Efficient response in primary care would reduce the use of hospitals by seniors

Mar 10 2008

Researchers from the Department of Preventive Medicine and Public Health from the University of Granada have carried out a study with patients over 60.

The main conclusion they have come to is that an efficient response in primary care would reduce hospitalisations in more than 50% of the cases caused by three of the most frequent pathologies in older population: diabetic ketoacidosis, digestive haemorrhage and chronic bronchitis.

The study, carried out by Doctor Isabel Valenzuela López and supervised by Professors Aurora Bueno Cavaillas and José Luis Gastón Morata, has analysed the main reasons for hospitalisations caused by the pathologies that demand an effective response in primary care and how these hospitalisations could be avoided.

The significance of such study is unquestionable, considering that the elderly population represents the highest public health consumption. Furthermore, the percentage of the Spanish population who reaches an elderly age has risen from 26% at the beginning of the 20th century to 86% today.

Chronic diseases

“The expanding proportion of elderly people has altered the pattern of illnesses which were once frequent - explains the author of this project- and now chronic diseases, a higher need of medicines and social care needs prevail”. All this means a higher consumption of both public health resources and national health assistance since the elderly population makes up between 40-45% of the hospitalisations, occupies 40-50% of doctors working in primary care, and is the recipient of more than 50% of the medicines prescribed in hospitals.

The researchers interviewed all the family doctors from seven different hospitals in Granada and asked them about the main reasons for hospitalisations in patients over 60 as well as to what extent these hospitalisations, caused by the problems described above, could be prevented. The interviewed professionals answered that a more efficient response in primary health care would reduce in more than 50% the hospitalisations caused by three pathologies: diabetic ketoacidosis, digestive haemorrhage and chronic bronchitis. However, in patients suffering from cancer and acute coronary syndrome an enhanced primary care would only reduce the hospitalisations by 25%.

Scientists analysed 6 health problems, 3 chronic diseases (acute coronary syndrome, chronic bronchitis and diabetes) and three acute ones (pneumonia, transient ischemic attack and digestive haemorrhage) to find the connection between primary care effectiveness and the prevention of hospitalisations caused by these health problems. 717 patients over 60 were taken for the study, with an average age of 75.65 years 59.97% of whom were men.

Twice the risk

Isabel Valenzuela outlines that, according to the study, “each new chronic disease suffered by a patient means twice the risk of hospitalisation by any of the 6 studied pathologies” which means that anyone suffering 5 or more diseases would present a probability of hospitalisation 61 times higher than someone healthy. Moreover, each new medicine prescribed increases the risk of hospitalisation. Those patients who have been taking 5 or more different medications for the last 6 months have a 4.84 times increase in their risk of hospitalisation for these pathologies.

In short, the number of pathologies suffered by individual as well as past hospitalisations for causes different to those studied was considered as a risk factor for hospitalisations, although more significantly for severe cases. The amount of medicines consumed and the number of visits to the hospital was related with a higher frequency of hospitalisation, especially in chronic cases.