Increased use of primary care may reduce rates of respiratory failure and admissions to the intensive care unit, according to
research presented at ATS 2019.

A review of nearly 2.5 million patient records found that regions with greater use of primary care had reduced respiratory
failure admissions, particularly among patients with chronic diseases like asthma, COPD, and congestive heart failure.

Researchers conducted a cross-sectional, ecological study among 2,441,999 Medicare beneficiaries admitted over a 20-month period to in 306 hospital referral regions (HRRs). Mechanical ventilation was categorized as potentially preventable when it was for a relevant ambulatory care sensitive conditions (ACSC, such as asthma, COPD, or CHF).

According to results, HRRs varied widely in:

  • All-cause yearly ICU admission rates (26.8 per 1000 beneficiaries in quartile 1 versus 66.3 per 1000 in quartile 4)
  • ACSC ICU admissions (2.3 in quartile 1 versus 7.8 in quartile 4)
  • All-cause MV (7.5 in quartile 1 versus 17.9 in quartile 4)
  • ACSC MV (1.9 in quartile 1 versus 5.3 in quartile 4)
  • Primary care utilization varied from 69.1% to 81.4%

After adjustment, a 10% absolute increase in primary care utilization was associated with a 12.7 per 1000 decline in the rate of all cause ICU admissions, a 1.5 per 1000 decline in ACSC ICU admissions, a 3.4 per 1000 decline in all-cause MV, and a 0.8 per 1000 decline in ACSC MV.

“Higher rates of primary care were associated with lower rates of all-cause and potentially preventable ICU and MV rates within a region,” researchers reported. “These results support the hypothesis that efforts to improve access to and use of ambulatory care could reduce rates of critical illness.”