Re-attendance at Emergency Department for Elderly Patients with Chronic Obstructive Pulmonary Disease Exacerbation

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.