title: Frequent hospital admission of older people with chronic disease: a cross-sectional survey with telephone follow-up and data linkage.
abstract: BACKGROUND
  The continued increase in hospital admissions is a significant and complex issue facing health services. There is little research exploring patient perspectives or examining individual admissions among patients with frequent admissions for chronic ambulatory care sensitive (ACS) conditions. This paper aims to describe characteristics of older, rural patients frequently admitted with ACS conditions and identify factors associated with their admissions from the patient perspective.
  
  
  METHODS
  Patients aged 65+ resident in North Coast NSW with three or more admissions for selected ACS chronic conditions within a 12 month period, were invited to participate in a postal survey and follow up telephone call. Survey and telephone data were linked to admission and health service program data. Descriptive statistics were generated for survey respondents; logistic regression models developed to compare characteristics of patients with 3 or with 4+ admissions; and comparisons made between survey respondents and non-respondents.
  
  
  RESULTS
  Survey respondents (n=102) had a mean age of 77.1 years (range 66-95 years), and a mean of 4.1 admissions within 12 months; 49% had at least three chronic conditions; the majority had low socioeconomic status; one in five (22%) reported some difficulty affording their medication; and 35% lived alone. The majority reported psychological distress with 31% having moderate or severe psychological distress. While all had a GP, only 38% reported having a written GP care plan. 22% of those who needed regular help with daily tasks did not have a close friend or relative who regularly cared for them. Factors independently associated with more frequent (n=4+) relative to less frequent (n=3) admissions included having congestive heart failure (p=0.003), higher social isolation scores (p=0.040) and higher Charlson Comorbidity Index scores (p=0.049). Most respondents (61%) felt there was nothing that could have avoided their most recent admission, although some potential avoidability of admission was described around medication and health behaviours. Respondents were younger and less sick than non-respondents.
  
  
  CONCLUSIONS
  This study provides a detailed description of older patients with multiple chronic conditions and a history of frequent admission in rural Australia. Our results suggest that programs targeting medication use, health behaviours and social isolation may help reduce multiple hospital admissions for chronic disease.
authors.affiliation: University Centre for Rural Health - University of Sydney, PO Box 3074, Lismore, NSW 2480, Australia. jo.longman@ucrh.edu.au
authors.forename: Jo M
authors.initials: JM
authors.lastname: Longman
authors.forename: Margaret
authors.initials: M
authors.lastname: I Rolfe
authors.forename: Megan D
authors.initials: MD
authors.lastname: Passey
authors.forename: Kathy E
authors.initials: KE
authors.lastname: Heathcote
authors.forename: Dan P
authors.initials: DP
authors.lastname: Ewald
authors.forename: Therese
authors.initials: T
authors.lastname: Dunn
authors.forename: Lesley M
authors.initials: LM
authors.lastname: Barclay
authors.forename: Geoffrey G
authors.initials: GG
authors.lastname: Morgan
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002391:Catchment Area, Health / Q000706:statistics & numerical data; D002908:Chronic Disease / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006299:Health Services for the Aged / Q000458:organization & administration*; D006305:Health Status Indicators; D006333:Heart Failure / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D008297:Male; D009517:New South Wales; D010359:Patient Readmission / Q000706:statistics & numerical data*; D017010:Reminder Systems; D012648:Self Care; D012944:Social Support; D012959:Socioeconomic Factors; D013315:Stress, Psychological; D011795:Surveys and Questionnaires; D013689:Telephone