Predictors of ED attendance in older patients with chronic disease: a data linkage study
Ting Xia
A B E , Joanne Enticott A , Christopher Pearce A C , Danielle Mazza A and Lyle R. Turner A D
A Department of General Practice, School of Primary and Allied Health Care, Monash University, 270 Ferntree Gully Road, Notting Hill, Vic. 3168, Australia. Email: joanne.enticott@monash.edu; chris.pearce@monash.edu; Danielle.Mazza@monash.edu; Lyle.Turner@iuih.org.au
B Insurance Work and Health Group, Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Vic. 3004, Australia.
C Melbourne East General Practice Network (trading as Outcome Health), 250 Mont Albert Road, Surrey Hills, Vic. 3127, Australia.
D The Institute for Urban Indigenous Health, 22 Cox Road, Windsor, Qld 4030, Australia.
E Corresponding author. Email: ting.xia@monash.edu
Australian Health Review 44(4) 550-556 https://doi.org/10.1071/AH19169
Submitted: 24 July 2019 Accepted: 19 November 2019 Published: 17 July 2020
Journal Compilation © AHHA 2020 Open Access CC BY-NC-ND
Abstract
Objective Older people represent a large proportion of emergency department (ED) presentations, with multiple comorbidities a strong predictor of frequent attendance. This study examined associations between the general practice management received by older patients with chronic disease and ED attendance.
Methods This retrospective study examined linked data from general practice and ED for patients aged ≥65 years who presented to a general practitioner (GP) between 2010 and 2014. Data from the computerised medical records of patients attending 50 general practice clinics in the inner east Melbourne region ere linked with ED attendance data from the same region. Patients with chronic disease were identified and characteristics of ED versus non-ED attendees were compared. Poisson regression was used to explore factors associated with ED usage.
Results During the study period, 67 474 patients aged ≥65 years visited a GP, with 63.3% identified as having at least one chronic condition and 21.4% of these having at least one ED presentation. Over 70% of the ED presentations in this group resulted in hospital admissions. The most common diagnoses for ED presentation were cardiovascular disorders, pain and injuries. ED attendance was associated with being aged ≥85 years (incidence rate ratio (IRR) 2.09; 95% confidence interval (CI) 1.96–2.11), higher socioeconomic status (IRR 1.49; 95% CI 1.45–1.53), having a GP management plan (IRR 1.47; 95% CI 1.43–1.52), multimorbidity (IRR 1.53; 95% CI 1.46–1.60), more frequent GP visits (IRR 1.10; 95% CI 1.05–1.15) and having a higher numbers of prescriptions (IRR 1.51; 95% CI 1.44–1.57).
Conclusion This study suggests that ED presentation is associated with greater frailty and multimorbidity in patients. Further research is necessary to determine why higher rates of chronic disease management through GP management plans and more frequent visits did not mediate higher rates of presentation and the reasons behind the socioeconomic differences in ED presentation for patients in this age group.
What is known about the topic? Increases in the volume and rate of ED presentations by older people will markedly affect emergency and acute hospital care and patient flow as the proportion of older Australians increases.
What does this paper add? We used a novel and highly transferable data linkage between data collected from the clinical records of general practice patients and their associated data from ED and hospital settings and examined the relationship between GP management received by older patients with chronic disease and ED attendance.
What are the implications for practitioners? Increasing utilisation of GP services may not have an effect on reducing ED attendance, particularly for older patients who may experience poorer overall health.
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