Primary Care Doctors and Their Role in Avoidable Hospitalizations

The U.S., as well as neighboring Canada, have been facing a shortage of primary care doctors for some time now. The demand for health services is growing, while there is a limited number of family practice physicians available, with limited hours. In this context, many patients turn to alternatives such as urgent care clinics or the E.R. One of the effects of this situation is that we are now seeing an increase in the rate of admission for avoidable hospital conditions (AHC). In other words, patients with conditions that are treatable at home or in an ambulatory form may well end up being hospitalized.

Studies have shown that, unsurprisingly, the number of family and general practice physicians per population is significantly correlated with adult and pediatric AHC rates.

How do primary care doctors contribute to lower AHC rates?

The general consensus is that primary care doctors provide better first-contact access to health care than other types of health services. Their role is not only to diagnose and to treat but to guide the patients towards other health structures. Taking into account that the family physician may have established trust with his/her returning patients, the primary care doctor acts as a first-stage health counselor. It’s the primary care physician that is the first person who can establish the seriousness of the condition. If patients skip this stage, they may find themselves confused and misguided, not being able to assess their own health status. In some contexts, this will likely lead to unnecessary procedures and even avoidable hospitalization, which may well turn out to be costly, in terms of finances, time and, sometimes, the general state of health.

Other studies have found that, in certain case studies, around 40% of hospitalizations were considered avoidable by the treating physicians.

The causes of avoidable hospitalization

According to Freund et al (2019), there are five main reasons why patients find themselves in the situation of hospitalization that can be avoided:

  • system related causes, such as the unavailability of ambulatory services
  • medical causes such us the misuse of medication, leading to complications
  • patient-related, such as when patients postpone their visit to the doctor until hospitalization becomes unavoidable
  • social causes, such as peer pressure or overprotective members of the family. Sometimes, a concerned mother, wife or husband may insist on a visit to the E.R., even though that is not necessary
  • physician related causes. In this case, they refer to primary care doctors and other physicians who are uncertain about a diagnostics and would rather ”play it safe” or the situations when their medical investigation Is not thorough enough.

Therefore, primary care doctors can be a cause of avoidable hospitalization themselves, but they can also be the filter that blocks the unnecessary escalation of a condition that can be treated at home.

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