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Table 4 Core findings of the effect of primary care resourcing on diabetes-related ambulatory care sensitive hospitalisations

From: A systematic review of evidence on the association between hospitalisation for chronic disease related ambulatory care sensitive conditions and primary health care resourcing

First author, date

Primary health care resource variable

Direction of association with avoidable hospitalisationsa

Supports hypothesisb

Comment

Dusheiko 2011

GPs per population

Not significant

No

Adjusted for facility-level prevalence of diabetes, mental health conditions, heart disease

Griffiths 2010

Patients per GP

Significant inverse

No

No adjustment for clinical health risks

Practice nurses per patient

Significant inverse

No

Adjusted for facility-level unadjusted diabetes prevalence

Lavoie 2010

PHC service availability (service categories: no permanent locally based service, part-time, working hours, 24/7 care)

Significant inverse

Yes

No adjustment for health status. Adjustment for age, gender and location but not reported

Ng 2010

GP contacts in the previous 12 months

Significant inverse

Yes

Adjusted for individual-level health utility, other chronic conditions, prior hospitalisations, lifestyle behaviours

Lin 2010

Diabetes outpatient visits

Significant positive

No

Adjusted for number of comorbidities and age

Bruni 2009

Use of diabetes outreach service

Significant positive

No

No adjustment for health status. Adjusted for age. Outreach service use was a proxy of disease severity.

Patients per GP

Significant positive

Yes

Funding incentives to promote better quality care

Significant inverse

Yes

El-Din 2009

≥6 PHC clinic visits

Significant positive

No

Adjusted for presence of nephropathy and HbA1c

Rizza 2007

Patients per GP

Significant positive

Yes

Adjusted for number of hospitalisations in previous year and length of stay and self-reported health status

Gulliford 2004, 2002

GPs per population

Significant inverse

Yes

No adjustment for health status.

 

Partnership size

Significant inverse

Yes

Adjusted for proportion of patients per health authority with a limiting long-term illness. Partnership size is a proxy for better access to multi-disciplinary care team.

  1. Notes:
  2. aA positive association means the outcome and exposure variables increase or decrease in the same direction, i.e. more practice nurses per patient results in more hospitalisations. An inverse association means the outcome and exposure variables move in the opposite direction, i.e. more practice nurses per patient results in less hospitalisations.
  3. bMore primary health care resources are associated with lower hospitalisation.