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B.C. study details increasing complexity of hospital patients' needs

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A British Columbia study showing that hospitalized patients' medical issues have become increasingly complex also highlights the need to address the growing pressures of an aging population on overworked health professionals, the lead researcher says.

Dr. Hiten Naik, an internal medicine physician and research fellow at the University of British Columbia, said policymakers need to invest more in hospital care teams that include pharmacists and physiotherapists.

“Oftentimes there will be less support on weekends, for example, and there's a gap at different times during the week,” said Naik, adding that one pharmacist could be staffing an entire ward.

“It should prompt a discussion on being more proactive because the health-care system can be a bit reactive.”

The number of hospitalized elderly patients with multiple conditions will only increase as people live longer due to medical innovation and treatment with various drugs, he said.

The study, published Monday in JAMA Internal Medicine, involved an analysis of health data covering 3.4 million non-elective hospitalizations in B.C. between 2002 and 2017. It found that by the end of that period, patients were nearly three times more likely to arrive in hospital through the emergency room, twice as likely to have multiple health issues and nearly twice as likely to be taking at least 10 medications.

Patients were also more likely to be 75 years or older, and they were more likely to be readmitted within 30 days after being discharged. During the first year of the study, the average patient was a 64-year-old male with three prescription medications.

However, the findings also show decreases in the likelihood of patients staying in the intensive care unit or dying in hospital, reflecting advancements in medical care that dramatically improved outcomes for those living with heart failure, HIV infection and lymphoma.

Naik said the COVID-19 pandemic revealed health-care staff burnout as a “real issue” but that more complex patients had already contributed to some of that burnout.

“Essentially, that's making our jobs more difficult because if someone has more medical issues, those are medical issues that need to be addressed.”

Naik said the study also showed that a proportion of hospitalizations increased due to substance use, including alcohol intoxication and withdrawal from opioids.

While the data lack information on factors that contribute to patient complexity, including homelessness and lack of social supports, it includes all hospitalized patients aged 18 and older during a 15-year period and goes beyond a single centre, disease or measure of complexity, compared with other research evaluating such trends in the Netherlands, China and Switzerland.

Dr. Samir Sinha, director of geriatrics at Sinai Health and University Health Network in Toronto, said the pandemic exacerbated conditions for seniors who were less likely to attend appointments with a primary care provider, missed cancer screenings and had their surgeries delayed, landing some of them in hospital.

“Then we were left dealing with significant consequences that in many ways could have been prevented,” he said.

Sinha said the key is to ensure more people have a family doctor and access to community care servicesto prevent or better manage chronic diseases sopatients don't languish on hospital wards.

“If we had a lot more of that we'd have a lot less pressure on our hospital system and our available staff would be better able to meet the demands on the acute-care system.”

Jane Meadus, a staff lawyer with the Advocacy Centre for the Elderly in Ontario, said providing enough home-care support would also reduce time spent in hospital and reduce burnout among seniors' family caregivers.

“That's a huge problem,” she said.

“This is the time of year when I start to hear from people who are trying to get out of hospital but told 'you can't have any home care because we've run out of our budget,”' she said of agencies that may have government funding renewed in April.

This report by The Canadian Press was first published Jan. 8, 2024.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

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