The Perceived Risk of Hospitalization in Primary Health Care – The Importance of Multidimensional Assessment

Abstract

Ageing has increased the use of health services, with a corresponding rise in avoidable hospitalizations. We aimed to assess and characterize the perceived risk of hospitalization in primary health care (PHC). 118 individuals aged ≥65 years, PHC patients, were assessed using the Community Risk Assessment Instrument by their General Practitioner, who identified their perceived risk of hospitalization, at one year. The instrument is composed of three domains (mental state, daily living activities (ADLs) state and medical state). Multivariate logistic regression was used to identify the best model to predict the risk of hospitalization. Four models were estimated, one for each domain and one with all the variables of the instrument. 58.5% were identified as being at risk of hospitalization. The best predictive models are those that include functionality assessment variables (ADL model and Community Assessment of Risk Instrument model). The model that includes all the variables of three domains presents the best predictive value. Mobility problems (Odds Ratio (OR) 16.18 [CI: 1.63–160.53]), meal preparation (OR 10.93 [CI: 1.59–75.13]), communication (OR 6.91 [CI: 1.37–34.80]) and palliative care (OR 4.84 [CI: 1.14–20.58]) are the best predictors of hospitalization risk. The use of multidimensional assessment tools can allow the timely identification of people at risk, contributing to a reduction in hospitalizations.

Early characterization of an adult population at an insurer’s point of entry as an opportunity to identify hospitalization risk

“…Las hospitalizaciones prevenibles son eventos que se desean minimizar con el fin de cuidar la salud de los afiliados y reducir costos en salud. En este sentido, se han identificado precursores de mayor riesgo de hospitalización como edad avanzada, vivir solo, dependencia para actividades cotidianas 2,3 , problemas cognitivos, de visión, comunicación y en la marcha que dificultan la autonomía y autocuidado de los pacientes y que han demostrado aumentar significativamente dicho riesgo de hospitalización 4,5 .…”

“…A lo anterior se suma que la mayoría de las hospitalizaciones evitables son en personas mayores de 65 años quienes tienen más comorbilidades 6 y, en consecuencia, se ha documentado que a mayor número de diagnósticos se tiene mayor probabilidad de ser hospitalizado 5,7 por lo que es importante este conocimiento por parte del prestador primario de salud para la gestión respectiva. Además, se han realizado estudios para identificar la población con más riesgo de hospitalización o necesidad de atención en los servicios de urgencias 8 y también se han diseñado instrumentos que permiten analizar este riesgo en poblaciones específicas de pacientes.…”