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. 2022 Dec;41(4):e328-e338.
doi: 10.1111/ajag.13110. Epub 2022 Jun 27.

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

Margaret Williamson  1 , Margo Linn Barr  1 , Alamgir Kabir  1 , Elizabeth Jane Comino  1 , Brendan Goodger  2 , Ben F Harris-Roxas  3 , Ann-Marie Crozier  4 , Tony Jackson  5 , Julie Finch  4 , Mark Fort Harris  1
Affiliations

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

Margaret Williamson et al. Australas J Ageing. 2022 Dec.

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.

Keywords: health-care utilisation; mortality; population characteristics.

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Conflict of interest statement

No conflicts of interest declared. MB AK and MW's positions were funded by the funding partners. The CES Primary and Community Health Cohort/Linkage Resource management group includes representatives from each of the funding partners. The management group oversees what projects are conducted using the Resource and provides input into the overall design, interpretation of the results and knowledge translation opportunities.

Figures

FIGURE 1
FIGURE 1
Research design
FIGURE 2
FIGURE 2
Flow diagram for the study participants
FIGURE 3
FIGURE 3
Kaplan−Meier survival curves: Effect of being frequent users of health services (A) general practitioner attendances, (B) medical specialist attendances, (C) emergency department presentations and (D) overnight hospitalisations on mortality, participants aged over 75 years, Central and Eastern Sydney
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