Potentially preventable hospitalisation in an Italian district (2006-2011)

Introduction The potentially preventable hospitalisations (PPH) include hospitalisation that could be avoided through policies for primary prevention. Representing an earlier indicator than mortality, it allows to evaluate the outcome of health interventions in shorter times also taking into account the increasingly longer survival in presence of disease. The purpose of this study was to consider the use of data on PPH as an index of health inequalities in the population, susceptible to primary prevention, and estimate the costs relating to it. Methods We analyzed the flow of five years (2006-2011) of hospital discharge records regarding an Italian local health unit (province of Grosseto, 228384 inhabitants, Tuscany Region). We considered the potentially preventable causes of avoidable hospitalisation, suggested by the Epidemiology and Applied ResearchProgram (ERA), occurred in people under 75 years old, native and foreigners. We added the voluntary interruption of pregnancy (VIP) to the ERA’s causes of PPH. Results The PPH are about 9% of all hospitalisations. The relative risk for a male than a female is 1.5 (excluding VIP). Foreigners have a half relative risk of PPH compared to italians (7.4 vs13.3); including among the causes the VIP the risk becomes equal (14.6vs 14.8). The cost ofPPH represents 10.3% of total hospital expenditure, rising to 12.8% with VIP. The distribution of the specific causes of PPH is different between natives and foreigners:in the latter we noticed reduced percentages of cardiomyopathies (13% vs 29%) and cancer (4% vs 12%), whereas an increased percentage of trauma (74% vs 48%):relative risks respectively of 0.42, 0.31 and 1.57. VIP across the whole population are placed in third place as causes of PPH, while if we consider only the immigrants they are placed in first place (49% of PPH). Conclusions The comparable rate of PPH between immigrants and italians could mean that there is fairness in the accessibility to primary prevention policies. The data on different relative risks for specific causes albeit partly due to the different composition of the two populations should be considered in the bid of services. The VIP should be routinely considered among the PPH, in view of its avoidance with interventions in health education / contraception.