Association between Primary Health Care Access and Acute CareUtilization for Hypertension: A Systematic Review

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.