Re-attendance at Emergency Department for Elderly Patients with Chronic Obstructive Pulmonary Disease Exacerbation
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Re-attendance at Emergency Department for Elderly Patients with Chronic Obstructive Pulmonary Disease Exacerbation Saengdao Janda1 · Siriorn Sindhu2 · Nantiya Watthayu3 · Piyanun Limruangrong4 · Chukiat Viwatwongkasem5 · Watchara Boonsawat6
© Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Re-attendance at the Emergency Department (ED) is more frequently found among elderly patients with chronic obstructive pulmonary disease (COPD) exacerbations than other ages. Furthermore, elderly patients are at greater risk for death. Each level of hospital has different resources and service system arrangements in the ED. The study was aimed at studying the factors influencing re-attendance in health service system and patient factors. A prospective cohort study of older aged ≥60 years was conducted. Patients were monitored for 60 days and 816 subjects were selected from 47 hospitals by the multistage method. According to the findings, 61.9 percent of patients were found to have re-attendance. Community hospitals had re-attendances similar to general and advanced hospitals (62.2%, 61.5% and 61.0%, respectively). Most of the patients had re-attendance once (51.3%) (Median = 38.5). In Thailand, the central region has the highest rate of re-attendance, but the ED has clinical practice guidelines (CPGs) for COPD at only 48.9 percent. The factors influencing re-attendance are OPD follow-up (HR 1.39; 95% CI 1.12-1.74), patients’ anxiety (HR 1.67; 95% CI 1.30-2.14) and previous visits and admissions to the ED. (HR 1.87; 95% CI 1.34-2.61) (HR 1.30; 95% CI 1.04-1.63). Nevertheless, level of hospital, CPGs and health education had no differences in re-attendance with statistical significance. The service system at the ED should have discharge plans covering prevention or reduction of re-attendance rates. In addition, hospitals with different levels should manage resources to reduce re-attendance rates. Keywords Aging · Chronic obstructive pulmonary disease · Exacerbation · Re-attendance · Emergency department
Siriorn Sindhu
[email protected]
Extended author information available on the last page of the article.
Ageing International
COPD is the third leading cause of death worldwide (World Health Organization, 2016) .Mortality rates from chronic lower respiratory diseases are the eighth highest in Thailand and rose from 11.3 to 13.9 per hundred thousand people from 2013 to 2017 with nearly 80 percent of incidents being found in elderly patients. In Thailand, COPD is most prevalent is the northern region (24.1%), followed by the southern region (18%) because air quality is lower than standard criteria due to forest fires, burning of agricultural materials, tobacco fermentation and air pollution from industrial factories (Department of Health and Department of Disease Control 2015; Guo et al. 2014). COPD is encountered least frequently in the northeastern region (9.7%). Furthermore, rates of ED visits due to COPD exacerbation have increased by 29 percent over the past three years (Bureau of Polic
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