Mapping emergency admissions of older adults with multimorbidity
Research type
Research Study
Full title
Journeys to hospital. An in-depth exploration of primary care’s role in the emergency admission of older people with multimorbidity
IRAS ID
161591
Contact name
Nicola Walker
Contact email
Sponsor organisation
University of Leicester
Duration of Study in the UK
2 years, 0 months, 30 days
Research summary
Summary of Research
Multimorbidity is the presence of more than one chronic disease. People with multimorbidity are more likely to experience an emergency admission to hospital. These admissions are expensive and can be distressing for patients and their carers. However, despite efforts to reduce emergency admissions, rates continue to increase, creating growing pressure on health system resources. A proportion of these admissions could be prevented or better managed in the community.
To understand the primary care factors associated with an emergency hospital admission for these people between 2 and 6 patients with multimorbidity and a recent emergency admission by their GP will be invited from each of up to six practices to participate in a qualitative study to map the patient's 'journey' from home to hospital.
Patient case records will be reviewed and those with a potentially avoidable admission will be invited for an interview. A visual map of each patient's journey will be drawn to document the series of steps occurring before admission. This will identify key events before admission and highlight individuals involved in the decision to admit them to hospital.
A carer will also be invited for interview as well as the admitting GP. For patients who lack capacity to consent we will approach the GP to nominate a consultee. Short periods of observation at the patient’s GP surgery and interviews with Practice Managers about the surgery’s approach to emergency admissions in older adults will be conducted.
Observational, interview and mapping data will be analysed to look for recurring themes to further explain the primary care factors associated with emergency admissions. Results of this study will aim to provide useful information for local policy makers and also inform the development of an intervention that could be used to reduce avoidable emergency admissions for patients with multimorbidity.Summary of Results
Seven case studies consisting of a patient or carer interview, admitting GP interview, medical record review were compiled. Patients had more than one chronic disease and a recent emergency admission by their GP. Medical records were reviewed for the twelve months prior to and including the admission. A map of the patient journey was drawn for each case detailing key interactions. Two focus groups of GPs, six further patient/ carer interviews and seven practice manager interviews were completed. Framework analysis was be used to help generate themes associated with the management of multimorbidity and the factors leading up to and involved in the decision-making processes in context of an admission.Poor collaboration within primary and secondary care was challenging for patients and GPs alike. Responsiveness of practices could have been timelier and more coordinated. Patients reported high trust in their GPs and were more willing to comply with management plans or an admission if they had a good relationship with them. GPs quoted external factors such as time pressures as impacting on an admission decision and also found prior knowledge of the patient, higher confidence levels in managing their condition and better access to support from secondary care colleagues assisted their decision.
As far as we are aware this is the first study in this area of its design. Improved collaboration within primary care teams and between primary and secondary care should the focus for improvement. Further research is needed to understand whether a more focused structured team approach with a lead clinician should be considered.
REC name
Wales REC 7
REC reference
17/WA/0198
Date of REC Opinion
17 Aug 2017
REC opinion
Further Information Favourable Opinion