The Perceived Risk of Hospitalization in Primary Health Care - The Importance of Multidimensional Assessment.

ABSTRACT

Ageing has increased the use of health services, with a corresponding rise in avoidable hospitalizations. We aimed to assess and characterize the perceived risk of hospitalization in primary health care (PHC). 118 individuals aged ≥65 years, PHC patients, were assessed using the Community Risk Assessment Instrument by their General Practitioner, who identified their perceived risk of hospitalization, at one year. The instrument is composed of three domains (mental state, daily living activities (ADLs) state and medical state). Multivariate logistic regression was used to identify the best model to predict the risk of hospitalization. Four models were estimated, one for each domain and one with all the variables of the instrument. 58.5% were identified as being at risk of hospitalization. The best predictive models are those that include functionality assessment variables (ADL model and Community Assessment of Risk Instrument model). The model that includes all the variables of three domains presents the best predictive value. Mobility problems (Odds Ratio (OR) 16.18 [CI 1.63-160.53]), meal preparation (OR 10.93 [CI 1.59-75.13]), communication (OR 6.91 [CI 1.37-34.80]) and palliative care (OR 4.84 [CI 1.14-20.58]) are the best predictors of hospitalization risk. The use of multidimensional assessment tools can allow the timely identification of people at risk, contributing to a reduction in hospitalizations.