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The relationship between rates of hospitalization for ambulatory care sensitive conditions and local access to primary healthcare in Manitoba First Nations communities

Results from the Innovation in Community-based Primary Healthcare Supporting Transformation in the Health of First Nations in Manitoba (iPHIT) study

Canadian Journal of Public Health volume 112, pages 219–230 (2021)Cite this article

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.

Résumé

Objectifs

L’objectif de cette étude était d’évaluer le rendement des modèles de soins de santé primaires (SSP) dispensés dans les Premières Nations et les communautés adjacentes du Manitoba, en utilisant les taux d’hospitalisation pour les conditions propices aux soins ambulatoires (CPSA) comme résultat principal.

Méthodes

Nous avons utilisé une régression logistique par équation d’estimation généralisée sur les données de réclamations administratives pour 63 communautés des Premières Nations du Manitoba (1986-2016) comprenant 140 111 personnes, hébergées au Manitoba Centre for Health Policy. Nous avons contrôlé l’âge, le sexe et le statut socioéconomique afin de décrire la relation entre les taux d’hospitalisation pour les CPSA et les modèles de soins de santé primaires dans les communautés des Premières Nations.

Résultats

Les taux d’hospitalisation pour les CPSA aigus, chroniques, évitables par la vaccination et liés à la santé mentale ont diminué au fil du temps dans les communautés des Premières Nations, mais demeurent considérablement plus élevés dans les communautés des Premières Nations et éloignées non des Premières Nations par rapport aux autres Manitobains. Lorsque l’on compare différents modèles de soins, les taux d’hospitalisation étaient historiquement plus élevés dans les communautés desservies par les centres/bureaux de santé, qu’ils soient ou non complétés par des services médicaux itinérants. Ces taux ont considérablement diminué au cours des deux dernières décennies.

Conclusion

L’accès local à un éventail plus large de services de SSP est associé à des taux plus faibles d’hospitalisation évitable dans les collectivités des Premières Nations. Le manque de ces services dans de nombreuses collectivités des Premières nations démontre l’incapacité du système de santé canadien actuel à répondre aux besoins des peuples des Premières nations. On peut s’attendre à ce que l’amélioration de l’accès aux soins de santé primaires dans les 63 collectivités des Premières nations se traduise par une réduction des taux d’hospitalisation et des coûts des soins de santé.

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Author information

Affiliations

  1. Department of Community Health Science, University of Manitoba, 715-727 McDermot Avenue, Winnipeg, MB, R3E 3P5, Canada

    Josée G. Lavoie, Wanda Philips-Beck, Kathi Avery Kinew & Alan Katz

  2. Ongomiizwin Research, University of Manitoba, Winnipeg, Canada

    Josée G. Lavoie, Wanda Philips-Beck & Grace Kyoon-Achan

  3. First Nations Health and Social Secretariat of Manitoba, Winnipeg, Canada

    Wanda Philips-Beck, Kathi Avery Kinew, Grace Kyoon-Achan & Stephanie Sinclair

  4. Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Canada

    Alan Katz

  5. Department of Family Medicine, University of Manitoba, Winnipeg, Canada

    Alan Katz

Authors
  1. Josée G. Lavoie
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  2. Wanda Philips-Beck
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  3. Kathi Avery Kinew
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  4. Grace Kyoon-Achan
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  5. Stephanie Sinclair
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  6. Alan Katz
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Corresponding author

Correspondence to Josée G. Lavoie.

Ethics declarations

The study received ethics approval from the University of Manitoba Health Research Ethics Board and data access approval from the Government of Manitoba Health Information Privacy Committee and the Health Information Research Governance Committee of First Nations Health Social Secretariat of Manitoba.

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The authors declare that they have no conflict of interest.

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Appendix

Appendix

Table 6 ICD codes used to define ambulatory care sensitive conditions
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Lavoie, J.G., Philips-Beck, W., Kinew, K.A. et al. The relationship between rates of hospitalization for ambulatory care sensitive conditions and local access to primary healthcare in Manitoba First Nations communities. Can J Public Health 112, 219–230 (2021). https://doi.org/10.17269/s41997-020-00421-3

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  • DOI: https://doi.org/10.17269/s41997-020-00421-3

Keywords

  • Indigenous health
  • Primary care
  • Avoidable hospitalization
  • Nursing stations
  • Rural and remote communities

Mots-clés

  • Santé autochtone
  • santé primaire
  • hospitalisation évitable
  • postes de soins infirmiers
  • collectivités rurales et éloignées