Avoidable Hospitalizations as an Indicator of Ambulatory Healthcare in Lithuania in 2012: What Can Be Done?

Sandra Mekšriūnaitė, Romualdas Gurevičius

Abstract


Background. Avoidable hospitalizations (AH) are hospitalizations that could be avoided through accessible and effective ambulatory care setting which provides preventive care, early diagnostics and disease management. The scale of AH in Lithuania up to this date has been scarcely researched, but it is a topical issue as it is in all other countries with health systems that provide universal coverage. Purposeful strategies in policy and management that increases the effectiveness of ambulatory care setting could reduce the number of AH and save budget as stationary care is known to be very expensive. The aim of this study is to evaluate patterns of AH in Lithuania in 2012 and to recommend strategies for reducing the number of AH.
Materials and methods. The research was based on Australian methodology, which is used to monitor the quality of ambulatory care. The study population was all residents of Lithuania that were hospitalized due to ambulatory care sensitive conditions (ACSC) in 2012. ACSC were selected by ICD-10-AM code and ACHI procedure codes. Data on hospitalizations was gathered from National Health Insurance Fund Information System (“Sveidra”) and Statistics of Lithuania.
Results. Over 110 thousands of acute care hospitalizations in Lithuania in 2012 can be considered as avoidable. It accounted for 16,2 percent of overall acute care hospitalizations. The majority of AH were due to diabetes and its complications, angina, congestive heart failure, influenza and pneumonia. AH rates differed by gender, age and residence place (urban/rural). The majority of patients were at pre-school and retirement age. AH rate for males and rural residents was higher than for females and urban residents. The majority of patients were hospitalized with committal. Rates of AH in municipalities ranged from 27.0 to 57.7 cases per 1000 population. Differences among municipalities can be considered as consequences of systematic causes in municipalities.
Conclusions. AH is a significant problem in Lithuania. Reducing the number of AH provides an opportunity to reduce the expenditure of National Health Insurance Fund. Not all opportunities are being used in ambulatory care to avoid the hospitalization. Further research on AH is recommended to elucidate essential reasons and to plan the strategies to increase the effectiveness of ambulatory care setting.

Keywords


ambulatory care sensitive conditions; avoidable hospitalizations; potentially preventable hospitalizations; diabetes mellitus; in-patient care; out-patient care

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DOI: http://dx.doi.org/10.13165/SPV-15-1-8-03

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"Health Policy and Management" ISSN online 2029-9001 / ISSN print 2029-3569