Speaker
Description
The research of prospective cohort study aimed to examine factors of health service delivery system and patient-related factors affecting re-attendance at the ED of the elderly patients with exacerbation of COPD with 60-day follow-up. The samples included 816 patients randomly selected with multistage method from 47 hospitals in 16 provinces covering all regions of Thailand. Data were collected during January- July 2018 and the samples were calculated with sample size requirement for survival study proportion for cohort study and proportion for multilevel analysis.
The findings reveal that patients re-attendance at the ED in 60 days occurred for 61.9$\%$. Community hospitals, re-attendance rate was 63.5$\%$ while the re-attendance rate at tertiary hospital was 54.9$\%$. The highest re-attendance rate was 5 times and the majority re-attended for 1 time (51.3$\%$). Time to re-attendant had a median of 38.5 days. Top 3 provinces with highest re-attendance rate included Srakaew, Nongbualamphu and Lampang. The result of multilevel survival analysis indicated that 1) the patients who previously visited at ED with COPD were likely to re-attend for 1.9 times of the patients whose never visited (HR 1.91; 95$\%$ CI 1.38 – 2.67) 2) the patients who were admitted with COPD tended to re-attend for 1.3 times of those who have never been admitted (HR 1.31; 95$\%$ CI 1.06 – 1.63) 3). The patients who had anxiety were likely to have re-attendance for 1.6 times of those with no anxiety (HR 1.61; 95$\%$ CI 1.26 – 2.05) and the patients who did not have an appointment to see physician at OPD after discharge from ED tended to re-attended the ED for 1.4 times of the patients with an appointment (HR 1.39; 95$\%$ CI 1.12 – 1.73).
The finding suggests that health service systems at ED should be improved with transferal of patients to continuing care.
| Area of Interest : | Nursing Research |
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