Potentially preventable visits to the emergency department in older adults: Results from a national survey in Italy

• Published in: PloS one 2017-12, Vol.12 (12), p.e0189925-e0189925
• Main Authors: Gasperini, Beatrice, Cherubini, Antonio, Pierri, Francesca, Barbadoro, Pamela, Fedecostante, Massimiliano, Prospero, Emilia
• Format: Article
• Language: English
• Subjects: Adults; Aged; Aged, 80 and over; Demographics; Earth Sciences; Elderly; Emergencies; Emergency medical services; Emergency Service, Hospital - utilization; Emergency services; Female; Health; Health aspects; Health care; Households; Humans; Independent variables; Italy; Lists; Male; Medical care utilization; Medical diagnosis; Medical emergencies; Medicine and Health Sciences; Older people; People and Places; Prevention; Preventive medicine; Quality of life; Regression analysis; Regression models; Risk; Statistical analysis; Surveys; Surveys and Questionnaires
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0189925

Despite older adults use emergency department more appropriately than other age groups, there is a significant share of admissions that can be considered potentially preventable. To identify socio-demographic characteristics and health care resources use of older adults admitted to emergency department for a potentially preventable visit. Data come from the Multipurpose Survey "Health conditions and use of health services", edition 2012-2013. A stratified multi-stage probability design was used to select a sample using municipal lists of households. 50474 community dwelling Italians were interviewed. In this analysis, 27003 subjects aged 65 years or older were considered. Potentially preventable visits were defined as an emergency department visit that did not result in inpatient admission. Independent variables were classified based on the socio-behavioral model of Andersen-Newman. Descriptive statistics and a logistic regression model were developed. In the twelve months before the interview 3872 subjects (14.3%) had at least one potentially preventable visit. Factors associated with an increased risk of a potentially preventable visit were older age (75-84 years: OR 1.096, CI 1.001-1.199; 85+years: OR 1.022, CI 1.071-1.391), at least one hospital admission (OR 3.869, IC 3.547-4.221), to waive a visit (OR 1.188, CI 1.017-1.389) or an exam (OR 1.300, CI 1.077-1.570). Factors associated with a lower risk were female gender (OR 0.893, CI 0.819-0.975), area of residence (Center: OR 0.850; CI 0.766-0.943; Islands: OR 0.617, CI 0.539-0.706, South: OR 0.560; CI 0.505-0.622), private paid assistance (OR 0.761, CI 0.602-0.962); a better health-related quality of life (PCS score 46-54: OR 0.744, CI 0.659-0.841; PCS score >55: OR 0.746, CI 0.644-0.865). Our study identified several characteristics associated with an increased risk of potentially preventable visits to the emergency department. This might allow the development of specific interventions to prevent the access of at risk subjects to the emergency department.