Abstract
Ambulatory Care Sensitive Conditions (ACSC) are disease groups or medical conditions
that, if patients are effectively taken care of in the ambulatory setting, hospital admissions can
be avoided or preventable. This study aimed to assess performances of primary-care provision
in the Bangkok area using 13 ACSCs set by Agency for Health Research and Quality (AHRQ),
USA. The analyses were conducted by using inpatient-service reimbursement databases from
2007 to 2014 of the Universal Coverage Scheme (UC), the Civil Servants Medical Benefit
Scheme (CSMBS) and the Social Security Scheme (SSS).
The study findings indicated that it was very likely to use ACSC statistics to assess
primary-care performances in the Bangkok area. Based on the year 2011 data which was the
most complete for all population groups, the Top 3 ACSCs were urinary tract infection,
congestive heart failure and adult asthma, respectively. The other close-call groups included
hypertension and angina without procedure. Surprisingly, the hospital admissions caused by
short-term and long-term complications of diabetes mellitus were not as high as expected.
ACSCs’ Inpatient services in the Bangkok area, particularly for the UC population, were
mainly for patients from Bangkok itself rather than those from vicinity provinces or other
provinces. It was worth noted that the amount and proportion of the hospital admissions in most
of the ACSCs were highest among patients registered with private providers (e.g. private
hospitals), followed by those registered under Bangkok Metropolitan’s provider network. It was
also found that the CSMBS patients tended to be in older than UC and SSS patients in almost all
ACSCs. They were also more likely to get admitted with Hypertension and COPD, compared to
the latter two groups.
Nevertheless, ACSC might not be applicable without restriction. There were problems
with the databases as they were from different responsible agencies with differing working
processes and data-processing capabilities. Quality of the databases varied somewhat.
Moreover, data analyses were affected by the fact that the three health schemes were designed
differently in terms of beneficiary registration.
In sum, primary-care services in the Bangkok area needed improvement. The most
significant ACSC target would be around heart and vascular diseases, along with the development of ACSC measures and quality of the databases such that they could be applied
in monitoring access to and quality of primary care.
