Josée G Lavoie1,2, Wanda Philips-Beck3,4,5, Kathi Avery Kinew3,5, Grace Kyoon-Achan4,5, Stephanie Sinclair5, Alan Katz3,6,7. 1. Department of Community Health Science, University of Manitoba, 715-727 McDermot Avenue, Winnipeg, MB, R3E 3P5, Canada. josee.lavoie@umanitoba.ca. 2. Ongomiizwin Research, University of Manitoba, Winnipeg, Canada. josee.lavoie@umanitoba.ca. 3. Department of Community Health Science, University of Manitoba, 715-727 McDermot Avenue, Winnipeg, MB, R3E 3P5, Canada. 4. Ongomiizwin Research, University of Manitoba, Winnipeg, Canada. 5. First Nations Health and Social Secretariat of Manitoba, Winnipeg, Canada. 6. Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Canada. 7. Department of Family Medicine, University of Manitoba, Winnipeg, Canada.
Abstract
OBJECTIVES: The objective of this study was to assess the performance of models of primary healthcare (PHC) delivered in First Nation and adjacent communities in Manitoba, using hospitalization rates for ambulatory care sensitive conditions (ACSC) as the primary outcome. METHODS: We used generalized estimating equation logistic regression on administrative claims data for 63 First Nations communities from Manitoba (1986-2016) comprising 140,111 people, housed at the Manitoba Centre for Health Policy. We controlled for age, sex, and socio-economic status to describe the relationship between hospitalization rates for ACSC and models of PHC in First Nation communities. RESULTS: Hospitalization rates for acute, chronic, vaccine-preventable, and mental health-related ACSCs have decreased over time in First Nation communities, yet remain significantly higher in First Nations and remote non-First Nations communities as compared with other Manitobans. When comparing different models of care, hospitalization rates were historically higher in communities served by health centres/offices, whether or not supplemented by itinerant medical services. These rates have significantly declined over the past two decades. CONCLUSION: Local access to a broader complement of PHC services is associated with lower rates of avoidable hospitalization in First Nation communities. The lack of these services in many First Nation communities demonstrates the failure of the current Canadian healthcare system to meet the need of First Nation peoples. Improving access to PHC in all 63 First Nation communities can be expected to result in a reduction in ACSC hospitalization rates and reduce healthcare cost.
OBJECTIVES: The objective of this study was to assess the performance of models of primary healthcare (PHC) delivered in First Nation and adjacent communities in Manitoba, using hospitalization rates for ambulatory care sensitive conditions (ACSC) as the primary outcome. METHODS: We used generalized estimating equation logistic regression on administrative claims data for 63 First Nations communities from Manitoba (1986-2016) comprising 140,111 people, housed at the Manitoba Centre for Health Policy. We controlled for age, sex, and socio-economic status to describe the relationship between hospitalization rates for ACSC and models of PHC in First Nation communities. RESULTS: Hospitalization rates for acute, chronic, vaccine-preventable, and mental health-related ACSCs have decreased over time in First Nation communities, yet remain significantly higher in First Nations and remote non-First Nations communities as compared with other Manitobans. When comparing different models of care, hospitalization rates were historically higher in communities served by health centres/offices, whether or not supplemented by itinerant medical services. These rates have significantly declined over the past two decades. CONCLUSION: Local access to a broader complement of PHC services is associated with lower rates of avoidable hospitalization in First Nation communities. The lack of these services in many First Nation communities demonstrates the failure of the current Canadian healthcare system to meet the need of First Nation peoples. Improving access to PHC in all 63 First Nation communities can be expected to result in a reduction in ACSC hospitalization rates and reduce healthcare cost.
Authors: Maria B Ospina; Don Voaklander; Ambikaipakan Senthilselvan; Michael K Stickland; Malcolm King; Andrew W Harris; Brian H Rowe Journal: PLoS One Date: 2015-04-13 Impact factor: 3.240