Department of General Practice, School of Primary and Allied Health Care, Monash University, 270 Ferntree Gully Road, Notting Hill, Vic. 3168, Australia. Email:
Aust Health Rev. 2020 Aug;44(4):550-556. doi: 10.1071/AH19169.
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, 67474 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.
目的
老年人在急诊科（ED）就诊中占很大比例，多种合并症是频繁就诊的强烈预测因素。本研究探讨了患有慢性疾病的老年患者接受全科医生管理与 ED 就诊之间的关联。
方法
本回顾性研究对 2010 年至 2014 年间在全科医生处就诊的年龄≥65 岁的患者进行了链接数据的分析。来自墨尔本内东区 50 家全科诊所的患者计算机化医疗记录中的数据与同一地区的 ED 就诊数据进行了链接。确定了患有慢性疾病的患者，并比较了 ED 就诊者与非 ED 就诊者的特征。使用泊松回归来探索与 ED 使用相关的因素。
结果
在研究期间，67474 名年龄≥65 岁的患者就诊于全科医生，其中 63.3%被确定为患有至少一种慢性疾病，其中 21.4%的患者至少有一次 ED 就诊。该组中超过 70%的 ED 就诊导致住院。ED 就诊的最常见诊断是心血管疾病、疼痛和损伤。ED 就诊与年龄≥85 岁（发病率比（IRR）2.09；95%置信区间（CI）1.96-2.11）、较高的社会经济地位（IRR 1.49；95%CI 1.45-1.53）、全科医生管理计划（IRR 1.47；95%CI 1.43-1.52）、多种合并症（IRR 1.53；95%CI 1.46-1.60）、更多的全科医生就诊（IRR 1.10；95%CI 1.05-1.15）和更高的处方数量（IRR 1.51；95%CI 1.44-1.57）相关。
结论
本研究表明，ED 就诊与患者的虚弱程度和多种合并症有关。需要进一步研究以确定为什么通过全科医生管理计划和更频繁的就诊来管理更多的慢性疾病并没有降低就诊率，以及为什么在这一年龄组中，社会经济差异与 ED 就诊有关。
关于该主题已知的内容？
老年人到急诊科就诊的人数和频率的增加将极大地影响急诊和急性医院护理以及患者流量，因为澳大利亚老年人的比例正在增加。
这篇论文增加了什么内容？
我们使用了一种新颖且高度可转移的数据链接，将从全科医生患者临床记录中收集的数据与其在 ED 和医院环境中的相关数据进行了链接，并研究了患有慢性疾病的老年患者接受的全科医生管理与 ED 就诊之间的关系。
对从业者的影响是什么？
增加对全科医生服务的利用可能不会对减少 ED 就诊产生影响，特别是对于整体健康状况较差的老年患者。
