Utilization of medical healthcare among older people In relation to long-term municipal care

Abstract: The overall aim of this thesis was to investigate utilization of medical healthcare, i.e. hospital care and outpatient care, over a period of 1 to 5 years among people aged 65 years or older. The aim was further to investigate medical healthcare utilization in relation to the predisposal factors age and sex; the enabling factors functional ability, cognitive ability, informal care, municipal long-term care and in relation to such care provided at home or in special accommodation; and the need factors multimorbidity, health complaints and mortality. Study I includes 4907 people aged 65 years or older who had one or more hospital stays during 2001. Out of these, 694 people received long- term municipal care and were included in Study II. Studies III and IV include 1079 people who received a decision concerning initiation of long-term municipal care for the first time in 2001, 2002 or 2003. The samples were identified and data collected through the Good Ageing in Skåne Study (GAS) and from the administrative registers Patient Administrative Support in Skåne (PASiS) and PrivaStat. The results from Study I show that 15% of the sample had 3 or more hospital stays during the year (range 3-15) and accounted for 35% of admissions. This group had significantly more contacts with physicians in outpatient care (median (md)=15) compared to those with 1 (md =8) or 2 admissions (md=11). The number of diagnosis groups (B=0.395) and the number of contacts with the physician in outpatient care (B=0.18) were associated with the number of hospital stays. The results from Study II show that those who were admitted to hospital and received long-term municipal care at home had a significantly larger proportion who were admitted 3 or more times (21% vs. 14%, p=0.006) and significantly more contacts with physicians in outpatient care (md=10 vs. md=7, p<0.001) than those admitted from special accommodation. Informal care was associated with care at home (OR=0.074) and with utilization of outpatient care (B=1.375). Dependency in PADL was associated with care in special accommodation (OR=1.1375) and with utilization of hospital care (B =-0.581). The results in Study III showed that that the mortality rate among those who received a decision concerning the initiation of long-term municipal care was high, 47% died within three years after the decision. Those cared for at home had significantly more hospital stays than those in special accommodation in the first year (mean 1.1 (SD 1.6) vs. 0.7 (SD 1.4), p=0.001) and in the second year (mean 0.9 (SD 1.5) vs. 0.6 (SD 1.3), p=0.003) but not in the third year (mean 0.6 (SD 1.3) vs. 0.5 (SD 1.4), p=0.4) after the initiation of long-term care. Those at home also had significantly more contacts with physicians in outpatient care in the first year (mean 11.4 (SD 9.8) vs. 8.8 (SD 8.5), p<0.001), in the second year (mean 10.4 (SD 9.9) vs. 7.6 (SD 7.1), p<0.001) and in the third year (mean 8.9 (SD 11.1) vs. 6.7 (SD 6.9), p=0.003). The results in Study IV showed that those who had 3 or more hospital stays in the first year after the initiation of long-term care remained the highest rates of hospital and outpatient care utilization in the subsequent two years and accounted for 57% of hospital admissions in the first year, 27% in the second and 18% in the third year. The risk of frequent hospital admissions in the second year was 27% in this group and 12% in the third year.