Avoidable hospitalization of children from ambulatory care sensitive conditions in Barbados: a measure of the access and uptake of primary health care

Background and Objective : Hospitalization from avoidable causes refers to hospitalizations for an Ambulatory Care Sensitive (ACS) condition and is considered to be a measure of access to appropriate primary health care. While not all admissions for these conditions are avoidable, timely ambulatory care could temper the disease course and thus prevent progression to where hospitalization is medically indicated. A disproportionately high rate of ACS conditions may reflect problems in access to timely primary care. In this study we determine the proportion of all medical admissions in children that were from ACS Conditions (ASSC's) and therefore avoidable. We also study the trend in the proportion of avoidable hospitalizations. Method: This study is a population based prospective clinical audit of children (Age <16 years) admitted to the Queen Elizabeth Hospital (QEH). The study period extends from the year 2013 through 2017. The pediatric-specific ACS conditions employed in this analysis were based on prior studies. All the children between the ages of 3 month and 15 years where one of the discharge diagnosis was an ACS condition were included in this study. Result: During the five years study period there were a total of 19349 children (<16 years) hospitalized for medical conditions to the QEH. Over the same period, there were a total of 4235 hospitalizations from ACSC’s which accounted for 21.89% of all medical hospitalizations in children. Among the ACSC’s as the cause of hospitalization, acute asthma (6.88%) and acute asthma complicated by respiratory tract infections (2.24%) was the commonest cause for avoidable hospitalizations in children. This was followed by admissions from acute gastroenteritis and dehydration (2.89%). Children less than 4 years in age accounted for 51% of all avoidable medical hospitalizations in children. Conclusion : Over a fifth of all the medical hospitalizations in children are from the ACSC’s and are therefore avoidable.