Health services use for ambulatory care sensitive conditions in the developing country of Barbados
Objective: This research examined hospitalization for ambulatory care sensitive conditions (ACSH) for the population of Barbados during 2003-2008. I examined differences in ACSH rates for females and males at the parish and population levels over the six year period. This study compared hospitalization rates across years and geographic locations for the six most prevalent ambulatory care sensitive conditions in the adult population, ages 20 and over, and for five individual ambulatory care sensitive conditions in the population ages 19 years and younger. I also compared ACSH rates in Barbados to published rates for other developed and developing countries. Methods: ACSHs were identified using data from the Queen Elizabeth Hospital in Barbados for 2003-2008. For the adult population, ages 20 and over, International Classification of Diseases, Tenth Revision Australian Modification (ICD-10-AM) codes and categories were used to identify ACSH rates based on the codes used to define potentially avoidable hospitalizations by the Victorian Government Department of Human Services (VGDHS, 2004), codes that are used by the government of Australia that have been validated through extensive research and publication. The United States Agency for Healthcare Research and Quality (AHRQ) area level pediatric quality indicators (PDIs) were used to identify ACSHs for the population ages 19 years and younger, using an ICD-10 cross-walk developed for this research. Cross-sectional and time series analyses of ACSH rates were performed for the period 2003-2008. Poisson analysis estimated relative rates and provided 95% confidence intervals and p-values, enabling comparisons of differences in hospitalization rates between women and men, among years of the study, and across parishes. Results: For the adult population, the gender analysis showed that women age 50+ had the highest percent of hospitalizations that were ACSH, nearly half of all hospitalizations (47.4%). Across years studied, the highest ACSH population-based rates were observed for men age 50+ (31.36 per 1000). Considerable variation in ACSH rates was observed among parishes for both men and women for all age groups. The analysis by gender found that, compared with men, women ages 20-49 had higher rates of hospitalization across the study period 2003-2008 and for each year. For women and men ages 50+, ACSH rates were higher for men than for women. For men and women ages 20-49 years, those who lived in St. Michael had the highest rates of ACSH of the eleven parishes. Among adults ages 20-49 and 50+, the top six ambulatory care sensitive conditions were influenza and pneumonia, congestive heart failure, diabetes, angina, dehydration, and hypertension. Among all ACSHs, the rate of hospitalization for influenza and pneumonia was highest for both women and men ages 20-49 and 50+. In the age 19 and younger population, ACSH rates differed considerably for girls and boys, and were generally higher for boys than girls across parishes and across the years 2003-2008. The most prevalent ACSH in the 19 and younger group was asthma. Trends for ACSH rates in Barbados were consistent with countries such as Taiwan and Australia, with considerable variability across the study years; however, there was notable evidence that ACSH rates may have increased considerably in the latter study years. Discussion: There were significant differences in ACSH rates across the parishes in Barbados for females and males. The substantial variation in ACSH rates among parishes suggests evidence of potential problems in access to primary care, particularly for residents of St. Michael, and the adult populations in St. Thomas, St. Andrew, and St. James. This study provides relevant base line information about ACSH rates and suggests the need for future research in this area. It is possible that the higher ACSH rates in these parishes are attributable to area factors other than primary care, factors such as disease prevalence or differences in education; further research should investigate this possibility.