Ambulatory care

Ambulatory care or outpatient care is medical care provided on an outpatient basis, including diagnosis, observation, consultation, treatment, intervention, and rehabilitation services. This care can include advanced medical technology and procedures even when provided outside of hospitals.[1][2][3][4][5]

Public ambulatory care facility in Maracay, Venezuela, providing primary care for ambulatory care sensitive conditions.

Ambulatory care sensitive conditions (ACSC) are health conditions where appropriate ambulatory care prevents or reduces the need for hospital admission (or inpatient care), such as diabetes or chronic obstructive pulmonary disease.[6]

Many medical investigations and treatments for acute and chronic illnesses and preventive health care can be performed on an ambulatory basis, including minor surgical and medical procedures, most types of dental services, dermatology services, and many types of diagnostic procedures (e.g. blood tests, X-rays, endoscopy and biopsy procedures of superficial organs). Other types of ambulatory care services include emergency visits, rehabilitation visits, and in some cases telephone consultations.[7]

Ambulatory care services represent the most significant contributor to increasing hospital expenditures and to the performance of the health care system in most countries, including most developing countries.[8][9]

Scope

Health care organizations use different ways to define the nature of care provided as "ambulatory" versus inpatient or other types of care.[7][8][10][11]

Sites where ambulatory care can be delivered include:

An examination room in a doctor's office.
  • Doctor's surgeries/Doctor's offices/General medical practice: This is the most common site for the delivery of ambulatory care in many countries, and usually consists of a physician's visit. Physicians of many specialties deliver ambulatory care, including specialists in family medicine, internal medicine, obstetrics, gynaecology, cardiology, gastroenterology, endocrinology, ophthalmology, and dermatology.
  • Clinics: Including ambulatory care clinics, polyclinics, ambulatory surgery centers, and urgent care centers.
    • In the United States, the Urgent Care Association of America (UCAOA) estimates that over 15,000 urgent care centers deliver urgent care services. These centers are designed to evaluate and treat conditions that are not severe enough to require treatment in a hospital emergency department but still require treatment beyond normal physician office hours or before a physician appointment is available.
    • In Russia and other countries of the former Soviet Union, Feldsher health stations are the main site for ambulatory care in rural areas.[12]
  • Hospitals: Including emergency departments and other hospital-based services such as same day surgery services and mental health services.
    • Hospital emergency departments: Some visits to emergency departments result in hospital admission, so these would be considered emergency medicine visits rather than ambulatory care. Most visits to hospital emergency departments, however, do not require hospital admission.
  • Non-medical institution-based settings: Including school and prison health; vision, dental and pharmaceutical care.
  • Non-institution settings: For example, mass childhood immunization campaigns using community health workers.[9]
  • Telematic: The telemedicine-based follow-up, has proven to be feasible and safe for the evaluation of early postoperative complications. Patients reported high levels of satisfaction with the procedure. Telemedicine-based follow-up could become standard practice with the development of a specific mobile application.[13]

Treatments

Ambulatory care sensitive conditions (ACSC) are illnesses or health conditions where appropriate ambulatory care prevents or reduces the need for hospital admission. Appropriate care for an ACSC can include one or more planned revisits to settings of ambulatory care for follow-up, such as when a patient is continuously monitored or otherwise advised to return when (or if) symptoms appear or reappear.

Relatively common ACSC include:[6][14][15][16][17]

Hospitalization for an ambulatory care sensitive conditions is considered to be a measure of access to appropriate primary health care, including preventive and disease management services. While not all admissions for these conditions are avoidable, appropriate ambulatory care could help prevent their onset, control an acute episode, or manage a chronic disease or condition.:[6][14][15] For Medicaid-covered and uninsured U.S. hospital stays in 2012, six of the top ten diagnoses were ambulatory care sensitive conditions.[18]

Complications

One potential complication of ambulatory care/outpatient care is the increased risk for missed outpatient appointments and medical followups.[19] Missed appointments are common worldwide and are costly for health care systems.[19] For example, missed outpatient appointments have been estimated to cost the National Health Service millions of pounds each year.[19] Missed appointments also cause scheduling problems in clinics.[19]

See also

References
  1. "What is Ambulatory Care?". WiseGeek.
  2. "Medical Definition of Ambulatory care". MedicineNet.com.
  3. "What is "Ambulatory Care"?". William Osler Health System. Archived from the original on 2011-09-28. Retrieved 25 July 2011.
  4. "Programs & Services: Ambulatory Care". Saskatoon Health Region. Archived from the original on 2011-09-05.
  5. "Ambulatory care". The Free Dictionary. Retrieved 25 July 2011.
  6. Canadian Institute for Health Information, Ambulatory Care Sensitive Conditions. Accessed 14 April 2014.
  7. "Comprehensive Ambulatory Care Classification System". Canadian Institute for Health Information. Archived from the original on 2011-09-29. Retrieved 25 July 2011.
  8. Karpiel MS. "Using patient classification systems to identify ambulatory care costs". CBS Business Network. Retrieved 25 July 2011.
  9. Berman P (2000). "Organization of ambulatory care provision: a critical determinant of health system performance in developing countries" (PDF). Bulletin of the World Health Organization. 78 (6): 791–802. PMC 2560790. PMID 10916916.
  10. Verran, Joyce A. (1986). "Testing a classification instrument for the ambulatory care setting". Research in Nursing & Health. 9 (4): 279–287. doi:10.1002/nur.4770090404. PMID 3101143.
  11. Alberta Health and Wellness. Alberta Ambulatory Care Reporting Manual. Archived 2011-10-07 at the Wayback Machine Edmonton, April 2009.
  12. Shabarova Z. "Primary Health Care in the NIS: Soviet Primary Health Care system review". Archived from the original on 2012-04-26.
  13. Segura-Sampedro JJ, Rivero-Belenchón I, Pino-Díaz V, Rodríguez Sánchez MC, Pareja-Ciuró F, Padillo-Ruiz J, Jimenez-Rodriguez RM (September 2017). "Feasibility and safety of surgical wound remote follow-up by smart phone in appendectomy: A pilot study". Annals of Medicine and Surgery. 21: 58–62. doi:10.1016/j.amsu.2017.07.040. PMC 5537421. PMID 28794868.
  14. "Concept: Ambulatory Care Sensitive (ACS) Conditions". Manitoba Centre for Health Policy and Evaluation. September 26, 2007. Retrieved 2014-04-14.
  15. "Hospitalizations for Ambulatory Care–Sensitive Conditions". Commonwealth Fund. Archived from the original on 2014-04-15. Retrieved 2014-04-14.
  16. Lui CK, Wallace SP (September 2011). "A common denominator: calculating hospitalization rates for ambulatory care-sensitive conditions in California". Preventing Chronic Disease. 8 (5): A102. PMC 3181231. PMID 21843405.
  17. Ansari Z, Haider SI, Ansari H, de Gooyer T, Sindall C (December 2012). "Patient characteristics associated with hospitalisations for ambulatory care sensitive conditions in Victoria, Australia". BMC Health Services Research. 12: 475. doi:10.1186/1472-6963-12-475. PMC 3549737. PMID 23259969.
  18. Lopez-Gonzalez L, Pickens GT, Washington R, Weiss AJ (October 2014). "Characteristics of Medicaid and Uninsured Hospitalizations, 2012". HCUP Statistical Brief #183. Rockville, MD: Agency for Healthcare Research and Quality.
  19. Whear, Rebecca; Thompson-Coon, Joanna; Rogers, Morwenna; Abbott, Rebecca A.; Anderson, Lindsey; Ukoumunne, Obioha; Matthews, Justin; Goodwin, Victoria A.; Briscoe, Simon; Perry, Mark; Stein, Ken (April 2020). "Patient-initiated appointment systems for adults with chronic conditions in secondary care". The Cochrane Database of Systematic Reviews. 4: CD010763. doi:10.1002/14651858.CD010763.pub2. ISSN 1469-493X. PMC 7144896. PMID 32271946.
This article is issued from Wikipedia. The text is licensed under Creative Commons - Attribution - Sharealike. Additional terms may apply for the media files.