Admission directe des patients âgés de plus de 70 ans en services hospitaliers : évaluation de l'utilisation par les médecins généralistes d'une ligne téléphonique directe (l'outil Allo Gériatrie) pour l'hospitalisation des sujets âgés en MCO de Gériatrie

Abstract : The French population is getting older, and the attendance of the emergency department by the elderly is becoming more important. Many patients are sent there to be hospitalized although it is not always indicated by the clinical context, because general practitioners have difficulty in sending their patients in direct hospitalization. In May 2017, the geriatric pole GeST14 within the Assistance Publique-Hôpitaux de Marseille set up a hotline called « Allo Gériatrie » which allows the general practitioners to contact a geriatrician directly. The main objective of this study is to assess the satisfaction of the general practitioners who used the hotline to have one of their patients hospitalized. The secondary objectives are to compare the characteristics of patients whether they were hospitalized from the emergency or directly from home, and to estimate the impact the hotline may have had on the number of elderly patients attending the emergency department of La Timone Hospital. A satisfaction survey consisting in a questionnaire was sent to the general practitioners who had used the hotline in the first 6 months to hospitalize patients aged 70 and more. A retrospective observational study was conducted to compare the patients aged 70 and more hospitalized from the emergency department or from home between May 3rd and November 3rd, 2017. Twenty-nine doctors (72.4%) answered the questionnaire, 66.7% were « very satisfied » and 28.6% were « rather satisfied » with the use of the hotline. Besides, 601 patients were included in the observational study: 55 in the group « Allo Gériatrie », 418 in the group « Emergency » and 128 in the group « Other ». Patients were 86 years old on average [IC 95%, 86.23-87.29; p = 0.146]. The clinical severity was comparable between the groups according to two criteria: the length of the stay, 13 days on average [IC 95%, 1.41-13.73; p = 0.651], and the cost of the stay, 5470 euros on average [IC 95%, 5301.646-5638.531; p = 0.693]. The diagnoses were significantly different between the groups (p < 0.05): the patients hospitalized from the emergency department seemed to have more infectious pathologies, strokes and other cardiovascular diseases, whereas those hospitalized from home seemed to have more dementia or onco-haematological pathologies decompensations. The patients hospitalized via the hotline tended to return home more often than the others (p = 0.069). Finally, we did not notice any decrease in the number of elderly people attending the emergency department of La Timone Hospital after the first 6 months the hotline had been set up. The geriatric hotline satisfies the general practitioners and helps improve the city-hospital link. The diagnoses differ from one patient to another whether they come from home or from the emergency department. Therefore, the development of geriatric hotlines for specific profiles of patients is justified.
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Amandine Colasson. Admission directe des patients âgés de plus de 70 ans en services hospitaliers : évaluation de l'utilisation par les médecins généralistes d'une ligne téléphonique directe (l'outil Allo Gériatrie) pour l'hospitalisation des sujets âgés en MCO de Gériatrie. Sciences du Vivant [q-bio]. 2018. ⟨dumas-02024584⟩

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