Visiting the primary care doctor regularly appeared to reduce the rate of all-cause use of critical care, according to research presented that the American Thoracic Society International Conference in Dallas.
“Some types of critical illness may be preventable. It is unclear whether policy or organizational efforts to promote use of primary care might reduce critical illness rates,” Andrew Admon, MD, pulmonologist at the University of Michigan, and colleagues wrote in the abstract. “We tested relationships between regional rates of primary care use and rates of ICU admission and mechanical ventilation.”
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Doctor's office. Source: Getty
The study included 2,441,999 Medicare beneficiaries admitted between January 2014 and September 2015 across 306 hospital referral regions (HRRs). Researchers defined preventable admissions as those for ambulatory care sensitive conditions (ACSC), where hospitalization could be avoided with timely ambulatory care. Mechanical ventilation (MV) was defined a preventable when used for a ACSC.
All-cause yearly ICU admission rates ranged widely between HRRs (26.8 per 1000 beneficiaries to 66.3 per 1000). Rates also ranged for ACSC ICU admission (2.3 to 7.8), all cause MV (7.5 to 17.9), ACSC MV (1.9 to 5.3), and primary care utilization 69.1% to 81.4%).
After adjustment, a 10% absolute increase in primary care utilization was associated with a 12.7 per 1000 decline (95% CI, -20.0 to -5.4) in the rate of all cause ICU admissions. Results also showed a decrease in ACSC ICU admissions (-1.5 per 1000; 95% CI, -2.7 to -0.4), all-cause MV (-3.4 per 1000; 95% CI, -4.9 to -1.9), and ACSC MV (-0.8 per 1000; 95% CI, -1.2 to -0.3) with increased primary care visits.
“Higher rates of primary care were associated with lower rates of all-cause and potentially preventable ICU and MV rates within a region,” the researchers concluded. “These results support the hypothesis that efforts to improve access to and use of ambulatory care could reduce rates of critical illness. Future work using individual-level data and natural experiments that have altered availability of primary care services should test this hypothesis.”
