Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 May 9:11:1147732.
doi: 10.3389/fpubh.2023.1147732. eCollection 2023.

Social determinants of ambulatory care sensitive conditions: a qualitative meta-synthesis based on patient perspectives

Hsueh-Fen Chen  1   2   3 , Hung-Ru Lin  4
Affiliations

Social determinants of ambulatory care sensitive conditions: a qualitative meta-synthesis based on patient perspectives

Hsueh-Fen Chen et al. Front Public Health. .

Abstract

Background: Hospitalizations or emergency department (ED) visits due to ambulatory care-sensitive conditions (ACSC) are preventable but cost billions in modern countries. The objective of the study is to use a meta-synthesis approach based on patients' narratives from qualitative studies to reveal why individuals are at risk of ACSC hospitalizations or ED visits.

Methods: PubMed, Embase, Cochrane Library, and Web of Science databases were utilized to identify qualified qualitative studies. The Preferred Reporting Items for Systematic Review and Meta-Analysis were used for reporting the review. The thematic synthesis was used to analyze the data.

Results: Among 324 qualified studies, nine qualitative studies comprising 167 unique individual patients were selected based on the inclusion/exclusion criteria. Through the meta-synthesis, we identified the core theme, four major themes, and the corresponding subthemes. Poor disease management, the core theme, turns individuals at risk of ACSC hospitalizations or ED visits. The four major themes contribute to poor disease management, including difficulties in approaching health services, non-compliance with medications, difficulties in managing the disease at home, and poor relationships with providers. Each major theme comprised 2-4 subthemes. The most cited subthemes are relative to upstream social determinants, such as financial constraints, inaccessible health care, low health literacy, psychosocial or cognitive constraints.

Conclusion: Without addressing upstream social determinants, socially vulnerable patients are unlikely to manage their disease well at home even though they know how to do it and are willing to do it.

Trial registration: National Library of Medicine, with ClinicalTrials.gov, Identifier: NCT05456906. https://clinicaltrials.gov/ct2/show/NCT05456906.

Keywords: ambulatory care-sensitive conditions; disease management; meta-synthesis; patient perspectives; qualitative studies; social determinants.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of the meta-synthesis steps.
Figure 2
Figure 2
Core theme and major themes.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Agency for Healthcare Research and Quality . Prevention quality indicators technical specifications updates-Version V2020 (ICD 10-CM/PCS) (2020). Available online at: https://qualityindicators.ahrq.gov/archive/pqi_techspec/icd10_v2020 (accessed May 11, 2018).
    1. Bindman AB, Grumbach K, Osmond D, Komaromy M, Vranizan K, Lurie N, et al. . Preventable hospitalizations and access to health care. JAMA. (1995) 274:305–11. 10.1001/jama.1995.03530040033037 - DOI - PubMed
    1. Tian Y, Dixon A, Gao H. Data briefing-emergency hospital admissions for ambulatory care-sensitive conditions: identifying the potential for reductions. King's Fund (2012). Available online at: http://www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/... (accessed August 10, 2022).
    1. Lesser A, Israni J, Lo AX, Ko KJ. Older adult visits to the emergency department for ambulatory care sensitive conditions. J Am Coll Emerg Physicians Open. (2020) 1:824–28. 10.1002/emp2.12164 - DOI - PMC - PubMed
    1. McDermott KW, Jiang HJ. Characteristics Costs of Potentially Preventable Inpatient Stays, 2017: Statistical Brief #259. (2020). Available online at: https://www.hcup-us.ahrq.gov/reports/statbriefs/sb259-Potentially-Preven... (accessed July 25, 2022).

Publication types

Associated data