Trends in health services utilization, medication use, and health conditions among older adults: a 2-year retrospective chart review in a primary care practice
1 Primary Care Research Unit, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Room E3-49, Toronto, ON M4N 3M5 Canada
2 University of Toronto Joint Centre for Bioethics, 88 College Street, Toronto, ON M5G 1L4 Canada
3 Institute for Clinical Evaluative Sciences, 2075 Bayview Ave., Toronto, ON M4N 3M5 Canada
4 Department of Family and Community Medicine, Faculty of Medicine * University of Toronto, 263 McCaul Street, 3rd Floor, Toronto, Ontario, M5T 1W7 Canada
5 Department of Public Health Sciences, University of Toronto, Building, 155 College Street, Toronto, ON M5T 3M7, Canada
BMC Health Services Research 2009, 9:217 doi:10.1186/1472-6963-9-217Published: 30 November 2009
Population aging poses significant challenges to primary care providers and healthcare policy makers. Primary care reform can alleviate the pressures, but these initiatives require clinical benchmarks and evidence regarding utilization patterns. The objectives of this study is to measure older patients' use of health services, number of health conditions, and use of medications at the level of a primary care practice, and to investigate age- and gender-related utilization trends.
A cross-sectional chart audit over a 2-year study period was conducted in the academic family practice clinic of Sunnybrook Health Sciences Centre in Toronto, Ontario, Canada. All patients 65 years and older (n = 2450) were included. Main outcome measures included the number of family physician visits, specialist visits, emergency room visits, surgical admissions, diagnostic test days, inpatient hospital admissions, health conditions, and medications.
Older patients (80-84 and 85+ age-group) had significantly more family physician visits (average of 4.4 visits per person per year), emergency room visits (average of 0.22 ER visits per year per patient), diagnostic days (average of 5.1 test days per person per year), health conditions (average of 7.7 per patient), and medications average of 8.2 medications per person). Gender differences were also observed: females had significantly more family physician visits and number of medications, while men had more specialist visits, emergency room visits, and surgical admissions. There were no gender differences for inpatient hospital admissions and number of health conditions. With the exception of the 85+ age group, we found greater intra-group variability with advancing age.
The data present a map of greater interaction with and dependency on the health care system with advancing age. The magnitudes are substantial and indicate high demands on patients and families, on professional health care providers, and on the health care system itself. There is the need to create and evaluate innovative models of care of multiple chronic conditions in the late life course.