Ambulatory care#Revisit

Health care organizations use different ways to define the nature of care provided as "ambulatory" versus inpatient or other types of care.{{cite journal | vauthors = Verran JA | title = Testing a classification instrument for the ambulatory care setting | journal = Research in Nursing & Health | volume = 9 | issue = 4 | pages = 279–287 | date = December 1986 | pmid = 3101143 | doi = 10.1002/nur.4770090404 }}Alberta Health and Wellness. [http://www.health.alberta.ca/documents/ACRM-09-pt0-7.pdf Alberta Ambulatory Care Reporting Manual.] {{Webarchive|url=https://web.archive.org/web/20111007110902/http://www.health.alberta.ca/documents/ACRM-09-pt0-7.pdf|date=2011-10-07}} Edmonton, April 2009.{{cite journal | vauthors = Batsis JA, DiMilia PR, Seo LM, Fortuna KL, Kennedy MA, Blunt HB, Bagley PJ, Brooks J, Brooks E, Kim SY, Masutani RK, Bruce ML, Bartels SJ | display-authors = 6 | title = Effectiveness of Ambulatory Telemedicine Care in Older Adults: A Systematic Review | journal = Journal of the American Geriatrics Society | volume = 67 | issue = 8 | pages = 1737–1749 | date = August 2019 | pmid = 31066916 | pmc = 6684409 | doi = 10.1111/jgs.15959 }}{{overcite|date=October 2024}}

File:Clinic_Space_in_Ambulatory_Clinic.jpg

Sites where ambulatory care can be delivered include:

• Doctor's surgeries/Doctor's offices/General medical practice: 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, including specialists in family medicine, internal medicine, obstetrics, gynaecology, cardiology, gastroenterology, endocrinology, ophthalmology, dermatology, and geriatrics.
• 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.{{cite web|title=Primary Health Care in the NIS: Soviet Primary Health Care system review|url=http://www.aiha.com/resources/Html/zoya.htm|url-status=dead|archive-url=https://web.archive.org/web/20120426034913/http://www.aiha.com/resources/Html/zoya.htm|archive-date=2012-04-26|vauthors=Shabarova Z}}
• 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|date=July 2011}}
• Non-institution settings: For example, mass childhood immunization campaigns using community health workers.
• 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.
• 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.{{cite journal | vauthors = Ohannessian R, Duong TA, Odone A | title = Global Telemedicine Implementation and Integration Within Health Systems to Fight the COVID-19 Pandemic: A Call to Action | journal = JMIR Public Health and Surveillance | volume = 6 | issue = 2 | pages = e18810 | date = April 2020 | pmid = 32238336 | pmc = 7124951 | doi = 10.2196/18810 | doi-access = free }}

File:Army_Nurse_Operating_Medical_Equipment_at_Camp_Bastion_Hospital,_Afghanistan.jpg

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.{{Cite book | vauthors = Kleinpeter MA |url=http://worldcat.org/oclc/64438214|title=Standardizing Ambulatory Care Procedures in a Public Hospital System to Improve Patient Safety.|date= January 2005 |publisher=Defense Technical Information Center|pmid=21250031|oclc=64438214}}{{cite journal | vauthors = Cup EH, Pieterse AJ, Hendricks HT, van Engelen BG, Oostendorp RA, van der Wilt GJ | title = Implementation of multidisciplinary advice to allied health care professionals regarding the management of their patients with neuromuscular diseases | journal = Disability and Rehabilitation | volume = 33 | issue = 9 | pages = 787–795 | date = 2011 | pmid = 20804405 | doi = 10.3109/09638288.2010.511414 | s2cid = 12392545 }}

Given the growth of ambulatory medicine, it has become a significant component of education for medical trainees across various specialties.{{cite journal | vauthors = Coyle A, Helenius I, Cruz CM, Lyons EA, May N, Andrilli J, Bannet MM, Pinotti R, Thomas DC | display-authors = 6 | title = A Decade of Teaching and Learning in Internal Medicine Ambulatory Education: A Scoping Review | journal = Journal of Graduate Medical Education | volume = 11 | issue = 2 | pages = 132–142 | date = April 2019 | pmid = 31024643 | pmc = 6476084 | doi = 10.4300/JGME-D-18-00596.1 }}{{cite journal | vauthors = Lukas RV, Blood AD, Brorson JR, Albert DV | title = Ambulatory training in neurology education | journal = Journal of the Neurological Sciences | volume = 372 | pages = 506–509 | date = January 2017 | pmid = 27838003 | doi = 10.1016/j.jns.2016.11.008 | s2cid = 34249972 }}{{cite journal | vauthors = Zimbrean PC, Ernst CL, Forray A, Beach SR, Lavakumar M, Siegel AM, Soeprono T, Schwartz AC | display-authors = 6 | title = The Educational Value of Outpatient Consultation-Liaison Rotations: A White Paper From the Academy of Consultation-Liaison Psychiatry Residency Education Subcommittee | journal = Psychosomatics | volume = 61 | issue = 5 | pages = 436–449 | date = September 2020 | pmid = 32650995 | pmc = 7235569 | doi = 10.1016/j.psym.2020.05.004 }} Over the past decades, internal medicine residency programs across North America have made efforts to incorporate more ambulatory training to the medical education curriculum.{{cite journal | vauthors = Colbert JA | title = Experiments in continuity--rethinking residency training in ambulatory care | journal = The New England Journal of Medicine | volume = 369 | issue = 6 | pages = 504–5 | date = August 2013 | pmid = 23924001 | doi = 10.1056/NEJMp1301604 }}{{cite journal | vauthors = McLeod PJ, Meagher TW | title = Ambulatory care training during core internal medicine residency training: the Canadian experience | journal = CMAJ | volume = 148 | issue = 12 | pages = 2143–2147 | date = June 1993 | pmid = 8324688 | pmc = 1485315 }} The ambulatory medical training is focused on patient management through multidisciplinary teamwork while creating longitudinal continuity in patient care.{{cite journal | vauthors = Papp KK, Wayne DB | title = Ambulatory education redesign: time to get inspired | journal = Journal of General Internal Medicine | volume = 28 | issue = 8 | pages = 982–983 | date = August 2013 | pmid = 23595934 | pmc = 3710389 | doi = 10.1007/s11606-013-2404-6 }}{{cite journal | vauthors = Huddle TS, Heudebert GR | title = Internal medicine training in the 21st century | language = en-US | journal = Academic Medicine | volume = 83 | issue = 10 | pages = 910–915 | date = October 2008 | pmid = 18820519 | doi = 10.1097/ACM.0b013e3181850a92 }}

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|date=June 2016}}

Relatively common ACSC include:{{cite web|date=September 26, 2007|title=Concept: Ambulatory Care Sensitive (ACS) Conditions|url=http://mchp-appserv.cpe.umanitoba.ca/viewConcept.php?conceptID=1023|access-date=2014-04-14|work=Manitoba Centre for Health Policy and Evaluation}}{{cite web|title=Hospitalizations for Ambulatory Care–Sensitive Conditions.|url=http://www.commonwealthfund.org/Performance-Snapshots/Overuse-of-Health-Care-Services/Hospitalizations-for-Ambulatory-Care--8211-Sensitive-Conditions.aspx|url-status=dead|archive-url=https://web.archive.org/web/20140415061340/http://www.commonwealthfund.org/Performance-Snapshots/Overuse-of-Health-Care-Services/Hospitalizations-for-Ambulatory-Care--8211-Sensitive-Conditions.aspx|archive-date=2014-04-15|access-date=2014-04-14|work=Commonwealth Fund}}{{cite journal | vauthors = Lui CK, Wallace SP | title = A common denominator: calculating hospitalization rates for ambulatory care-sensitive conditions in California | journal = Preventing Chronic Disease | volume = 8 | issue = 5 | pages = A102 | date = September 2011 | pmid = 21843405 | pmc = 3181231 | url = https://www.cdc.gov/pcd/issues/2011/nov/11_0276.htm }}{{cite journal | vauthors = Ansari Z, Haider SI, Ansari H, de Gooyer T, Sindall C | title = Patient characteristics associated with hospitalisations for ambulatory care sensitive conditions in Victoria, Australia | journal = BMC Health Services Research | volume = 12 | pages = 475 | date = December 2012 | pmid = 23259969 | pmc = 3549737 | doi = 10.1186/1472-6963-12-475 | doi-access = free }}{{cite journal | vauthors = Comerford D, Shah R | title = Ambulatory approach to cancer care. Part 1: the patient experience | journal = British Journal of Nursing | volume = 27 | issue = 17 | pages = S4–S12 | date = September 2018 | pmid = 30235032 | doi = 10.12968/bjon.2018.27.17.S4 | s2cid = 52306687 }}{{cite journal | vauthors = Comerford D, Shah R | title = Ambulatory approach to cancer care. Part 2: the role of nurses and the multidisciplinary team and safety | journal = British Journal of Nursing | volume = 28 | issue = 4 | pages = S20–S26 | date = February 2019 | pmid = 30811233 | doi = 10.12968/bjon.2019.28.4.S20 | s2cid = 73487721 }}{{cite journal | vauthors = Comerford D, Shah R | title = Ambulatory approach to cancer care. Part 3: starting and maintaining the service and its challenges and benefits | journal = British Journal of Nursing | volume = 28 | issue = 17 | pages = S4–S8 | date = September 2019 | pmid = 31556736 | doi = 10.12968/bjon.2019.28.17.S4 | s2cid = 203439523 }}{{cite journal | vauthors = Schoenfeld R, Nguyen GC, Bernstein CN | title = Integrated Care Models: Optimizing Adult Ambulatory Care in Inflammatory Bowel Disease | journal = Journal of the Canadian Association of Gastroenterology | volume = 3 | issue = 1 | pages = 44–53 | date = February 2020 | pmid = 34169226 | doi = 10.1093/jcag/gwy060 | pmc = 8218536 }}{{cite journal | vauthors = Vinson DR, Berman DA | title = Outpatient treatment of deep venous thrombosis: a clinical care pathway managed by the emergency department | journal = Annals of Emergency Medicine | volume = 37 | issue = 3 | pages = 251–258 | date = March 2001 | pmid = 11223760 | doi = 10.1067/mem.2001.113703 | doi-access = free }}{{cite journal | vauthors = Gilbert EM, Gerzenshtein L | title = Integration of outpatient infectious diseases clinic pharmacy services and specialty pharmacy services for patients with HIV infection | journal = American Journal of Health-System Pharmacy | volume = 73 | issue = 11 | pages = 757–763 | date = June 2016 | pmid = 27126831 | doi = 10.2146/ajhp150701 }}{{cite journal | vauthors = Hui D, Hannon BL, Zimmermann C, Bruera E | title = Improving patient and caregiver outcomes in oncology: Team-based, timely, and targeted palliative care | journal = CA: A Cancer Journal for Clinicians | volume = 68 | issue = 5 | pages = 356–376 | date = September 2018 | pmid = 30277572 | doi = 10.3322/caac.21490 | pmc = 6179926 }}{{overcite|date=October 2024}}{{col-begin}}

{{col-2}}

• Angina
• Asthma
• Cancer
• Chronic obstructive pulmonary disease
• Chronic pain
• Congestive heart failure
• Dental conditions
• Diabetes
• Dyslipidemia
• ENT (Ear-nose-throat) diseases{{col-2}}
• Epilepsy
• HIV
• Hypertension
• Inflammatory bowel disease
• Influenza, pneumonia and other vaccine-preventable diseases
• Iron-deficiency anemia
• Palliative care
• Pelvic inflammatory disease
• Thromboembolic diseases
• Tuberculosis

{{col-end}}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. For Medicaid-covered and uninsured U.S. hospital stays in 2012, six of the top ten diagnoses were ambulatory care sensitive conditions.{{cite journal|date=October 2014|title=Characteristics of Medicaid and Uninsured Hospitalizations, 2012|url=https://www.hcup-us.ahrq.gov/reports/statbriefs/sb182-Medicaid-Uninsured-Hospitalizations-2012.jsp|journal=HCUP Statistical Brief |issue=183|publisher=Agency for Healthcare Research and Quality|location=Rockville, MD|vauthors=Lopez-Gonzalez L, Pickens GT, Washington R, Weiss AJ|pmid=25535644 }}

There have been concerns regarding the safety of ambulatory medicine.{{cite journal | vauthors = Bates DW, Singh H | title = Two Decades Since To Err Is Human: An Assessment Of Progress And Emerging Priorities In Patient Safety | journal = Health Affairs | volume = 37 | issue = 11 | pages = 1736–1743 | date = November 2018 | pmid = 30395508 | doi = 10.1377/hlthaff.2018.0738 | s2cid = 53227942 | doi-access = free }}{{cite journal | vauthors = Geraedts M, Krause S, Schneider M, Ortwein A, Leinert J, de Cruppé W | title = Patient safety in ambulatory care from the patient's perspective: a retrospective, representative telephone survey | journal = BMJ Open | volume = 10 | issue = 2 | pages = e034617 | date = February 2020 | pmid = 32066609 | doi = 10.1136/bmjopen-2019-034617 | pmc = 7044884 }} Some of the common potential sources of harm include errors to medications and diagnostics as well as breakdowns in communications and coordination of care.{{cite journal | vauthors = Singh H, Carayon P | title = A Roadmap to Advance Patient Safety in Ambulatory Care | journal = JAMA | volume = 324 | issue = 24 | pages = 2481–2482 | date = December 2020 | pmid = 33351052 | pmc = 8016440 | doi = 10.1001/jama.2020.18551 }} One major complication of ambulatory care that predisposes to patients to harm is the risk for missing appointments.{{cite journal | vauthors = Whear R, Thompson-Coon J, Rogers M, Abbott RA, Anderson L, Ukoumunne O, Matthews J, Goodwin VA, Briscoe S, Perry M, Stein K | display-authors = 6 | title = Patient-initiated appointment systems for adults with chronic conditions in secondary care | journal = The Cochrane Database of Systematic Reviews | volume = 2020 | pages = CD010763 | date = April 2020 | issue = 4 | pmid = 32271946 | pmc = 7144896 | doi = 10.1002/14651858.CD010763.pub2 }} Missed appointments are common, costly, and can lead to significant delays in both diagnosis and treatment.

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. Some have raised the notion of designing health professionals payment policies with greater focus on safety in addition to patient volumes. 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.{{cite journal | vauthors = Carayon P, Wooldridge A, Hoonakker P, Hundt AS, Kelly MM | title = SEIPS 3.0: Human-centered design of the patient journey for patient safety | journal = Applied Ergonomics | volume = 84 | pages = 103033 | date = April 2020 | pmid = 31987516 | pmc = 7152782 | doi = 10.1016/j.apergo.2019.103033 }}{{cite journal | vauthors = Goodell M | title = Improving Ambulatory Patient Safety: The Role of Family Medicine | journal = Family Medicine | volume = 49 | issue = 2 | pages = 155–156 | date = February 2017 | pmid = 28218948 | url = https://fammedarchives.blob.core.windows.net/imagesandpdfs/pdfs/FamilyMedicineVol49Issue2Goodell155.pdf }}

• Primary care
• Reason for encounter
• Health care provider
• Ambulatist
• Ambulatory care nursing
• Ambulatory as a medical term
• National Association for Ambulatory Urgent Care

{{Reflist}}

Category:Ambulatory care

Category:Types of health care facilities

Category:Hospital departments