Multidimensional characteristics of complex chronic patients in emergency services in primary care

Abstract

<h2>ABSTRACT</h2><h3>Background</h3> In Spain, people between 65 and 74 years old have an average of 2.8 chronic problems or diseases, rising to 3.2 among people aged 75 and older. <h3>Aims</h3> We aimed to describe the multidimensional characteristics of complex chronic patients who sought urgent care. <h3>Design</h3> We conducted a descriptive, cross-sectional, retrospective study, drawing on a large electronic health record database in primary care in Barcelona, Spain. <h3>Methods</h3> We used health record data about subjects' clinical state, functional state, mental health state, social state, nutritional state, and movement. A descriptive analysis was carried out to determine percentages and means, given a standard deviation. <h3>Finding</h3> In 2019, 3,732 complex chronic patients sought urgent care at the centres under study. Subjects had a mean age of 82.5 ± 9.8 years, and 58.7% (n = 2,189) were women. Frailty was present in 69.3% (n = 2,586), and 81.7% (n = 3,050) were adherent to therapy. There were 2,470 visits to hospital emergency rooms (66.2%) and 1,651 hospital admissions (44.2%). Malnutrition was evident in 46.5% (n = 1,623) and 27.9% (n = 1,042) had low risk of social exclusion. <h3>Discussion</h3> Having such descriptive information can help health services from all areas and levels of care to use comprehensive, collaborative practices to care for complex chronic patients and their non-institutional caregivers. <h3>Conclusion</h3> We noted a high proportion of emergency room visits and hospital admissions among complex chronic patients. Low-level depression and malnutrition were detected. Proactive multidisciplinary interventions could improve the situation of these patients.