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Preventable hospitalization and the role of primary care: a comparison between Italy and Germany.

Rosano, A., Peschel, P., Kugler, J., Zee, J. van der, Ricciardi, W., Guasticchi, G. Preventable hospitalization and the role of primary care: a comparison between Italy and Germany. European Journal of Public Health: 2010, 20(suppl. 1), p. 100. Abstract. 3rd European Public Health Conference 'Integrated Public Health', 10 - 13 November 2010, Amsterdam.
Background: Hospitalization may often be prevented by timely and effective outpatient care. For Italy we found that the type and density of primary-care facilities, among other factors, influence admission rates. However, results from Italy may not be valid for other types of health-care systems, e.g. in Germany. Both countries dispose of appropriate hospital statistics and try to reduce costs of the hospital sector, but the position of both primary care and ambulatory specialist care varies considerably. The objective of the study is to compare hospital admissions for main ambulatory care sensitive conditions, in this case diabetes and asthma, in Italy and Germany and to discuss possible relationship with the different model of primary care supply. Methods: Trend analysis of hospitalization rates (HRs) for asthma and diabetes from 2001 to 2007 and correlation with quantitative measures of primary care services. Results: In Italy admissions for diabetes and asthma were about 90 000, 1% of total admissions. In 2007 in Germany avoidable admissions attributable to diabetes and asthma were 245 000, accounting for 1.4% of total admissions. During the studied period HR for diabetes decreased by 30% in Italy and increased by 11% in Germany. In the same period the number of practising physicians per 1000 persons was stable in Germany
and decreased in Italy, where the number of doctor visits increased by 14%. Discussion: Preliminary results for Italy showed that in the studied period HR for diabetes steadily decreased, with no increase of primary care physicians, but with an intensification of their workload. In Italy policies aimed at reducing the recourse to hospitalization seem to be successful. Family practitioners have a different role: they are gatekeepers in Italy and not in Germany. This may play a role in the attempt to shift health assistance from in-patient care to out-patient care.