[Care contacts of elderly patients in the emergency care pathway: a retrospective cohort study].

Autor:	Berben SAA; Acute Zorgregio Oost, Nijmegen., Bloemhoff A; Acute Zorgregio Oost, Nijmegen.; Contact: A. Bloemhoff (anneke.bloemhoff@azo.nl)., Habets KCF; Acute Zorgregio Oost, Nijmegen., Liefers J; Acute Zorgregio Oost, Nijmegen., Hensens CJM; Coöperatie Integrale Huisartsenzorg, Nijmegen., van Grunsven PM; Regionale Ambulancevoorziening Veiligheidsregio Gelderland-Zuid, Nijmegen., Schoon Y; Radboudumc, afd. Geriatrie, Nijmegen., van den Berg HAM; Acute Zorgregio Oost, Nijmegen.
Jazyk:	Dutch; Flemish
Zdroj:	Nederlands tijdschrift voor geneeskunde [Ned Tijdschr Geneeskd] 2019 Jul 29; Vol. 163. Date of Electronic Publication: 2019 Jul 29.
Abstrakt:	Objective: To gain insight into the differences in emergency care offered to elderly (65+ years) and younger patients (20-64 years). The emergency care pathway includes: out-of-hours general practitioner cooperatives, regional ambulance services, psychiatric emergency medical services, accident and emergency departments and acute cardiac care units. Design: Retrospective cohort study. Method: We used data from all emergency care contacts from the Emergency Care Monitor of April 2015 and April 2016 from an emergency care region in the east of the Netherlands ('Acute Zorgregio Oost'); this involved 84,647 care contacts with 55,061 patients. We defined pathway emergency care contacts as multiple emergency care contacts with different healthcare providers within the emergency care pathway, and differentiated between single or repeated care contacts with a single emergency healthcare provider. We investigated differences in presenting symptoms, diagnoses, lead time, hospital admissions and mortality in the chain care. Results: Emergency care contact was more often pathway contact in elderly than in younger patients (26% vs. 16%; p < 0.0001). Elderly patients more often received a diagnosis of CVA, pneumonia or exacerbation of COPD, while younger patients more often had simple contusions or abdominal symptoms. Pathway lead time was longer in elderly than in younger patients (median difference: 33 minutes; 95% CI: 25-40. Elderly patients were admitted to hospital more often (71% vs. 39%, p < 0.0001) and their mortality rate was higher (2.0% vs. 0.5%; p < 0.0001). Conclusion: Elderly patients in the emergency care pathway have more frequent and longer pathway contact and present themselves with a more complicated and life-threatening clinical picture than younger patients. New solutions should be explored to ensure that the emergency care pathway remains accessible and available and offers sufficient quality for the increasing number of elderly.
Databáze:	MEDLINE
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