Adhikari et al., Prim Health Care 2019, 9:1 DOI: 10.4172/2167-1079.1000319 Volume 9 • Issue 1 • 1000319 Prim Health Care, an open access journal ISSN: 2167-1079 Open Access Review Article J o u r n a l o f P r i m a r y H e a lt h c a r e : O p e n A c c e s s ISSN: 2167-1079 Primary Health Care: Open Access *Corresponding author: Kamala Adhikari, MSc, PhD, Department of Community Health Sciences, University of Calgary, 3330 Hospital Drive NW, Calgary, T2N 4N1, Alberta, Canada, E-mail: kamala.adhikaridahal@ucalgary.ca Received: December 24, 2018; Accepted: January 08, 2019; Published: January 15, 2019 Citation: Adhikari K, Qureshi H, Metcalfe A, Walker RL, Cunningham CT, et al. (2019) Association between Primary Health Care Access and Acute Care Utilization for Hypertension: A Systematic Review. Prim Health Care 9: 319. doi: 10.4172/2167-1079.1000319 Copyright: © 2019 Adhikari K, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Keywords: Ambulatory care sensitive conditions; Primary health care; Hypertension; Emergency department visits; Hospitalization Background Timely and efective outpatient care can help avoid a hospitalization through disease control and prevention [1]. A disproportionate number of these potentially avoidable hospital admissions occur in people with chronic conditions [2]. Many chronic conditions can be managed efectively in Primary Health Care (PHC) with the right medical screening, monitoring, management and follow-up [3-6]. Tese chronic conditions are known as Ambulatory Care Sensitive Conditions (ACSCs). Te concept of ACSCs was frst developed in the United States to identify hospitalizations that could potentially be avoided with access to appropriate ambulatory or PHC in the community [5,7]. Now internationally recognized and widely used across countries as a health care quality indicator, hospitalizations and emergency department visits for ACSCs represent a proxy measure of access to and quality of PHC for patients with ACSCs [2,8,9]. In theory, if timely access and efective PHC is provided to patients with ACSCs, the onset of complications and risk of acute care episodes could be reduced [7,8,10]. Tus, it has been hypothesized that greater access to PHC could potentially lower the hospitalization rates for ACSCs. However, this expected association between PHC access and ACSC hospitalizations is not strongly supported by evidence [7,10- 14]. Tere are conficting fndings with respect to the association between PHC access and hospitalizations for ACSCs; however, there are few systematic studies of this association. To our knowledge, there has only been one systematic review assessing the association between access to PHC and risk of hospitalization among people with diabetes [4]. Tis review found inconclusive evidence to support the theory that PHC access is associated with reduced ACSC hospitalizations. It is unknown how generalizable these results are to other ACSCs, such as hypertension, asthma, congestive heart failure or chronic obstructive pulmonary disease. One ACSC that has not been systematically reviewed in the context of PHC access and hospitalization rate is hypertension. Hypertension is one of the most common chronic conditions with a global prevalence of about 40 percent in adults over the age of 25 [15]. Health care spending for the management of hypertension and related complications is also high (estimated to be 10% of all health care spending) [16,17]. Moreover, the majority of patients with hypertension are managed in primary care and hypertension is the most common reason for patients to visit their primary care provider in Canada [13,15]. Terefore, this systematic review examines the association between PHC access and hospitalizations or emergency department visits for hypertension in an adult population. Association between Primary Health Care Access and Acute Care Utilization for Hypertension: A Systematic Review Kamala Adhikari 1 *, Hena Qureshi 1 , Amy Metcalfe 1,2 , Robin L Walker 1,3 , Ceara T Cunningham 1,3 , Kerry McBrien 1,4 and Paul E Ronksley 1 1 Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada 2 Department of Obstetrics and Gynecology, University of Calgary, Calgary, Alberta, Canada 3 Alberta Health Services, Alberta, Canada 4 Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada Abstract Background: Ambulatory Care Sensitive Conditions (ACSC) are chronic conditions for which hospitalizations can potentially be avoided through timely and effective primary health care; one of these is hypertension. However, the association between primary health care access and ACSC hospitalizations is not consistent in the literature. We conducted a systematic review to assess the association between primary health care access and hospitalizations or emergency department visits using hypertension as the ACSC of interest. Methods: We searched two electronic databases (Medline and Embase) from inception to September 2017 to identify all observational studies evaluating the association between primary health care access and acute care utilization (hospitalizations or emergency department visits) for patients diagnosed with hypertension. Results were synthesized narratively. Study quality was assessed using components of the Newcastle Ottawa Scale and the Downs and Black Checklist. Results: Our search strategy yielded 5,123 abstracts; 3 met all inclusion criteria. Two studies found a positive association between primary health care access (the number of primary care visits or general practitioner density) and hospitalization rates for hypertension, while the other study found increases in general practitioner density resulted in a reduction in hospitalization rates for hypertension. Study metrics and quality varied substantially across the selected studies. No studies adjusted for system-level factors or severity of hypertension. Conclusions: There is limited and inconclusive evidence on the relationship between access to primary health care and acute care utilization for hypertension. Further research, including adjustment for disease severity and key confounders is required to elucidate this relationship.