Association Between Early Consultation by the Primary Care Physician After Hospitalization in Geriatric Medicine Department, and the Risk of Re-hospitalization at 1 and 3 Months

The time it takes for patients to be readmitted to hospital is a major public health issue, both in terms of medical time and costs. Indeed, 15% of patients of all ages are likely to be rehospitalized within a month of hospitalization.

From an economic point of view, in the United States in 2013, 20% of patients underwent an early rehospitalization, compared with around 15% in France in 2015, generating up to $26 billion in annual expenditure in the USA for these stays alone. Among the causes of these early rehospitalizations are cancer, heart, lung, liver and infectious diseases, most of which require close monitoring, especially for the most fragile populations.

Intrinsic risk factors such as age, the presence of multiple co-morbidities and a history of depression play an important role; but it has also been shown that extrinsic risk factors such as the presence or absence of therapeutic education, or re-hospitalizations for different medical reasons, are just as important. Another factor is the lack of access to primary resources (housing, food), to primary care (including primary care physician), pharmacies and transport. As a result, the risk of mortality within a year is three times higher than for patients who are not rehospitalized within less than 1 month.

Several studies estimate that 16% to 23% of re-hospitalizations within 30 days of discharge are avoidable. In this context, a number of programs have been proposed to reduce the rate of rehospitalization, particularly in patients with heart disease. For example, an interventional study showed that close follow-up over 3 months by an advanced practice nurse (APN) for patients initially hospitalized for myocardial infarction prolonged the time to the next readmission and reduced the number of deaths and, consequently, the cost of care. These parameters also improved with the intervention of an APN at the end of the hospital stay.

However, the populations studied in these interventional studies are very often patients with cardiac pathologies. Few of these studies look specifically at geriatric populations, even though the mean ages of the populations are very frequently over 60 years old. Focusing specifically on the elderly population, a systematic review in 2023 studying the risk factors for rehospitalization at 30 and 90 days, worldwide, found a risk of rehospitalization of 10.3% to 37.6% and 16% to 58% respectively.