The devil is in the details: trends in avoidable hospitalization rates by geography in British Columbia, 1990–2000

BACKGROUND: Researchers and policy makers have focussed on the development of indicators to help monitor the success of regionalization, primary care reform and other health sector restructuring initiatives. Certain indicators are useful in examining issues of equity in service provision, especially among older populations, regardless of where they live. AHRs are used as an indicator of primary care system efficiency and thus reveal information about access to general practitioners. The purpose of this paper is to examine trends in avoidable hospitalization rates (AHRs) during a period of time characterized by several waves of health sector restructuring and regionalization in British Columbia. AHRs are examined in relation to non-avoidable and total hospitalization rates as well as by urban and rural geography across the province. METHODS: Analyses draw on linked administrative health data from the province of British Columbia for 1990 through 2000 for the population aged 50 and over. Joinpoint regression analyses and t-tests are used to detect and describe trends in the data. RESULTS: Generally speaking, non-avoidable hospitalizations constitute the vast majority of hospitalizations in a given year (i.e. around 95%) with AHRs constituting the remaining 5% of hospitalizations. Comparing rural areas and urban areas reveals that standardized rates of avoidable, non-avoidable and total hospitalizations are consistently higher in rural areas. Joinpoint regression results show significantly decreasing trends overall; lines are parallel in the case of avoidable hospitalizations, and lines are diverging for non-avoidable and total hospitalizations, with the gap between rural and urban areas being wider at the end of the time interval than at the beginning. CONCLUSION: These data suggest that access to effective primary care in rural communities remains problematic in BC given that rural areas did not make any gains in AHRs relative to urban areas under recent health sector restructuring initiatives. It remains important to continue to monitor the discrepancy between them as a reflection of inequity in service provision. In addition, it is important to consider alternative explanations for the observed trends paying particular attention to the needs of rural and urban populations and the factors influencing local service provision

Título: The present state of England

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Man In Society : The Old Testament Doctrine

London255 p.: 21 c

Magn Britanni Notitia [electronic resource] : Or, The present state of Great Britain; with divers remarks upon the antient state thereof. By John Chamberlayne, Esq; the seven and twentieth edition of the south part, call'd England; and the sixth of the north part, call'd Scotland; with improvements, and more correct and large additions in the list of the officers, &c. than in any former impression. In two parts. With His Majesty's royal privilege.

'A general list or catalogue of all the offices and officers employed in the several branches of His Majesty's government ..', London, 1725, and 'A list of all the offices and officers in II. North-Britain, or Scotland' have separate pagination and registers.With a cancel titlepage, and an advertisement leaf following the second part.Electronic reproduction.English Short Title Catalog,Reproduction of original from Boston Public Library