Ambulatory care

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The VA Sepulveda Ambulatory Care Centre in California is a large ambulatory care center where ambulatory care sensitive conditions (ACSC) are routinely assessed and managed. VA Sepulveda Ambulatory Care Center Building 200 (1).jpg
The VA Sepulveda Ambulatory Care Centre in California is a large ambulatory care center where ambulatory care sensitive conditions (ACSC) are routinely assessed and managed.

Ambulatory care or outpatient care is medical care provided on an outpatient basis, including diagnosis, observation, consultation, treatment, intervention, and rehabilitation services. This care can include advanced medical technology and procedures even when provided outside of hospitals. [1] [2] [3] [4] [5]

Contents

Ambulatory care sensitive conditions (ACSC) are health conditions where appropriate ambulatory care prevents or reduces the need for hospital admission (or inpatient care), such as diabetes or chronic obstructive pulmonary disease. [6]

Many medical investigations and treatments for acute and chronic illnesses and preventive health care can be performed on an ambulatory basis, including minor surgical and medical procedures, most types of dental services, dermatology services, and many types of diagnostic procedures (e.g. blood tests, X-rays, endoscopy and biopsy procedures of superficial organs). Other types of ambulatory care services include emergency visits, rehabilitation visits, and in some cases telephone consultations. [7]

Ambulatory care services represent the most significant contributor to increasing hospital expenditures and to the performance of the health care system in most countries, including most developing countries. [8] [9]

Scope

Health care organizations use different ways to define the nature of care provided as "ambulatory" versus inpatient or other types of care. [7] [8] [10] [11] [12]

A typical assessment and treatment space for patients in an ambulatory care clinic. Clinic Space in Ambulatory Clinic.jpg
A typical assessment and treatment space for patients in an ambulatory care clinic.

Sites where ambulatory care can be delivered include:

Personnel and medical education

A nurse operating medical equipment in an ambulatory care setting. Army Nurse Operating Medical Equipment at Camp Bastion Hospital, Afghanistan.jpg
A nurse operating medical equipment in an ambulatory care setting.

Ambulatory care services typically consist of a multidisciplinary team of health professionals that may include (but is not limited to) physicians, nurse practitioners, nurses, pharmacists, occupational therapists, physical therapists, speech therapists, and other allied health professionals. [16] [17]

Given the growth of ambulatory medicine, it has become a significant component of education for medical trainees across various specialties. [18] [19] [20] Over the past decades, internal medicine residency programs across North America have made efforts to incorporate more ambulatory training to the medical education curriculum. [21] [22] The ambulatory medical training is focused on patient management through multidisciplinary teamwork while creating longitudinal continuity in patient care. [23] [24]

Treatments

Ambulatory care sensitive conditions (ACSC) are illnesses or health conditions where appropriate ambulatory care prevents or reduces the need for hospital admission. Appropriate care for an ACSC can include one or more planned revisits to settings of ambulatory care for follow-up, such as when a patient is continuously monitored or otherwise advised to return when (or if) symptoms appear or reappear.[ citation needed ]

Relatively common ACSC include: [6] [25] [26] [27] [28] [29] [30] [31] [32] [33] [34] [35]

Hospitalization for an ambulatory care sensitive conditions is considered to be a measure of access to appropriate primary health care, including preventive and disease management services. While not all admissions for these conditions are avoidable, appropriate ambulatory care could help prevent their onset, control an acute episode, or manage a chronic disease or condition. [6] [25] [26] For Medicaid-covered and uninsured U.S. hospital stays in 2012, six of the top ten diagnoses were ambulatory care sensitive conditions. [36]

Safety

There have been concerns regarding the safety of ambulatory medicine. [37] [38] Some of the common potential sources of harm include errors to medications and diagnostics as well as breakdowns in communications and coordination of care. [39] One major complication of ambulatory care that predisposes to patients to harm is the risk for missing appointments. [40] Missed appointments are common, costly, and can lead to significant delays in both diagnosis and treatment. [39] [40]

Advancements in information technology (IT) have helped to address some safety concerns of ambulatory medicine by minimizing mismanagement of electronic health records (EHR), improving interoperability, and increasing health professionals communication. [39] Some have raised the notion of designing health professionals payment policies with greater focus on safety in addition to patient volumes. [39] Furthermore, strategies for increased patient and caregiver engagement have been heralded as potentially beneficial in both patient care as well as data gathering for patient safety. [41] [42]

See also

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References

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