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

Abstract

Background: 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. Aims: We aimed to describe the multidimensional characteristics of complex chronic patients who sought urgent care. Design: We conducted a descriptive, cross-sectional, retrospective study, drawing on a large electronic health record database in primary care in Barcelona, Spain. Methods: 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. Finding: 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. Discussion: 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 noninstitutional caregivers. Conclusion: 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.