Older persons are frailer after an emergency care visit to the out-of-hours general practitioner cooperative in the Netherlands: a cross-sectional descriptive TOPICS-MDS study.

BACKGROUND: In the Netherlands, community-dwelling older people with primary care emergency problems contact the General Practitioner Cooperative (GPC) after hours. However, frailty remains an often unobserved hazard with adverse health outcomes. The aim of this study was to provide insight into differences between older persons with or without GPC emergency care visits (reference group) regarding frailty and healthcare use. METHODS: A cross-sectional descriptive study design was based on data from the public data repository of The Older Persons and Informal Caregivers Survey Minimum Dataset (TOPICS-MDS). Frailty in older persons (65+ years, n = 32,149) was measured by comorbidity, functional and psychosocial aspects, quality of life and a frailty index. Furthermore, home care use and hospital admissions of older persons were identified. We performed multilevel logistic and linear regression analyses. A random intercept model was utilised to test differences between groups, and adjustment factors (confounders) were used in the multilevel analysis. RESULTS: Compared to the reference group, older persons with GPC contact were frailer in the domain of comorbidity (mean difference 0.52; 95% CI 0.47-0.57, p < 0.0001) and functional limitations (mean difference 0.53; 95% CI 0.46-0.60, p < 0.0001), and they reported less emotional wellbeing (mean difference - 4.10; 95% CI -4.59- -3.60, p < 0.0001) and experienced a lower quality of life (mean difference - 0.057; 95% CI -0.064- -0.050, p < 0.0001). Moreover, older persons more often reported limited social functioning (OR = 1.50; 95% CI 1.39-1.62, p < 0.0001) and limited perceived health (OR = 1.50, 95% CI 1.39-1.62, p < 0.0001). Finally, older persons with GPC contact more often used home care (OR = 1.37; 95% CI 1.28-1.47, p < 0.0001) or were more often admitted to the hospital (OR = 2.88; 95% CI 2.71-3.06, p < 0.0001). CONCLUSIONS: Older persons with out-of-hours GPC contact for an emergency care visit were significantly frailer in all domains and more likely to use home care or to be admitted to the hospital compared to the reference group. Potentially frail older persons seemed to require adequate identification of frailty and support (e.g., advanced care planning) both before and after a contact with the out-of-hours GPC.

Frequent attendance of primary care out-of-hours services in the Netherlands: characteristics of patients and presented morbidity.

BACKGROUND: Over the last years, a system of regional general practices was developed in The Netherlands, responsible for the primary care out-of-hours services (OHS). As in daytime, frequent attendance of the OHS increases workload and the health care; detailed description of the background of frequent attendance is required to develop interventions aiming at reduction. OBJECTIVES: To assess the characteristics of the frequent attenders (FAs) and the presented morbidity during their consultations and to study the persistence of frequent attendance. METHODS: We performed a retrospective descriptive 1-year database investigation of all patient contacts (n = 44 953) made in 2007 with the OHS 'de Gelderse Vallei'. We analysed characteristics of normal attender, FA and very frequent attender (VFA) and compared the reason for encounter, GP diagnoses, psychiatric co-morbidities and management during their 2007 consultations. RESULTS: VFAs, constituting 1% of the attenders and 7.7% of the total number of contacts, more often reported agitation as reason for encounter. The prevalence of psychiatric diagnosis in the VFA group (15.3%) was significantly higher than in other groups. Reassurance was the most frequent prevalent management action in each group. The prevalence of chronic diseases and psychological problems was higher in the VFA groups. CONCLUSIONS: Frequent attendance puts severe pressure on OHS resources. Much of the frequent attendance can be explained by the increased incidence of chronic diseases and psychiatric co-morbidity.