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Increasing Use of Primary Care May Lower Rates of Respiratory Failure

Wallace Stephens
Increased use of primary care could lower rates of respiratory failure and reduce admissions to intensive care units. 
Increased use of primary care could lower rates of critical illnesses that result in respiratory failure and reduce admissions to intensive care units (ICUs), according to an abstract presented at the 2019 American Thoracic Society International Conference, held May 17-22 in Dallas, Texas.

Respiratory failure is caused by problems that interfere with inhalation or exhalation.1 It is a common, leading cause of death in the United States.1 Some illnesses that result in respiratory failure may be prevented.2

Researchers sought to investigate whether efforts to encourage the use of primary care could lead to a reduction in rates of critical respiratory illnesses by testing relationships between regional rates of primary care use, rates of ICU admission, and rates of mechanical ventilation (MV).

They conducted a cross-sectional, ecological study of Medicare recipients admitted from January 2014 to September 2015. Admissions were categorized as potentially preventable using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for ambulatory care sensitive conditions (ACSCs). MV was defined using ICD-9-CM codes and categorized as potentially preventable when it was used for relevant ACSCs, which included asthma, chronic obstructive pulmonary disease, or congestive heart failure.

Data were grouped by hospital referral region (HRR) and researchers used linear regression to estimate relationships between primary care use, per capita rates of all-cause and ACSC-related ICU admissions, and rates of MV. Analyses were adjusted for regional demographics, including age, gender, race, and median income, comorbidity burden, year, and availability of providers, such as primary care practices, intensivists, and pulmonologists.

Researchers identified 2,441,999 patients from 306 HRRs. Yearly all-cause ICU admission rates, ACSC ICU admissions, all-cause MV, and ACSC MV broadly varied among HRRs. Use of primary care varied from 69.1% in the bottom decile of HRRs to 81.4% in the top decile.

After adjustment, researchers found 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 wrote. “These results support the hypothesis that efforts to improve access to and use of ambulatory care could reduce rates of critical illness. Future work using individual-level data and natural experiments that have altered availability of primary care services should test this hypothesis.”

Reference
1. Schraufnagel DE, ed. Breathing in America: Diseases, Progress, and Hope. American Thoracic Society; 2010. http://www.thoracic.org/patients/patient-resources/breathing-in-america/resources/breathing-in-america.pdf. Accessed May 201, 2019
2. Admon AJ, Prescott HC, Valley TS, Iwashyna TJ, Cooke CR, Regional Rates of Primary Care Visits, ICU Admission, and Mechanical Ventilation. Presented at 2019 American Thoracic Society International Conference; May 17-22, 2019, Dallas, TX. Abstract A5576.


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