Fréquence de consultation du médecin généraliste à 30 jours des sujets âgés de 75 ans et plus, rentrés à domicile à l’issue de leur admission aux urgences

Abstract : Background: Older people in emergency department are becoming more numerous. Half of them are discharged home and follow-up is based on the general practitioner. Objectives: The main goal is to measure the rate of general practitioner consult, 30 days after a home-discharged from the emergency department, for patients aged 75 years and over. Determinants of the consultation, 30-day hospital readmission rate and its risk factors were sought. Method: A descriptive, retrospective, mono-centric study in the emergency department of Annecy was conducted. Emergency files of 500 patients aged 75 and over, admitted in 2017 for medical complaint, and discharged home, were analyzed. Presence of a follow-up consultation was obtained by phone interview with the general practitioner of each patient. Readmissions were identified by computer. Results: General practitioner was contacted by phone for 338 patients (67.6%). A follow-up visit occurred for 196 patients (58%) within a median of 6 days. Patients with cardiological history (OR 1.875 [95%CI 1.058-3.324]), those who living alone (1.957, 1.043-3.742) and those to whom the instruction to consult has been given (1.844 [1.141-2.981]) have more often had a follow-up visit. Of the 500 patients, 91 were readmitted (18.2%) within a median of 8 days. Age greater than 85 years (1.63 [1.04-2.57]) and presence of several comorbidities (2.064 [1.165-3.659]) were predictive of readmission risk. Presence of a 3-dimensional imaging exam was associated with a lower readmission rate (0,255 [0,104-0,625]). Conclusion: Follow-up consultation by general practitioner after an emergency home-discharge occurs early and frequently. It could be beneficial for all the patients and its impact on the readmission rate deserves to be studied in this population.
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Master Thesis
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Guillaume Legris. Fréquence de consultation du médecin généraliste à 30 jours des sujets âgés de 75 ans et plus, rentrés à domicile à l’issue de leur admission aux urgences. Médecine humaine et pathologie. 2018. ⟨dumas-01960019⟩

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