Frequent users of health services among community‐based older Australians: Characteristics and association with mortality

Abstract

Objectives To investigate characteristics of frequent users of general practice (GP; ≥21 visits in a year), medical specialist (≥10 visits), emergency department (ED; ≥2 presentations) and hospital services (≥2 overnight hospitalisations) and the association with mortality for people aged over 75 years. Methods The study included residents from Central and Eastern Sydney, Australia, aged over 75 years who participated in a large community‐dwelling cohort study. Demographic, social and health characteristics data were extracted from the 45 and Up Study survey. Health service (GP, medical specialist, ED and hospitalisations) use and mortality data were extracted from linked administrative data. We calculated adjusted prevalence ratios to identify independent characteristics associated with frequent users of services at baseline (approx. 2008) and adjusted hazard ratios to assess the association between frequent users of services and mortality. Results Frequent users of services (GPs, medical specialists, EDs and hospitals) were more likely to be associated with ever having had heart disease and less likely to be associated with reporting good quality of life. Characteristics varied by service type. Frequent users of services were 1.5–2.0 times more likely to die within 7 years compared to those who were less frequent service users after controlling for all significant factors. Conclusions Our analysis found that frequent service users aged over 75 years had poorer quality of life, more complex health conditions and higher mortality and so their health service use was not inappropriate. However, better management of these frequent service users may lead to better health outcomes.

Impact of multimorbidity and complex multimorbidity on healthcare utilisation in older Australian adults aged 45 years or more: a large population-based cross-sectional data linkage study

“…Data collected via baseline questionnaire included sociodemographic and lifestyle characteristics, and self-reported health status and chronic conditions 33. We used a 3-year baseline period (the year before, the year of and the year after recruitment) to assess healthcare service utilisation to obtain a more accurate picture of participant’s service use for our analysis 34. We excluded from our analytic population those who: (1) withdrew from the 45 and Up Study (n=414); (2) had a date of birth in the 45 and Up Study dataset indicating they were <45 years old (n=7); (3) had a linkage error, multiple death records or an unusual date of death (n=20); (4) had completed their baseline survey before 20 February 2006, as death records from the NSW Register of Births, Deaths and Marriages (RBDM) were only available from that date (n=15 227); or (5) had died within the 3-year baseline period during which healthcare service utilisation was assessed (n=3193) (figure 1).…”

“…We used these data to calculate the average annual number of hospitalisations for each participant during the 3-year baseline period. We defined ‘high hospital use’ as an annual average of ≥2 overnight hospital stays during the baseline period 34…”

“…The EDDC contained records for all emergency department (ED) presentations for participants between 2006 and 2018. We defined ‘high ED use’ as an annual average of ≥2 ED presentations during the baseline period 34. Given ED data were unavailable before 2006, we excluded people who completed the baseline questionnaire on or before 2006 for this outcome only.…”

“…We defined ‘high hospital use’ as an annual average of ≥2 overnight hospital stays during the baseline period. 34 …”

“…We defined 'high hospital use' as an annual average of ≥2 overnight hospital stays during the baseline period. 34 The EDDC contained records for all emergency department (ED) presentations for participants between 2006 and 2018. We defined 'high ED use' as an annual average of ≥2 ED presentations during the baseline period.…”