The impact of diabetes on multiple avoidable admissions: a cross-sectional study

Joana Seringa,Ana Patrícia Marques,Cátia Gaspar,Rui Santana,Bruno Moita,João Filipe Raposo

doi:10.1186/s12913-019-4840-4

Abstract

BackgroundMultiple admissions for ambulatory care sensitive conditions (ACSC) are responsible for an important proportion of health care expenditures. Diabetes is one of the conditions consensually classified as an ACSC being considered a major public health concern. The aim of this study was to analyse the impact of diabetes on the occurrence of multiple admissions for ACSC.MethodsWe analysed inpatient data of all public Portuguese NHS hospitals from 2013 to 2015 on multiple admissions for ACSC among adults aged 18 or older. Multiple ACSC users were identified if they had two or more admissions for any ACSC during the period of analysis. Two logistic regression models were computed. A baseline model where a logistic regression was performed to assess the association between multiple admissions and the presence of diabetes, adjusting for age and sex. A full model to test if diabetes had no constant association with multiple admissions by any ACSC across age groups.ResultsAmong 301,334 ACSC admissions, 144,209 (47.9%) were classified as multiple admissions and from those, 59,436 had diabetes diagnosis, which corresponded to 23,692 patients. Patients with diabetes were 1.49 times (p < 0,001) more likely to be admitted multiple times for any ACSC than patients without diabetes. Younger adults with diabetes (18–39 years old) were more likely to become multiple users.ConclusionDiabetes increases the risk of multiple admissions for ACSC, especially in younger adults. Diabetes presence is associated with a higher resource utilization, which highlights the need for the implementation of adequate management of chronic diseases policies.

Highlights

Multiple admissions for ambulatory care sensitive conditions (ACSC) are responsible for an important proportion of health care expenditures
A level of significance < 0.05, for a 95% confidence interval, was defined. In this 3 year period, ACSC represented 15.3% of all admissions occurred at all public Portuguese National Health Service (NHS) hospitals, corresponding to a financial burden of 710.023.509 €
48% of these admissions were considered multiple admissions for ACSC and, of those, 41% had a diabetes diagnosis, which corresponded to 59,436 admissions and 23,692 patients

Summary

Introduction

Multiple admissions for ambulatory care sensitive conditions (ACSC) are responsible for an important proportion of health care expenditures. Admissions for ACSC are associated with worse quality of ambulatory care and represent a significant burden on health care systems and a negative experience to patients [6,7,8]. Within this concept, the subgroup of multiple admissions for ACSC has been gaining a growing importance. The occurrence of ACSC admissions is worrying and may highlight the need for specific interventions in order to correct the underlying processes of care, but the recurrence over time of this admissions may indicate systemic problems addressing patients’ health needs

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