The COVID – 19 pandemic influence on hospitalizations for ambulatory care-sensitive condition

Abstract Aim To explore whether the COVID-19 pandemic influenced hospitalizations for ambulatory care-sensitive conditions (ACSCs) during the COVID-19 pandemic in Split-Dalmatia County, Croatia. Methods We employed a cross-sectional comparative study using two different time periods, the prepandemic (March 2019 to February 2020) and the pandemic (March 2020 to February 2021) to explore possibilities of COVID-19 pandemic influence on hospitalizations for ambulatory care-sensitive conditions (ACSCs) during the COVID-19 pandemic in Split-Dalmatia County. The research used data from the national information system on hospitalizations from the Clinical Hospital Center Split, University Hospital Split. The ACSCs was classified in the categories of vaccine preventable, chronic and acute disease. The indicators were statistically analysed. The z-score test for two population proportions is used. Results During prepandemic (March 2019 to February 2020) there were 48,289 hospitalizations, in the pandemic period (March 2020 to February 2021) there were 37,999 hospitalizations. The ACSCs hospitalizations made 6.4% in the prepandemic and 7.1% in the pandemic period. In the pandemic there was a significantly higher ACSCs hospitalizations compared to the prepandemic (z =-3.9348; p = 0.00008; p < 0), which was supported by a significant increase regarding ACSCs hospitalizations in the category of acute diseases, among women (z=-3.6614; p = 0.00026; p < 0 .05), in age groups 0-19 years (z=-4.0492; p < 0.00001; p < 0.05) and 20-64 years (z= -3.8818; p = 0 .0001; p < 0.05). Conclusions The results of the study show that the COVID-19 pandemic contributed to the total number of hospitalizations as well as the hospitalization of the ACSC. One of the reasons for these changes was certainly the changed organization of the work of the entire health system due to the COVID-19 pandemic. Key messages • The results of the study show that the COVID-19 pandemic contributed to the total number of hospitalizations as well as the hospitalization of the ACSC. • One of the reasons for these changes was certainly the changed organization of the work of the entire health system due to the COVID-19 pandemic.

Epidemic transition, sustained costs and health workforce shortage challenges have led numerous countries to strengthen primary care (PC) and implement new models of care. Faced with declining numbers of general practitioners (GPs), France has introduced medical assistants (MAs) in 2019 to guarantee access to care and maintain workforces in deprived areas. Trained to perform administrative and clinical tasks delegated by a physician, MAs are expected to optimize medical time and improve working conditions in practices. How does French model of MAs impact quality and productivity in GPs' practices and articulate with other policies? We conducted a qualitative case study in 6 pilot practices to explore the effects of MAs' work (interviews with 12 GPs, 6 MAs, collection of tasks performed by 6 MAs), complemented with views from public policy makers and health professional unions (9 interviews). MA was defined as a function centered on physicians' needs, accessible both to administrative staff and nursing professions. MAs with a clinical profile performed a wider range of tasks, were more prone to perform clinical tasks and build developed interactions with patients, and seemed better fitted for chronic disease care management. Recruitment of MAs by physicians is supported with grants that decrease yearly while practice productivity is expected to rise. In general, a gain of efficiency in daily workload enabled GPs to slightly increase their productivity. However, for most GPs, it primarily helped them to maintain high workload without burning out. Although MAs with clinical background seem better suited for patients' needs, recent figures have shown that more than half of MAs employed are former secretaries. If inperson secretaries could be endorsed with further administrative duties, MAs could hold a more clinical role in PC teams including physicians and allied health professionals. Other aspects than productivity must be taken into account in a support policy.

Key messages:
Regardless of productivity objectives to attain, hiring MAs can relieve physicians' workload and stress, preventing them from burning out and guarantee access to care in deprived areas. MA's clinical profile could have a stronger impact on public health issues such as chronic disease care management. was classified in the categories of vaccine preventable, chronic and acute disease. The indicators were statistically analysed. The z-score test for two population proportions is used.

Conclusions:
The results of the study show that the COVID-19 pandemic contributed to the total number of hospitalizations as well as the hospitalization of the ACSC. One of the reasons for these changes was certainly the changed organization of the work of the entire health system due to the COVID-19 pandemic.

Key messages:
The results of the study show that the COVID-19 pandemic contributed to the total number of hospitalizations as well as the hospitalization of the ACSC. One of the reasons for these changes was certainly the changed organization of the work of the entire health system due to the COVID-19 pandemic.
Background: Efficiency has been identified as a key intermediate policy objective for Universal Health Coverage. Despite that, it was estimated that 20 to 40% of health sector resource utilization is wasteful globally. An efficient use of existing resources in healthcare is critical and a priority policy in sustaining positive health outcomes for the population. This study aimed to perform a longitudinal efficiency analysis was found concerning health systems specific to all the Latin America region over the last 13 years.

Background:
Diabetologists, as other specialists, are more likely concentrated in towns and cities rather than in the countryside so the people who live in these municipalities have a wider supply of health services. Our aim is to determine whether there are significant differences in the use of diabetology services between patients who live in the municipality with these services or not in Czechia.

Methods:
The sorted anonymized data obtained from the General Health Insurance Company of the Czech Republic (GHIC CR) were used. The studied patients were people with a diagnosis of type 2 diabetes mellitus (E11) who were insured by GHIC CR and used health services in 2019 in Czechia.

Results:
The distribution of providers of diabetology services (PDS) is relatively even throughout the country, and PDS are mainly concentrated in the municipality with a large population. In total, 52% of patients have the diabetologist in their municipality of residence. Patients living in the municipality with PDS have greater odds of using their services (OR 1.63, Cl 1.61-1.65). Specifically, 67% of the patients who have the diabetologist in their municipality of residence use diabetology services compared to 55% of the patients living in the municipality without PDS commute for diabetology services to the other municipality.

Conclusions:
The results show that diabetology services are concentrated mainly in towns and cities and patients living in the municipality with the diabetologist use more diabetology services compared to patients living in the municipality without them. At the same time, it seems that more than half of the patients in the municipality where is not PDS are willing and able to commute for diabetology services.

Key messages:
Although patients living in the municipality without the diabetologist use diabetology services less often than with them, due to the commuting for healthcare, the differences are blurred.