Older frequent users of acute care can experience fragmented care. There is a need to understand the issues in a local context before attempting to address fragmented care. 0.5% (n=61) of the population in a defined local government area were identified as having ≥4 unplanned emergency department (ED) presentations/ admissions to an acute-care hospital over 13 months. A retrospective case-series study was conducted to examine detailed pathways of care for 17 patients within the identified population. The two dominant presentation reasons were clinical symptoms associated with a declining/significant loss of capacity in fundamental self-care activities and chronic cardiac/respiratory conditions. Of patients discharged home, 21% of discharge letters were delayed >7 days and only 19% received a written discharge plan. Half of community dwelling patients received home nursing and/or assistance. Frequent users of acute care can experience untimely hospital communication and may require more coordinated care provided in the community to assist self-care and manage chronic conditions.
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Damery S, Flanagan S, Combes G. Does integrated care reduce hospital activity for patients with chronic diseases? An umbrella review of systematic reviews. BMJ Open. 2016;6(11):e011952.
Flanagan S, Damery S, Combes G. The effectiveness of integrated care interventions in improving patient quality of life (QoL) for patients with chronic conditions. An overview of the systematic review evidence. Health Qual Life Outcomes. 2017;15(1):188.
Shaw SE, Rosen R. Fragmentation: a wicked problem with an integrated solution? J Health Serv Res Policy. 2013;18(1):61–4.
Kitson A, Powell K, Hoon E, Newbury J, Wilson A, Beilby J. Knowledge translation within a population health study: how do you do it? Implement Sci. 2013;8:54.
Australian Bureau of Statistics. National Regional Profile -Campbelltown (SA) Canberra: Australian Bureau of Statistics; 2012 [updated 26 June 2015].
Australian Institute of Health and Welfare. National healthcare agreement: PI 18-Selected potentially preventable hospitalisations 2015 [20 May 2015]. Available from: https://doi.org/meteor.aihw.gov.au/content/index.phtml/itemId/559032.
Bywood P, Jackson-Bowers E, Muecke S. Initiatives to integrate primary and acute health care, including ambulatory care services. Adelaide: Primary Health Care Research & Information Service. 2011.
WHO. World Report on Ageing and Health. Geneva: World Health Organization. 2015.
Longman JM, M IR, Passey MD, Heathcote KE, Ewald DP, Dunn T, et al. Frequent hospital admission of older people with chronic disease: a cross-sectional survey with telephone follow-up and data linkage. BMC Health Serv Res. 2012;12:373.
Braet A, Weltens C, Sermeus W, Vleugels A. Risk factors for unplanned hospital re-admissions: a secondary data analysis of hospital discharge summaries. J Eval Clin Pract. 2015.
O’Halloran J, Britt H. General practice encounters with older Australians. Australas J Ageing. 2004;23(1):7–12.
Li JY, Yong TY, Hakendorf P, Ben-Tovim D, Thompson CH. Timeliness in discharge summary dissemination is associated with patients’ clinical outcomes. J Eval Clin Pract. 2013;19(1):76–9.
Oliver D, Foot C, Humphries R. Making our health and care systems fit for an ageing population. London: The Kings Fund. 2014.
International Association of Public Participation. IAP2’s Public Participation Spectrum: International Association of Public Participation; 2014 [cited 2015 24 June]. Available from: file:///C:/Users/a1107184/Downloads/IAP2’s%20Public%20Participation%20Spectrum%20(3).pdf.
Mudge AM, Barras M, Adsett J, Mullins RW, Lloyd S, Kasper K. Improving care transitions in individuals frequently admitted to the hospital. JAGS. 2014;62(10):1994–6.
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Dollard, J., Harvey, G., Dent, E. et al. Older People Who are Frequent Users of Acute Care: A Symptom of Fragmented Care? A Case Series Report on Patients’ Pathways of Care. J Frailty Aging 7, 193–195 (2018). https://doi.org/10.14283/jfa.2018.12
- Frail elderly
- ambulatory care
- disease management
- delivery of health care