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Santos S, Veiga PM, Paúl C. The Perceived Risk of Hospitalization in Primary Health Care – The Importance of Multidimensional Assessment. Gerontol Geriatr Med 2022; 7:23337214211063030. [PMID: 35321531 PMCID: PMC8935591 DOI: 10.1177/23337214211063030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 10/22/2021] [Accepted: 11/02/2021] [Indexed: 11/23/2022] Open
Abstract
Ageing has increased the use of health services, with a corresponding rise in avoidable hospitalizations. We aimed to assess and characterize the perceived risk of hospitalization in primary health care (PHC). 118 individuals aged ≥65 years, PHC patients, were assessed using the Community Risk Assessment Instrument by their General Practitioner, who identified their perceived risk of hospitalization, at one year. The instrument is composed of three domains (mental state, daily living activities (ADLs) state and medical state). Multivariate logistic regression was used to identify the best model to predict the risk of hospitalization. Four models were estimated, one for each domain and one with all the variables of the instrument. 58.5% were identified as being at risk of hospitalization. The best predictive models are those that include functionality assessment variables (ADL model and Community Assessment of Risk Instrument model). The model that includes all the variables of three domains presents the best predictive value. Mobility problems (Odds Ratio (OR) 16.18 [CI: 1.63–160.53]), meal preparation (OR 10.93 [CI: 1.59–75.13]), communication (OR 6.91 [CI: 1.37–34.80]) and palliative care (OR 4.84 [CI: 1.14–20.58]) are the best predictors of hospitalization risk. The use of multidimensional assessment tools can allow the timely identification of people at risk, contributing to a reduction in hospitalizations.
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Affiliation(s)
- Sara Santos
- Abel Salazar Institute of Biomedical Sciences—University of Porto, Portugal
- CINTESIS, Faculty of Medicine—University of Porto, Portugal
| | - Pedro Mota Veiga
- NECE Research Unit in Business Sciences, University of Beira Interior, Covilhã, Portugal
- Higher School of Education, Polytechnic Institute of Viseu, Portugal
| | - Constança Paúl
- Abel Salazar Institute of Biomedical Sciences—University of Porto, Portugal
- CINTESIS, Faculty of Medicine—University of Porto, Portugal
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Santos S, O'Caoimh R, Teixeira L, Alves S, Molloy W, Paúl C. Validation of the Portuguese Version of the Risk Instrument for Screening in the Community (RISC) Among Older Patients in Primary Care in Northern Portugal. Front Public Health 2021; 9:614935. [PMID: 34485207 PMCID: PMC8414545 DOI: 10.3389/fpubh.2021.614935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 07/12/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Aging is associated with an increase in adverse health outcomes for older people. Short screening instruments that easily and quickly identify those at highest risk can enable decision-makers to anticipate future needs, allocate scarce resources and act to minimize risk. The Risk Instrument for Screening in the Community (RISC) is a brief (2-5 min) Likert scale that scores one-year risk of institutionalization, hospitalization and death from low (1/5) to severe (5/5). Objectives: To externally validate the RISC, scored by general practitioners (GP's), in primary care in Northern Portugal. Methods: The RISC was translated and culturally adapted to Portuguese. A cohort of 457 older adults (aged ≥65) under active follow-up with their GP's were screened. Outcomes at one-year were recorded. Accuracy was determined from the area under the curve (AUC) of receiver operating curve analysis. Results: The mean age of participants was 75.2 years; 57% were female. The proportion identified as being at maximum risk (RISC scores of 3-5/5) of institutionalization, hospitalization and death, were 14.9, 52.4 and 38.4%, respectively. At follow-up 2% (10/431) were institutionalized, 18.6% (84/451) were hospitalized and 3% (14/456) died. Those who were institutionalized (p = 0.021), hospitalized (p = 0.012) or dead (p < 0.001) at one-year were significantly older. Those living alone were more likely to be institutionalized (p = 0.007). The RISC showed fair accuracy in predicting hospitalization (AUC of 0.62 [95% CI: 0.55-0.69]) and good accuracy for Institutionalization (AUC of 0.79 [95% CI: 0.62-0.96]) and death (AUC of 0.77 [95% CI: 0.65-0.88]). Conclusions: The Portuguese version of the RISC accurately predicted institutionalization and death at one-year but like most short screens was less able to predict hospitalization. Given its brevity, the RISC is useful for quickly identifying and stratifying those at increased risk in primary care.
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Affiliation(s)
- Sara Santos
- Abel Salazar Institute of Biomedical Sciences, University of Porto, Porto, Portugal
- CINTESIS, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Rónán O'Caoimh
- Centre for Gerontology and Rehabilitation, St Finbarrs Hospital, University College Cork, Cork, Ireland
| | - Laetitia Teixeira
- Abel Salazar Institute of Biomedical Sciences, University of Porto, Porto, Portugal
- CINTESIS, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Sara Alves
- Abel Salazar Institute of Biomedical Sciences, University of Porto, Porto, Portugal
- CINTESIS, Faculty of Medicine, University of Porto, Porto, Portugal
| | - William Molloy
- Centre for Gerontology and Rehabilitation, St Finbarrs Hospital, University College Cork, Cork, Ireland
| | - Constança Paúl
- Abel Salazar Institute of Biomedical Sciences, University of Porto, Porto, Portugal
- CINTESIS, Faculty of Medicine, University of Porto, Porto, Portugal
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