RESUMO
The growing elderly population and their overlapping conditions require more specialised care. The difficulties accessing scheduled hospital admissions often lead to visits to accident and emergency departments (A&E), which can have a harmful effect on these patients. The French Regional Health Agency (ARS) has developed geriatric hotlines in certain geriatric departments. An analysis of the populations concerned will allow adjustments to be made to this system in order to improve care pathways for the elderly and to better meet the needs of general practitioners. This is a descriptive, retrospective, monocentric epidemiological study conducted between February and July 2017. The caller, the reason for the call, the general practitioner's request, the demographic and geriatric characteristics of the patients and the response provided were described. Calls were mainly made by general practitioners, in 72.8% of the cases, for acute conditions. Access to hospital admission accounted for 69.6% of the requests, while a home assessment accounted for 16% of requests. Fifty-five per cent of the patients were admitted to hospital and 75% of them were admitted directly to the geriatric department. Twenty-one per cent of requests for hospital admission received other treatment. The average age of the patients was 86, with a majority of patients being poly-medicated, having multiple pathologies and also more neurocognitive disorders than the general population. Guidance is provided in 30% of the calls, improving the care pathway of these elderly patients. The time to response and to hospital admission is short, thus favouring direct access to hospital departments. The main independent risk factor for hospital admission was the presence of acute illness. This link between community and hospital care seems to respond to the principal requests of general practitioners, i.e. hospitalisation for acute conditions. It is beneficial for the management of these patients who are at risk of decompensation. Coordination and communication between the different players involved in community and hospital care must continue to develop to improve the care pathway of these complex geriatric patients.
RESUMO
The increasing elderly population and their overlapping conditions require more specialised care. The difficulties accessing scheduled hospital admission lead to visits to Accident and Emergency Department (A&E), which have a harmful effect on these patients. The Regional Health Agency (ARS) has developed geriatric hotlines in all geriatric sectors. An analysis of the population concerned will allow changes to be made to this system in order to improve the care pathway for the elderly and to better meet the needs of the general practitioners. This was a descriptive, retrospective, monocentric epidemiological study conducted from February to July 2017. The applicant, reason for the call, the general practioner's request, the demographic and geriatric characteristics of the patients, the response provided were described. The calls were mainly made by the general practitioners, in 72.8% of the cases, for acute conditions. Access to hospital admission accounted for 69.6% of the requests, a home assessment, 16 %. Fifty-five per cent of the patients were admitted to hospital, 75 % of them directly in geriatrics. Twenty-one per cent of the requests for hospital admission received other treatment. The average age was 86 years, with a majority of patients being poly-medicated, having multiple pathologies and also more neurocognitive disorders than the general population. Guidance is provided in 30 % of the calls, improving the care pathway of these elderly patients. The time to response and to hospital admission is short, thus favouring direct access to hospital departments. The main independent risk factor for hospital admission was the presence of acute illness. This community-hospital link seems to answer the principal request of GPs, i.e. hospitalization in acute condition. It is beneficial for the management of these patient at risk of decompensation. Coordination and communication between the different community-hospital players must continue to develop to improve the care pathway of these complex geriatric patients.