Ambulatory care

Ambulatory care is a personal health care consultation, treatment, or intervention using advanced medical technology or procedures delivered on an outpatient basis. 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.

Many medical investigations and treatments for acute illness 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.

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.

Settings
Health care organizations use different ways to define the nature of care provided as "ambulatory" versus inpatient or other types of care.

Sites where ambulatory care can be delivered include:


 * Doctor's surgeries (known as doctor's offices in American English): This is the most common site for the delivery of ambulatory care in many countries, and usually consists of a physician's visit. Physicians of many specialties deliver ambulatory care.  These physicians include specialists in family medicine, internal medicine, obstetrics, gynaecology, cardiology, gastroenterology, endocrinology, ophthalmology, and dermatology.


 * Clinics: Including ambulatory care clinics, polyclinics, ambulatory surgery centers, and urgent care centers.
 * 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.


 * 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.


 * Non-institution settings: For example, mass childhood immunization campaigns using community health workers.

Conditions
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 and/or advised to return when (or if) symptoms appear or reappear.

Relatively common ACSC include:


 * asthma
 * angina
 * diabetes (complications)
 * chronic obstructive pulmonary disease
 * pelvic inflammatory disease
 * hypertension
 * gastroenteritis
 * gangrene
 * ear-nose-throat (ENT) infections


 * congestive heart failure
 * epilepsy
 * influenza, pneumonia and other vaccine-preventable diseases
 * tuberculosis
 * iron deficiency anemia
 * urinary tract infections
 * cellulitis
 * dental conditions.

Hospitalization for an ACSC 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.: