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Observational Study
. 2018 Apr;50(4):222-227.
doi: 10.1016/j.aprim.2017.02.011. Epub 2017 Jun 10.

[Frequent attenders in Primary Health Care Centres and frequent attenders in Emergency Departments]

[Article in Spanish]
Cesáreo Fernández Alonso  1 , Juan Mariano Aguilar Mulet  2 , Rodolfo Romero Pareja  3 , Arístides Rivas García  4 , Manuel Enrique Fuentes Ferrer  5 , Juan Jorge González Armengol  6 ; en representación del Grupo de Trabajo del Paciente Fidelizado del Plan Estratégico de Urgencias de la Comunidad de Madrid
Affiliations
Observational Study

[Frequent attenders in Primary Health Care Centres and frequent attenders in Emergency Departments]

[Article in Spanish]
Cesáreo Fernández Alonso et al. Aten Primaria. 2018 Apr.

Abstract
in English, Spanish

Objective: To identify predictors of frequent attenders (HF) in Primary Health Care (PHC) centres in a sample of frequent attenders (HF) in Emergency Departments (ED).

Design: This was an observational, retrospective, multicentre cohort study.

Participants: The HF patients were selected from patients seen in the ED between January 1 and December 31, 2013. Setting Patients were recruited from 17 public hospitals of the Community of Madrid, Spain.

Method: Variables on the index visit to the ED were collected. The sample was analysed in terms of being or not being an HF user in PHC. An HF user is considered a patient who made at least 10 visits in each level of care for a year.

Results: A total of 1284 HF patients were included. An analysis was performed on 423 (32.9%) HF users in ED with 16 (12-25) visits to PHC vs. 861 (67.1%) non-HF users in ED, with 4 (2-6) visits to PHC. Independent predictors of HF in PHC: over 65 years (OR: 1.51; 95% CI: 1.07-2.13; P=.019), cognitive impairment (OR: 1.63; 95% CI: 1.01-2.65; P=.049), taking >3 drugs (OR: 1.56; 95% CI: 1.06-2.30; P=.025), and living in the community vs. nursing home or homeless (OR: 3.05; 95% CI: 1.14-8.16; P=.026).

Conclusions: Among HF patients in the ED, the fact that of being over 65 years, taking 3or more drugs, suffering cognitive impairment, and living in the community, are also considered to be predictors of HF in PHC.

Objetivo: Identificar factores predictores de hiperfrecuentación en Atención Primaria (AP) en una muestra de pacientes hiperfrecuentadores (HF) en servicios de urgencias hospitalarios (SUH).

Diseño: Estudio observacional retrospectivo multicéntrico.

Participantes: Se seleccionaron pacientes mayores de 14 años HF en el SUH entre el 1 de enero y el 31 de diciembre de 2013. Emplazamiento: se reclutaron pacientes atendidos en los SUH de 17 hospitales públicos de la Comunidad de Madrid.

Método: Se recogieron variables relativas a la visita índice del SUH. Se analizó la muestra en función de ser o no HF en AP. Se considera HF al paciente que realizó al menos 10 visitas en cada nivel asistencial durante un año.

Resultados: Se incluyeron 1.284 pacientes HF en SUH. Se analizaron 423 (32,9%) HF en AP con 16 visitas (RIC 12-25) frente a 861 (67,1%) pacientes no HF en AP con 4 visitas (RIC 2-6). Factores independientes predictores de HF en AP fueron la edad > 65 años (OR: 1,51; IC 95%: 1,07-2,13; p = 0,019), el deterioro cognitivo (OR: 1,63; IC 95%: 1,01-2,65; p = 0,049), el número de fármacos ≥3 (OR: 1,56; IC 95%: 1,06-2,30; p = 0,025) y vivir en la comunidad frente a vivir institucionalizado o en la calle (OR: 3,05; IC 95%: 1,14-8,16; p = 0,026).

Conclusiones: En una muestra de pacientes HF en los SUH, el hecho de ser mayor de 65 años, tomar 3 o más fármacos, presentar deterioro cognitivo y vivir en la comunidad se consideran factores predictores de ser HF también en AP.

Keywords: Atención primaria; Emergency Department; Factores predictores; Frequent attendance; Hiperfrecuentación; Predictors; Primary Health Care; Urgencias hospitalarias.

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