Preventable hospitalization and the role of primary care: a comparison between Italy and Germany

Aim The aim of the study is to compare the hospital admissions for ambulatory care sensitive conditions (ACSCs) in Italy and Germany and to discuss possible relationships to the different models of primary-care supply. Subjects and methods Information on hospital discharges from 2001 to 2008 in Italy and from 2000 to 2008 in Germany was used. A descriptive analysis of hospitalization rates (HR) for ACSCs and a correlation analysis with contextual factors-availability of general practitioners (GPs), number of hospital beds and gross domestic product (GDP) per person-were provided. The HR for ACSCs was analyzed using a Poisson regression model. Potential effects of contextual risk factors were also analyzed using a multilevel mixed effects Poisson regression model. Results In Italy avoidable admissions accounted for 8 % of total admissions, in Germany 11 %. In Italy, HR for avoidable acute conditions were stable in the study period, while that for chronic conditions decreased by 23 %. In Germany, the HR for ACSCs increased, both for acute and dramatically for chronic conditions. We found a clear pattern of higher HR for chronic ACSCs in southern regions in Italy and in eastern states in Germany. Conclusions Geographic distribution of HRs for chronic ACSCs was related to GDP per person both in Italy and in Germany. In Italy, policies aimed at reducing the recourse to hospitalization seem to be successful. GPs, who are gatekeepers in Italy, may have played a role in shifting health assistance from in-patient care to out-patient care. Findings for Germany suggest a suboptimal use of hospital facilities and perhaps an underuse of either primary care and/or ambulatory specialist care.