Can ambulatory care sensitive condition hospitalizations be interpreted as an indicator of primary care performance during COVID-19? A scoping review

Hospitalizations for Ambulatory Care Sensitive Conditions (ACSCs) are commonly used as indicators of primary care performance and have been widely employed to assess the impact of disasters on health systems; however, their use during pandemics has not yet been comprehensively mapped. This scoping review aimed to synthesize evidence on trends in ACSCs hospitalizations during the COVID-19 pandemic to evaluate their usefulness as an indicator of health system performance in health emergencies. The review followed the JBI methodology and included peer-reviewed studies published from 2020 onwards reporting hospitalization trends for ACSCs, with no language or geographic restrictions. Two reviewers independently screened studies, with disagreements resolved by a third reviewer, and data were extracted using a researcher-developed tool and descriptively synthesized. Sixteen quantitative studies based on secondary data met the inclusion criteria, most of which were conducted in North America. Overall, the evidence showed a reduction in ACSCs-related hospitalizations during the pandemic, although trends varied by age group and diagnosis, with the largest declines observed for respiratory conditions, particularly asthma and chronic obstructive pulmonary disease. Six studies also examined vulnerability factors, identifying racial/ethnic minority status, socioeconomic disadvantage, and mental health conditions as important determinants of hospitalization. The observed reduction in ACSCs hospitalizations is likely explained by changes in care-seeking behaviour, infection-control measures, and healthcare reorganization rather than improved primary care performance. Therefore, ACSCs hospitalizations should be interpreted cautiously during health emergencies, as declining rates may conceal unmet healthcare needs instead of reflecting better primary care system performance.