Ambulatory care

The VA Sepulveda Ambulatory Care Centre in California is a large ambulatory care center where ambulatory care sensitive conditions (ACSC) are routinely assessed and managed.

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]

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][12]

A typical assessment and treatment space for patients in an ambulatory care clinic.

Sites where ambulatory care can be delivered include:

  • 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, dermatology, and geriatrics.
  • 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.[13]
  • 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.[citation needed]
  • Non-institution settings: For example, mass childhood immunization campaigns using community health workers.[9]
  • Telematic: Telemedicine is an expanding sector of ambulatory medicine that aims to improve patient access to care; particularly those living in remote regions. Studies have suggested that telemedicine can be effective in delivering adequate patient care including older adults.[14]
    • Due to the COVID-19 pandemic, many countries developed large scale telemedicine frameworks in effort to continue outpatient assessments and follow-ups across various specialties while minimizing the spread of COVID-19.[15]

Personnel and Medical Education

A nurse operating medical equipment in an ambulatory care setting.

Ambulatory care services typically consist of a multidisciplinary team of health professionals that may include (but is not limited to) physicians, nurse practitioners, nurses, pharmacists, occupational therapists, physical therapists, speech therapists, and other allied health professionals.[16][17]

Given the growth of ambulatory medicine, it has become an significant component of education for medical trainees across various specialties.[18][19][20] Over the past decades, internal medicine residency programs across North America have made efforts to incorporate more ambulatory training to the medical education curriculum.[21][22] The ambulatory medical training is focused on patient management through multidisciplinary teamwork while creating longitudinal continuity in patient care.[23][24]

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.[citation needed]

Relatively common ACSC include:[6][25][26][27][28][29][30][31][32][33][34][35]

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][25][26] For Medicaid-covered and uninsured U.S. hospital stays in 2012, six of the top ten diagnoses were ambulatory care sensitive conditions.[36]

Safety

There have been concerns regarding the safety of ambulatory medicine.[37][38] Some of the common potential sources of harm include errors to medications and diagnostics as well as breakdowns in communications and coordination of care.[39] One major complication of ambulatory care that predisposes to patients to harm is the risk for missing appointments.[40] Missed appointments are common, costly, and can lead to significant delays in both diagnosis and treatment.[39][40]

Advancements in information technology (IT) have help to address some safety concerns of ambulatory medicine by minimizing mismanagement of electronic health records (EHR), improving interoperability, and increasing health professionals communication.[39] Some have raised the notion of designing health professionals payment policies with greater focus on safety in addition to patient volumes.[39] Furthermore, strategies for increased patient and caregiver engagement have been heralded as potentially beneficial in both patient care as well as data gathering for patient safety.[41][42]

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. ^ a b c Canadian Institute for Health Information, Ambulatory Care Sensitive Conditions. Accessed 14 April 2014.
  7. ^ a b "Comprehensive Ambulatory Care Classification System". Canadian Institute for Health Information. Archived from the original on 2011-09-29. Retrieved 25 July 2011.
  8. ^ a b Karpiel MS. "Using patient classification systems to identify ambulatory care costs". CBS Business Network. Retrieved 25 July 2011.
  9. ^ a b 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 JA (December 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. ^ Batsis JA, DiMilia PR, Seo LM, Fortuna KL, Kennedy MA, Blunt HB, et al. (August 2019). "Effectiveness of Ambulatory Telemedicine Care in Older Adults: A Systematic Review". Journal of the American Geriatrics Society. 67 (8): 1737–1749. doi:10.1111/jgs.15959. PMC 6684409. PMID 31066916.
  13. ^ Shabarova Z. "Primary Health Care in the NIS: Soviet Primary Health Care system review". Archived from the original on 2012-04-26.
  14. ^ Batsis JA, DiMilia PR, Seo LM, Fortuna KL, Kennedy MA, Blunt HB, et al. (August 2019). "Effectiveness of Ambulatory Telemedicine Care in Older Adults: A Systematic Review". Journal of the American Geriatrics Society. 67 (8): 1737–1749. doi:10.1111/jgs.15959. PMC 6684409. PMID 31066916.
  15. ^ Ohannessian R, Duong TA, Odone A (April 2020). "Global Telemedicine Implementation and Integration Within Health Systems to Fight the COVID-19 Pandemic: A Call to Action". JMIR Public Health and Surveillance. 6 (2): e18810. doi:10.2196/18810. PMC 7124951. PMID 32238336.
  16. ^ Kleinpeter MA (January 2005). Standardizing Ambulatory Care Procedures in a Public Hospital System to Improve Patient Safety. Defense Technical Information Center. OCLC 64438214. PMID 21250031.
  17. ^ Cup EH, Pieterse AJ, Hendricks HT, van Engelen BG, Oostendorp RA, van der Wilt GJ (2011). "Implementation of multidisciplinary advice to allied health care professionals regarding the management of their patients with neuromuscular diseases". Disability and Rehabilitation. 33 (9): 787–795. doi:10.3109/09638288.2010.511414. PMID 20804405. S2CID 12392545.
  18. ^ Coyle A, Helenius I, Cruz CM, Lyons EA, May N, Andrilli J, et al. (April 2019). "A Decade of Teaching and Learning in Internal Medicine Ambulatory Education: A Scoping Review". Journal of Graduate Medical Education. 11 (2): 132–142. doi:10.4300/JGME-D-18-00596.1. PMC 6476084. PMID 31024643.
  19. ^ Lukas RV, Blood AD, Brorson JR, Albert DV (January 2017). "Ambulatory training in neurology education". Journal of the Neurological Sciences. 372: 506–509. doi:10.1016/j.jns.2016.11.008. PMID 27838003. S2CID 34249972.
  20. ^ Zimbrean PC, Ernst CL, Forray A, Beach SR, Lavakumar M, Siegel AM, et al. (September 2020). "The Educational Value of Outpatient Consultation-Liaison Rotations: A White Paper From the Academy of Consultation-Liaison Psychiatry Residency Education Subcommittee". Psychosomatics. 61 (5): 436–449. doi:10.1016/j.psym.2020.05.004. PMC 7235569. PMID 32650995.
  21. ^ Colbert JA (August 2013). "Experiments in continuity--rethinking residency training in ambulatory care". The New England Journal of Medicine. 369 (6): 504–5. doi:10.1056/NEJMp1301604. PMID 23924001.
  22. ^ McLeod PJ, Meagher TW (June 1993). "Ambulatory care training during core internal medicine residency training: the Canadian experience". CMAJ. 148 (12): 2143–2147. PMC 1485315. PMID 8324688.
  23. ^ Papp KK, Wayne DB (August 2013). "Ambulatory education redesign: time to get inspired". Journal of General Internal Medicine. 28 (8): 982–983. doi:10.1007/s11606-013-2404-6. PMC 3710389. PMID 23595934.
  24. ^ Huddle TS, Heudebert GR (October 2008). "Internal medicine training in the 21st century". Academic Medicine. 83 (10): 910–915. doi:10.1097/ACM.0b013e3181850a92. PMID 18820519.
  25. ^ a b "Concept: Ambulatory Care Sensitive (ACS) Conditions". Manitoba Centre for Health Policy and Evaluation. September 26, 2007. Retrieved 2014-04-14.
  26. ^ a b "Hospitalizations for Ambulatory Care–Sensitive Conditions". Commonwealth Fund. Archived from the original on 2014-04-15. Retrieved 2014-04-14.
  27. ^ 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.
  28. ^ 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.
  29. ^ Comerford D, Shah R (September 2018). "Ambulatory approach to cancer care. Part 1: the patient experience". British Journal of Nursing. 27 (17): S4–S12. doi:10.12968/bjon.2018.27.17.S4. PMID 30235032. S2CID 52306687.
  30. ^ Comerford D, Shah R (February 2019). "Ambulatory approach to cancer care. Part 2: the role of nurses and the multidisciplinary team and safety". British Journal of Nursing. 28 (4): S20–S26. doi:10.12968/bjon.2019.28.4.S20. PMID 30811233. S2CID 73487721.
  31. ^ Comerford D, Shah R (September 2019). "Ambulatory approach to cancer care. Part 3: starting and maintaining the service and its challenges and benefits". British Journal of Nursing. 28 (17): S4–S8. doi:10.12968/bjon.2019.28.17.S4. PMID 31556736. S2CID 203439523.
  32. ^ Schoenfeld R, Nguyen GC, Bernstein CN (February 2020). "Integrated Care Models: Optimizing Adult Ambulatory Care in Inflammatory Bowel Disease". Journal of the Canadian Association of Gastroenterology. 3 (1): 44–53. doi:10.1093/jcag/gwy060. PMC 8218536. PMID 34169226.
  33. ^ Vinson DR, Berman DA (March 2001). "Outpatient treatment of deep venous thrombosis: a clinical care pathway managed by the emergency department". Annals of Emergency Medicine. 37 (3): 251–258. doi:10.1067/mem.2001.113703. PMID 11223760.
  34. ^ Gilbert EM, Gerzenshtein L (June 2016). "Integration of outpatient infectious diseases clinic pharmacy services and specialty pharmacy services for patients with HIV infection". American Journal of Health-System Pharmacy. 73 (11): 757–763. doi:10.2146/ajhp150701. PMID 27126831.
  35. ^ Hui D, Hannon BL, Zimmermann C, Bruera E (September 2018). "Improving patient and caregiver outcomes in oncology: Team-based, timely, and targeted palliative care". CA: A Cancer Journal for Clinicians. 68 (5): 356–376. doi:10.3322/caac.21490. PMC 6179926. PMID 30277572.
  36. ^ 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.
  37. ^ Bates DW, Singh H (November 2018). "Two Decades Since To Err Is Human: An Assessment Of Progress And Emerging Priorities In Patient Safety". Health Affairs. 37 (11): 1736–1743. doi:10.1377/hlthaff.2018.0738. PMID 30395508. S2CID 53227942.
  38. ^ Geraedts M, Krause S, Schneider M, Ortwein A, Leinert J, de Cruppé W (February 2020). "Patient safety in ambulatory care from the patient's perspective: a retrospective, representative telephone survey". BMJ Open. 10 (2): e034617. doi:10.1136/bmjopen-2019-034617. PMC 7044884. PMID 32066609.
  39. ^ a b c d Singh H, Carayon P (December 2020). "A Roadmap to Advance Patient Safety in Ambulatory Care". JAMA. 324 (24): 2481–2482. doi:10.1001/jama.2020.18551. PMC 8016440. PMID 33351052.
  40. ^ a b Whear R, Thompson-Coon J, Rogers M, Abbott RA, Anderson L, Ukoumunne O, et al. (April 2020). "Patient-initiated appointment systems for adults with chronic conditions in secondary care". The Cochrane Database of Systematic Reviews. 2020 (4): CD010763. doi:10.1002/14651858.CD010763.pub2. PMC 7144896. PMID 32271946.
  41. ^ Carayon P, Wooldridge A, Hoonakker P, Hundt AS, Kelly MM (April 2020). "SEIPS 3.0: Human-centered design of the patient journey for patient safety". Applied Ergonomics. 84: 103033. doi:10.1016/j.apergo.2019.103033. PMC 7152782. PMID 31987516.
  42. ^ Goodell M (February 2017). "Improving Ambulatory Patient Safety: The Role of Family Medicine" (PDF). Family Medicine. 49 (2): 155–156. PMID 28218948.