community care. The purpose of this study was to examine the association between one ACSC, uncomplicated hypertension, and previous primary care physician (PCP) utilization. Methods A cohort of patients with hypertension was identified using administrative databases in Alberta between fiscal years 1994 and 2008. We applied the Canadian Institute for Health Information's case definition to detect patients with uncomplicated hypertension as the most responsible reason for hospitalization and/or Emergency Department (ED) visit. We assessed hypertension-related and all-cause PCP visits. Results The overall adjusted rate of ACSC hospitalizations and ED visits for uncomplicated hypertension was 7.1 and 13.9 per 10,000 hypertensive patients, respectively. The likelihood of ACSC hospitalization for uncomplicated hypertension was associated with age, household income quintile, region of residence, and Charlson comorbidity status (all P < 0.0001). The adjusted rate of ACSC hospitalizations for uncomplicated hypertension increased from 4.8 per 10,000 hypertensive patients for those without hypertension-related PCP visits before diagnosis to 10.5 per 10,000 hypertensive patients for those with 5 or more hypertension-related PCP visits. The rate of ACSC hospitalizations and/or ED visits for uncomplicated hypertension increased as the number of hypertension-related PCP visits increased even after stratifying according to demographic and clinical characteristics. Conclusions As the frequency of hypertension-related PCP visits increased, the rate of ACSC hospitalizations and/or ED visits for uncomplicated hypertension increased. This suggests that ACSC hospitalization for uncomplicated hypertension might not be a particularly good indicator for access to primary care.