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Master Thesis

Profil des patients âgés de 75 ans et plus, éligibles au PAERPA, admis de manière non pertinente aux urgences de l’hôpital Saint-André

Abstract : Introduction: PAERPA is a national experiment aimed at optimizing the care of patients aged 75 and over in order to offer them an ideal course of care. The main objective of this system is to reduce avoidable admissions to the emergency unit. Object: describing the medico-social profile of patients aged 75 and over, eligible for PAERPA in Bordeaux, and whose admission to the emergency at Saint André Hospital was assess irrelevant. Methods: this is a descriptive, cross-sectional, single-center and retrospective study including all patients aged 75 and over, admitted to the SAU at St André Hospital, hospitalized at short-term hospitalization unit (UHCD) and evaluated by the geriatric mobile unit. The evaluation of the relevance of the admission used the French version of the Appropriateness Evaluation Protocol (AEPf) applied to patients with a modified Clinical Classification of Emergency Patients (CCMUm) score of 1 and 2. The characteristics of the patients were compared between the group of relevant admissions (AP) and irrelevant admissions (ANP). Results: 134 patients were included between May 2017 and April 2018: 20.9% of admissions to the SAU were assess irrelevant. ANP patients did not differ significantly from AP patients on age, gender, the fact of living alone at home, having a caregiver or being referred to the SAU by their general practitioner. Medically, ANP patients more frequently had a 3 ≤ ADL ≤ 5 (72.7% vs 42.1%; p = 0.04), had more known cognitive impairment (60.7% vs 35.8 %; p = 0.003) and benefited from more help from a nurse (100% vs. 78%; p=0.001). They were more frequently referred to the SAU for a social reason (32.1% vs 1.9%; p <0.001) but also for a medical reason which was at the end a social reason (17.9% vs 3.8%; p=0,02). Regarding hospitalization at UHCD, ANP patients were more frequently waiting for a place in a nursing home (EHPAD) (32.1% vs. 6.6%; p <0.001) and were less hospitalized for medical supervision (48.1% vs. 25%; p=0.04). At the end of the hospitalization, ANP patients were more frequently institutionalized in a nursing home (25% vs 5.6%; p <0.001). There was no difference between the 2 groups regarding the fact of being integrated into the PAERPA device (32, 1% vs 26.4%; p = 0.71) or to have a general practitioner who was very satisfied with the device (67% vs 69.2%; p = 1). However, with regard to relay nursing home (EHPAD Relais), the general practitioner in the AP group were significantly more satisfied (50% vs. 20%; p = 0.04). Analysis of the needs of ANP patients on admission to the emergency department (SAU) showed that 50% of them need a treatment procedure or a diagnostic opinion and 42.8% had a non-medical need. The most suitable accommodation was a medical and paramedical structure (57.1%) and the main reason for admission was "relay services not available" (64.3%). Conclusion: there is indeed a profile of ANP patients: these patients are more weak, less independent and benefit from an already optimized support environment and assistance. It seems that this population is not the target of the PAERPA device, and it does not seem to represent a suitable resource for the emergency medical and social needs of these patients.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-03500427
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Submitted on : Wednesday, December 22, 2021 - 11:31:56 AM
Last modification on : Tuesday, January 4, 2022 - 3:37:20 AM

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  • HAL Id : dumas-03500427, version 1

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Laura Chamayou. Profil des patients âgés de 75 ans et plus, éligibles au PAERPA, admis de manière non pertinente aux urgences de l’hôpital Saint-André. Médecine humaine et pathologie. 2021. ⟨dumas-03500427⟩

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