Are avoidable hospitalizations associated with the primary healthcare governance model? a public health perspective
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Public Health Unit, Vale do Sousa Norte, Portugal Rua Rainha D. Leonor, 107 4590-612 Paços de Ferreira Portugal
NOVA School of Business and Economics
Family Health Unit, Unidade de Saúde Familiar Prelada, ACES Porto Ocidental, Portugal PHC - Commissioning Department, Northern Regional Administration of Health, Portugal; CINTESIS@RISE - Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal Portugal
Publication date: 2023-04-26
Popul. Med. 2023;5(Supplement):A910
Primary healthcare (PHC) mission is to provide first level continuity of care and act as health system (HS) gatekeeper. Avoidable hospitalizations (Avh) are recognized as a sensible PHC performance measure. A governance model centred on general practitioner (GP) public or self/company delivery have found mixed results on Avh, while there is a large performance variation between HS. Therefore, the study aims to assess how PHC governance models determine Avh, as well as how interacts with the HS public model, considering GP availability and outpatient coverage.

An ecological study was conducted and countries were the observation unit. Data for GP employment type (public and self or company) and 2019 asthma and chronic obstructive pulmonary disease (COPD) and diabetes Avh was collected from Organisation for Economic Co-operation and Development health statistics. Eurostat database and Health in Transition reports were also used as sources. A three-step regression analysis was conducted based on population characteristics, PHC coverage and HS models.

The study included 26 countries, 13 public-employee and 13 self/company-employed. For Asthma and COPD Avh, the first two models registered negative coefficients (p(M0)= -4.256 [CI 95% -75.1;66.6] and p(M1)= -4.746 [CI 95% -84.7;75.2]), while after interaction with HS models a positive coefficient (p(M2)= +23.815 [CI 95% -157.1;204.7]). In diabetes Avh, all the models registered a positive and increasing coefficient (p(M0)= +35.551 [CI 95% -26.7;97.8], p(M1)= +37.128 [CI 95% -32.4;106.7] and p(M2)= +43.873 [CI 95% -32.4;106.7]).

This study creates evidence and hypotheses that GP public-employed might provide more quality of continuity care, particularly for diabetes management. The main limitations are the mix of PHC and HS models in most countries, the co-burden of disease variations and individual level demand for out-of-pocket services. In addition, these results show that PHC and HS models might influence how population access different levels of care.

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