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Individual and Area-level Factors Contributing to the Geographic Variation in Ambulatory Care Sensitive Conditions in Finland: A Register-based Study.

https://arctichealth.org/en/permalink/ahliterature310786
Source
Med Care. 2021 02 01; 59(2):123-130
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
02-01-2021
Author
Markku Satokangas
Martti Arffman
Harri Antikainen
Alastair H Leyland
Ilmo Keskimäki
Author Affiliation
Department of General Practice and Primary Health Care, Network of Academic Health Centres, University of Helsinki.
Source
Med Care. 2021 02 01; 59(2):123-130
Date
02-01-2021
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Adult
Aged
Aged, 80 and over
Ambulatory Care - methods - statistics & numerical data
Cross-Sectional Studies
Female
Finland
Geographic Mapping
Health Services Accessibility - standards - statistics & numerical data
Humans
Male
Middle Aged
Registries - statistics & numerical data
Abstract
Measuring primary health care (PHC) performance through hospitalizations for ambulatory care sensitive conditions (ACSCs) remains controversial-recent cross-sectional research claims that its geographic variation associates more with individual socioeconomic position (SEP) and health status than PHC supply.
To clarify the usage of ACSCs as a PHC performance indicator by quantifying how disease burden, both PHC and hospital supply and spatial access contribute over time to geographic variation in Finland when individual SEP and comorbidities were adjusted for.
The Finnish Care Register for Health Care provided hospitalizations for ACSCs (divided further into subgroups of acute, chronic, and vaccine-preventable causes) in 2011-2017. With 3-level nested multilevel Poisson models-individuals, PHC authorities, and hospital authorities-we estimated the proportion of the variance in ACSCs explained by selected factors at 3 time periods.
In age-adjusted and sex-adjusted analysis of total ACSCs the variances between hospital authorities was nearly twice that between PHC authorities. Individual SEP and comorbidities explained 19%-30% of the variance between PHC authorities and 25%-36% between hospital authorities; and area-level disease burden and arrangement and usage of hospital care a further 14%-16% and 32%-33%-evening out the unexplained variances between PHC and hospital authorities.
Alongside individual factors, areas' disease burden and factors related to hospital care explained the excess variances in ACSCs captured by hospital authorities. Our consistent findings over time suggest that the local strain on health care and the regional arrangement of hospital services affect ACSCs-necessitating caution when comparing areas' PHC performance through ACSCs.
PubMed ID
33201086 View in PubMed
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Trajectory modelling of ambulatory care sensitive conditions in Finland in 1996-2013: assessing the development of equity in primary health care through clustering of geographic areas - an observational retrospective study.

https://arctichealth.org/en/permalink/ahliterature309163
Source
BMC Health Serv Res. 2019 Sep 04; 19(1):629
Publication Type
Journal Article
Observational Study
Date
Sep-04-2019
Author
Markku Satokangas
Sonja Lumme
Martti Arffman
Ilmo Keskimäki
Author Affiliation
Social and Health Systems Research Unit, National Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland. markku.satokangas@thl.fi.
Source
BMC Health Serv Res. 2019 Sep 04; 19(1):629
Date
Sep-04-2019
Language
English
Publication Type
Journal Article
Observational Study
Keywords
Cluster analysis
Finland - epidemiology
Health equity
Health Services Accessibility - statistics & numerical data
Humans
Primary Health Care
Quality Indicators, Health Care
Retrospective Studies
Abstract
Due to stagnating resources and an increase in staff workload, the quality of Finnish primary health care (PHC) is claimed to have deteriorated slowly. With a decentralised PHC organisation and lack of national stewardship, it is likely that municipalities have adopted different coping strategies, predisposing them to geographic disparities. To assess whether these disparities emerge, we analysed health centre area trajectories in hospitalisations due to ambulatory care sensitive conditions (ACSCs).
ACSCs, a proxy for PHC quality, comprises conditions in which hospitalisation could be avoided by timely care. We obtained ACSCs of the total Finnish population aged =20 for the years 1996-2013 from the Finnish Hospital Discharge Register, and divided them into subgroups of acute, chronic and vaccine-preventable causes, and calculated annual age-standardised ACSC rates by gender in health centre areas. Using these rates, we conducted trajectory analyses for identifying health centre area clusters using group-based trajectory modelling. Further, we applied area-level factors to describe the distribution of health centre areas on these trajectories.
Three trajectories - and thus separate clusters of health centre areas - emerged with different levels and trends of ACSC rates. During the study period, chronic ACSC rates decreased (40-63%) within each of the clusters, acute ACSC rates remained stable and vaccine-preventable ACSC rates increased (1-41%). While disparities in rate differences in chronic ACSC rates between trajectories narrowed, in the two other ACSC subgroups they increased. Disparities in standardised rate ratios increased in vaccine-preventable and acute ACSC rates between northern cluster and the two other clusters. Compared to the south-western cluster, 13-16% of health centre areas, in rural northern cluster, had 47-92% higher ACSC rates - but also the highest level of morbidity, most limitations on activities of daily living and highest PHC inpatient ward usage as well as the lowest education levels and private health and dental care usage.
We identified three differing trajectories of time trends for ACSC rates, suggesting that the quality of care, particularly in northern Finland health centre areas, may have lagged behind the general improvements. This calls for further investments to strengthen rural area PHC.
PubMed ID
31484530 View in PubMed
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