HANNA BRING: Exploring potentially preventable emergency department visits in frail older adults – increasing knowledge for the development of a complex intervention in primary care

Project description

Background

The growing proportion of older individuals is placing increasing demands on healthcare organizations. Frail older people with multiple long-term conditions have a high risk of acute illness and make up a substantial part of all emergency department (ED) visits. In Sweden in 2023, 47% of all emergency visits by individuals aged 18 years or older were made by those 65 years or older, and 20% were made by those 80 years or older. Frail older people are often complex to assess and at risk for complications in the ED. The proportion of ED visits deemed to be preventable in older people varies between 5,7% and 53,5% in previous studies. A well-functioning primary care system that detects and addresses declines in health status early could prevent such visits. There are clinical examples on how to organize primary health care for older people, but only some have been scientifically evaluated, and with mixed results. Further knowledge is needed to identify the key issues that need to be addressed.

Aim

This doctoral project is a part the development of a complex intervention in primary care aiming to reduce emergency department visits in frail older adults in Sweden

The specific aim of this doctoral project is to explore reasons for preventable emergency visits in frail older people.

Method

The doctoral project uses qualitative and quantitative methodology.

Two qualitative studies are planned. In study 1, home health care patients and their family members are interviewed about their experiences with healthcare in the time leading up to an ED visit. The interviews are analyzed with thematic analysis. In study 2, a range of health care professionals involved in the care of frail older people (from primary care, home health care during and out of office hours, hospital-at-home services, geriatrics, ambulance services, and emergency department) participate in a free-text survey with questions regarding the potential preventability of ED visits. The free-text answers are analyzed with qualitative content analysis.

In two epidemiological register-based studies reasons and risk factors for ED visits in patients receiving home healthcare are explored. Study 3 focuses on the incidence of ED visits, diagnosis given at ED visit, and the proportion of potential preventable ED visits. In study 4, the relevance of factors linked to the primary care practice providing care (such as list size or accessibility) are investigated.