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. 2019 Jan 18;19(1):50.
doi: 10.1186/s12913-018-3850-y.

Underutilized and undertheorized: the use of hospitalization for ambulatory care sensitive conditions for assessing the extent to which primary healthcare services are meeting needs in British Columbia First Nation communities

Josée G Lavoie  1   2 , Sabrina T Wong  3 , Naser Ibrahim  4 , John D O'Neil  5 , Michael Green  6 , Amanda Ward  7
Affiliations

Underutilized and undertheorized: the use of hospitalization for ambulatory care sensitive conditions for assessing the extent to which primary healthcare services are meeting needs in British Columbia First Nation communities

Josée G Lavoie et al. BMC Health Serv Res. .

Abstract

Background: Since the 1960s, the federal government has been providing or funding a selection of community-based primary healthcare (PHC) programs on First Nations reserves. A key question is whether local access to PHC can help address health inequities in First Nations on-reserve communities in British Columbia (BC).

Objectives: This paper examines whether hospitalization for Ambulatory Care Sensitive Conditions (1) can be used as a proxy measure for the organization of PHC in First Nations reserve areas; and (2) is associated with premature mortality rates.

Methods: In this descriptive correlational study, we used administrative data available through Population Data BC, including demographic and ecological information (i.e. geo-codes indicating location of residence). We used two different measures of hospitalization: rates of episodic hospital care and rates of length of stay. We correlated hospitalization rates with premature mortality rates and the level of care available in First Nations communities, which depends on a federal funding formula based upon community size and, more specifically, the level of isolation from a provincial point of care.

Results: First Nations communities in BC that have local 24/7 access to PHC services have similar rates of hospitalization for ACSC to those living in urban centres. This is demonstrated by the similarities in the strengths of the correlation between premature mortality rates and rates of avoidable hospitalization for conditions treatable in a PHC setting. This is not the case for communities served by a Health Centre (weaker correlation) and for communities serviced by a Health Station or with no on-reserve point of care (no correlation).

Conclusions: Improving access to PHC services in First Nations communities can be associated with a significant reduction in avoidable hospitalization and premature mortality rates. The method we tested is an important tool that could serve health care planning decisions in small communities.

Keywords: Avoidable hospitalization; Indigenous populations; Primary care; Rural and remote care.

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Conflict of interest statement

Ethics approval and consent to participate

Ethical approval was obtained from the University of British Columbia’s Behavioural Research Ethics Board (H11–01070) and the University of Manitoba’s Bannatyne Campus Research Ethics Board (HS18505[H2012:064). Access to the British Columbia health administrative data was secured through Pop Data BC (Lavoie 12–005).

Consent for publication

N/A

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Determinants of Rates of Hospitalization for ACSC and Associated Premature Mortality Rates
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