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
| العنوان: | 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 |
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| المؤلفون: | Martti Arffman, Ilmo Keskimäki, Sonja Lumme, Markku Satokangas |
| المساهمون: | Yhteiskuntatieteiden tiedekunta - Faculty of Social Sciences, Tampere University, Department of General Practice and Primary Health Care, Clinicum, Helsinki Inequality Initiative (INEQ) |
| المصدر: | BMC Health Services Research BMC Health Services Research, Vol 19, Iss 1, Pp 1-12 (2019) |
| بيانات النشر: | Springer Science and Business Media LLC, 2019. |
| سنة النشر: | 2019 |
| مصطلحات موضوعية: | sairaalahoito, Health informatics, Health Services Accessibility, Health administration, 0302 clinical medicine, ADMISSIONS, INFECTION, Epidemiology, PROGRAM, EPIDEMIOLOGY, Terveystiede - Health care science, Cluster Analysis, 030212 general & internal medicine, POPULATION, Finland, education.field_of_study, Health Equity, lcsh:Public aspects of medicine, 030503 health policy & services, Health Policy, Nursing research, laatu, AVOIDABLE HOSPITALIZATION, Development of health equity, Primary care, oikeudenmukaisuus, 3. Good health, 0305 other medical science, Research Article, medicine.medical_specialty, Population, DIAGNOSIS, 4 MUNICIPALITIES, 03 medical and health sciences, Tilastotiede - Statistics and probability, Inpatient hospitalisation, Ambulatory care, Environmental health, medicine, Humans, Group-based trajectory modelling, education, Quality Indicators, Health Care, Retrospective Studies, perusterveydenhuolto, Primary Health Care, business.industry, Public health, Ambulatory care sensitive conditions, lcsh:RA1-1270, COMMUNITY-ACQUIRED PNEUMONIA, vältettävissä olevat hoitojaksot, 3141 Health care science, RISK-FACTORS, Rural area, business |
| الوصف: | Background 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). Methods 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. Results 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. Conclusions 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. Electronic supplementary material The online version of this article (10.1186/s12913-019-4449-7) contains supplementary material, which is available to authorized users. |
| وصف الملف: | fulltext |
| تدمد: | 1472-6963 |
| الوصول الحر: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::871395cd0def1c498c3cb70205cb1335Test https://doi.org/10.1186/s12913-019-4449-7Test |
| حقوق: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....871395cd0def1c498c3cb70205cb1335 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 14726963 |
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