PT  - JOURNAL ARTICLE
AU  - Tobias Freund
AU  - Stephen M. Campbell
AU  - Stefan Geissler
AU  - Cornelia U. Kunz
AU  - Cornelia Mahler
AU  - Frank Peters-Klimm
AU  - Joachim Szecsenyi
TI  - Strategies for Reducing Potentially Avoidable Hospitalizations for Ambulatory Care–Sensitive Conditions
AID  - 10.1370/afm.1498
DP  - 2013 Jul 01
TA  - The Annals of Family Medicine
PG  - 363--370
VI  - 11
IP  - 4
4099  - http://www.annfammed.org/content/11/4/363.short
4100  - http://www.annfammed.org/content/11/4/363.full
SO  - Ann Fam Med2013 Jul 01; 11
AB  - PURPOSE Hospitalizations for ambulatory care–sensitive conditions (ACSCs) are seen as potentially avoidable with optimal primary care. Little is known, however, about how primary care physicians rate these hospitalizations and whether and how they could be avoided. This study explores the complex causality of such hospitalizations from the perspective of primary care physicians. METHODS We conducted semistructured interviews with 12 primary care physicians from 10 primary care clinics in Germany regarding 104 hospitalizations of 81 patients with ACSCs at high risk of rehospitalization. RESULTS Participating physicians rated 43 (41%) of the 104 hospitalizations to be potentially avoidable. During the interviews the cause of hospitalization fell into 5 principal categories: system related (eg, unavailability of ambulatory services), physician related (eg, suboptimal monitoring), medical (eg, medication side effects), patient related (eg, delayed help-seeking), and social (eg, lack of social support). Subcategories frequently associated with physicians’ rating of hospitalizations for ACSCs as potentially avoidable were after-hours absence of the treating physician, failure to use ambulatory services, suboptimal monitoring, patients’ fearfulness, cultural background and insufficient language skills of patients, medication errors, medication nonadherence, and overprotective caregivers. Comorbidities and medical emergencies were frequent causes attributed to ACSC-based hospitalizations that were rated as being unavoidable. CONCLUSIONS Primary care physicians rated a significant proportion of hospitalizations for ACSCs to be potentially avoidable. Strategies to avoid these hospitalizations may target after-hours care, optimal use of ambulatory services, intensified monitoring of high-risk patients, and initiatives to improve patients’ willingness and ability to seek timely help, as well as patients’ medication adherence.