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Patient-perceived access to care is a driver of increased emergency department presentations by the elderly

conference contribution
posted on 2023-05-23, 13:38 authored by Claire MorleyClaire Morley, Gregory PetersonGregory Peterson, Jim Stankovich, Leigh Kinsman

BACKGROUND: Emergency department crowding is one of the biggest issues facing healthcare sustems worldwide. Increased presentation by the elderly have been identified as a potential contributing factor. Patient-perceived access to care has been suggested as one explanation for increased elderly presentations. A group of conditions collectively called Potentially Preventable Hospitalisations (PPHs) are a commonly used measure of patient-perceived access to primary care services.

AIM: To investigate the hypothesis that patient-perceived access to care, as measured by PPHs, is a factor leading to increased emergency department presentations and subsequent hospitalisations of elderly patients.

METHOD: Six years of inpatient data, from one Australian hospital, were coded to identify PPHs. The data were further divided to identify (i) admissions by those aged ≥75 years and (ii) admissions by patients aged ≥75 years with a length of stay ≤2 days (short-stay). Descriptive statistics were used to compare changes in rates of admissions for PPHs versus non-PPHs.

RESULTS: PPHs accounted for 7.4% of all admissions and increased by 21% over 6 years, whereas non-PPHs increased by only 1.7%. Twenty-five percent of PPHs were by patients aged ≥ 75 years. PPHs related to chronic disease increased at the greatest rate (16%) for this patient demographic. Short-stay admissions for PPHs accounted for 51% of all PPHs in patients aged ≥75 years, and increased by 70% over six years. Congestive cardiac failure (CCF) was the most common associated condition, accounting for 21% of all short-stay PPHs in the elderly.

CONCLUSION: Our analysis suggests that patient-perceived access to care, as measured by PPHs, is a driver of increased emergency department presentations and subsequent hospital admissions of patients aged ≥75 years. Short-stay admissions for chronic conditions are the biggest contributor. Understanding elderly patients' perceptions of access to chronic care management outside of the hospital setting may provide insights into how best to improve access to required services, and thereby reduce the need for expensive, short-term, acute care management of chronic conditions.

History

Publication title

6th Annual Worldwide Nursing Conference (WNC2018)

Pagination

51-58

ISSN

2315-4330

Department/School

School of Nursing

Publisher

Global Science and Technology Forum

Place of publication

Singapore

Event title

6th Annual Worldwide Nursing Conference (WNC2018)

Event Venue

Singapore

Date of Event (Start Date)

2018-01-01

Date of Event (End Date)

2018-01-01

Rights statement

Copyright 2018 GSTF

Repository Status

  • Restricted

Socio-economic Objectives

Clinical health not elsewhere classified

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