Impact of the strengths of Primary Care (Accessibility, Longitudinality and Comprehensiveness) on Mortality and Avoidable hospitalisations. ALIME-AP Study

File: PI24/0136

Project description:

Main objective:

To assess the association between the strength of PC, as defined by its process characteristics, and total mortality, cardiovascular mortality, cancer mortality and hospitalisations for PC-sensitive conditions (PCSC) in two Autonomous Communities.

Specific objectives:

1.-To evaluate the association between the longitudinality of care by the same family doctor in health centres in two Autonomous Communities and total mortality, mortality due to cardiovascular causes, mortality due to cancer and hospitalisations due to ACSC.

2.-To identify which factors related to accessibility in health centres in two Autonomous Communities are associated with total mortality, mortality due to cardiovascular causes, mortality due to cancer and hospitalisations due to ACSC..

3.-To study the association between the comprehensiveness of care in health centres in two Autonomous Communities and total mortality, mortality due to cardiovascular causes, mortality due to cancer and hospitalisations due to ACSC..

4.-To analyse whether the potential association between PC characteristics and total mortality, cardiovascular mortality, cancer mortality and hospitalisations for ACSC is different in different social strata and for outcomes in men and women in two Autonomous Communities.

Design:

Ambispective study on a cohort, the population attended in the health centres of the Communities of Madrid and the Basque Country, in which the exposure variables will be certain dimensions of the provision of PC services and the outcome variables will be total mortality, mortality from cardiovascular causes, mortality from cancer and hospitalisations due to PC-sensitive conditions (PCSC).

Expected impact:

This project aims to find out whether certain characteristics of the service provided by family doctors in primary care, specifically accessibility, longitudinality and comprehensiveness, are associated with better health outcomes such as a decrease in adjusted mortality or avoidable hospitalisations.

Knowing which characteristics of health service provision are related to better health outcomes, especially if the outcomes are represented by variables such as mortality, has direct implications for decision-making in terms of the provision and financing of such services. Some evidence of such relationships has been found in other European countries, but it is important to explore and confirm the existing relationships in our health system, taking the above-mentioned evidence as a reference.

Assessing how these elements interact locally becomes essential to identify potential hotspots in health service delivery. This analysis should guide the planning and financing of services, focusing on crucial points that may impact positively or negatively on health outcome.

It highlights the importance of investing in the organisation and strengthening of primary care, backed by the available evidence on improvements that can have the greatest impact on health maintenance. If associations such as those that give rise to the research idea are found, it would mean having to reorient care processes by providing better infrastructure and funding to the level of care that serves as access to the public care structure, which is closer to the citizen and which resolves a large percentage of their health demands.

Understanding and optimising the structure of primary care seems essential to achieve positive and sustainable health outcomes in local communities, thus ensuring informed and evidence-based decision-making in health system planning and financing.

Funding Entity: 

Carlos III Health Institute. Call for projects in health research 2024.