Increased Access to Primary Care May Reduce Respiratory Failure Rates

Increased access to primary care may reduce rates of respiratory failure among patients with asthma and chronic obstructive pulmonary disease (COPD), according to a new study presented at the American Thoracic Society’s 2019 International Conference.

Findings were presented by lead researcher Andrew J. Admon, MD, MPH, from the division of pulmonary and critical care medicine at the University of Michigan, on Tuesday, May 21.

Dr Admon and colleagues came to this conclusion after assessing 2,441,999 Medicare beneficiaries admitted to hospitals in 306 Hospital Referral Regions (HRRs) between January 2014 and September 2015.

To conduct the analysis, ICD-9-CM codes were used to identify cases of potentially preventable ambulatory care sensitive conditions (ACSC), including asthma, COPD, and congestive heart failure, as well as those requiring mechanical ventilation.

Linear regression was used to estimate the relationships between primary care use and per capita rates of all-cause-related intensive care unit admissions, mechanical ventilation rates, and ACSC-related intensive care unit admissions.

Overall, HRRs varied widely in all-cause annual intensive care unit admission rates, ACSC intensive care unit admissions, all-cause mechanical ventilation, and ACSC mechanical ventilation.

“Primary care utilization varied from 69.1% in the bottom decile of HRRs to 81.4% in the top decile,” the researchers wrote.

After adjusting for regional demographics, comorbidity burden, provider availability, and year, the researchers found that a 10% absolute increase in primary care utilization was associated with a 12.7 per 1000 decline in the rate of all-cause intensive care unit admissions, a 1.5 per 1000 decline in ACSC intensive care unit admissions, a 3.4 per 1000 decline in all-cause mechanical ventilation, and a 0.8 per 1000 decline in ACSC mechanical ventilation.

“These results support the hypothesis that efforts to improve access to and use of ambulatory care could reduce rates of critical illness. Future work using individual-level data and natural experiments that have altered availability of primary care services should test this hypothesis,” the researchers concluded.

—Amanda Balbi

Reference:

Admon AJ, Prescott HC, Valley TS, Iwashyna TJ, Cooke CR. Regional rates of primary care visits, ICU admission, and mechanical ventilation. Paper presented at: ATS International Conference; May 17-22, 2019; Dallas, TX. https://www.abstractsonline.com/pp8/#!/5789/presentation/18206.