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]
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]
Sites where ambulatory care can be delivered include:
In the United States, the
Urgent Care Association of America (UCAOA) estimates that over 15,000 urgent care centers deliver urgent care services. These centers are designed to evaluate and treat conditions that are not severe enough to require treatment in a hospital emergency department but still require treatment beyond normal physician office hours or before a physician appointment is available. In Russia and other countries of the former
Soviet Union,
Feldsher health stations are the main site for ambulatory care in rural areas.[13]
Hospitals: Including
emergency departments and other hospital-based services such as same day surgery services and mental health services.
Hospital emergency departments: Some visits to emergency departments result in hospital admission, so these would be considered
emergency medicine visits rather than ambulatory care. Most visits to hospital emergency departments, however, do not require hospital admission.
Non-medical institution-based settings: Including school and prison health; vision, dental and pharmaceutical care.[citation needed]
Non-institution settings: For example, mass childhood immunization campaigns using
community health workers.[9]
Telemedicine: An expanding sector of ambulatory medicine that uses telecommunications and information technology to improve patient access to care; particularly those living in remote regions. Studies have suggested that telemedicine can be effective in delivering adequate patient care including older adults.[14]
Due to the
COVID-19 pandemic, many countries developed large scale telemedicine frameworks in effort to continue outpatient assessments and follow-ups across various specialties while minimizing the spread of
COVID-19.[15]
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]
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]
^Verran JA (December 1986). "Testing a classification instrument for the ambulatory care setting". Research in Nursing & Health. 9 (4): 279–287.
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^Cup EH, Pieterse AJ, Hendricks HT, van Engelen BG, Oostendorp RA, van der Wilt GJ (2011). "Implementation of multidisciplinary advice to allied health care professionals regarding the management of their patients with neuromuscular diseases". Disability and Rehabilitation. 33 (9): 787–795.
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^Lukas RV, Blood AD, Brorson JR, Albert DV (January 2017). "Ambulatory training in neurology education". Journal of the Neurological Sciences. 372: 506–509.
doi:
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^Colbert JA (August 2013). "Experiments in continuity--rethinking residency training in ambulatory care". The New England Journal of Medicine. 369 (6): 504–5.
doi:
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^Huddle TS, Heudebert GR (October 2008). "Internal medicine training in the 21st century". Academic Medicine. 83 (10): 910–915.
doi:
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PMID18820519.
^Comerford D, Shah R (February 2019). "Ambulatory approach to cancer care. Part 2: the role of nurses and the multidisciplinary team and safety". British Journal of Nursing. 28 (4): S20–S26.
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^Comerford D, Shah R (September 2019). "Ambulatory approach to cancer care. Part 3: starting and maintaining the service and its challenges and benefits". British Journal of Nursing. 28 (17): S4–S8.
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^Gilbert EM, Gerzenshtein L (June 2016). "Integration of outpatient infectious diseases clinic pharmacy services and specialty pharmacy services for patients with HIV infection". American Journal of Health-System Pharmacy. 73 (11): 757–763.
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