‘Patient journeys into hospital’. An in-depth exploration of primary care’s role in the emergency admission of older people with multimorbidity.

Introduction

Levels of emergency hospital admissions in multimorbidity are high. Many of these admissions could be avoided.

Aim

To understand the primary care factors and decision making associated with emergency GP hospital admissions for patients with multimorbidity.

Method

Seven case studies consisted of interviews with a patient or carer, GP and medical record reviews. Patients had more than one chronic disease and a recent emergency admission by their GP. Medical records were reviewed for twelve months prior to and including the admission. Maps of the patient journeys detailed key interactions. Two focus groups of GPs, six further patient/ carer interviews and seven practice manager interviews were completed. Framework analysis helped generate themes associated with the primary care factors leading up to and involved in the decision-making processes in context of an admission.

Results

Poor coordination of care within and between primary, community and secondary care was challenging for patients and GPs alike. Responsiveness of practices could have been timelier and collaborated better. Patients reported high trust in their GPs which increased agreement with management plans or admission. GPs and patients followed a structured admission decision pathway. Time pressures and worry re negative outcomes impacted on GP’s admission decisions. Prior knowledge of the patient, higher confidence levels in their condition and better access to support from secondary care colleagues assisted their decision. Level of trust in the GP and the language and context of their explanation influenced patient’s agreement to admission.

Conclusion

As far as we are aware this is the first study in this area of its design. Improved collaboration and coordination within primary care teams and between primary and secondary care should the focus for improvement.