Analysis of the role of general practice in preventing avoidable hospitalisation through a multilevel approach

Objectives: To examine the relationship between Avoidable Hospitalisation (AH) and General Practitioners (GPs) organisation, prescriptions of diagnostic procedures and drugs. The study was carried out in the Lazio Region (Italy) within different organisational models of primary care (PC) delivery. Methods: Secondary data of a set of health services provided by GPs delivered to the population included in the lists of GPs working in the Lazio region in 2008 were used. The indicator of AH was built by selecting fourteen amenable conditions to be considered as Ambulatory Care Sensitive Conditions (ACSCs). Age-adjusted hospitalisation rate for ACSCs by treating GP per 1’000 patients was calculated using the hospitalisation records of 2008. The relation between the rates of AH, acute and chronic conditions separately, and GPs organisation and the rate of prescriptions of diagnostic procedures and drugs per 100 patients were analysed through the use of a multilevel Poisson regression model, adjusted according to patients’ health status. Results: The study included data from all the active GPs (4’837) in the Lazio Region and their 4’666’037 registered patients. The overall AH rate of the registered patients was 7.7 per 1’000, 2.2 for acute and 5.5 for chronic conditions. The amount of prescriptions of diagnostic procedures by GPs is associated with a 7% (IRR=0.93;95% C.I.:0.89-0.97) reduction of the chronic AH rate. Patients registered with GPs adhering to a team resulted in a decrease in hospitalisation rates of 5% (IRR= 0.95;95% C.I.:0.91-0.99) for avoidable acute conditions. Conclusion: The study showed that the role of GPs in preventing AH for acute conditions may be substantial, particularly when team practice is performed and specifically when additional diagnostics are prescribed. The study provides further evidence in favour of the validity of AH as an outcome measure of quality and accessibility of primary care.