Patients with dementia have higher odds of ED visits while under interprofessional care

Patients with dementia who were enrolled in a practice with an interprofessional primary care team were more likely to visit the ED than those with a physician-only team, a recent study found.

The results were contrary to the expectations of Nadia Sourial, PhD, an associate research professor in the department of family and emergency medicine at the University of Montreal Research Center, and colleagues.

“Given the multifaceted needs of people with dementia, we hypothesized that access to [interprofessional care teams] would be associated with decreased ED use,” they wrote in Annals of Family Medicine, adding that interprofessional care teams would offer “an integrated approach to counseling, managing comorbidities and medications, and coordinating care.”

Sourial and colleagues collected data from the health research corporation ICES on yearly cohorts of community-dwelling adults aged 65 years and older. From 2005 to 2013, the researchers identified adults who were newly diagnosed with dementia in the 2 years prior to the start of each yearly cohort.

Of the 95,323 participants who were included in the final analysis, 46,829 were enrolled in a Family Health Team practice providing interprofessional primary care (IPC), while 48,499 were enrolled in a Family Health Organization practice providing non-interprofessional primary care (non-IPC). Enrollment was based on the timing of a dementia diagnosis.

In an IPC setting, family physicians collaboratively worked with a multitude of health care professionals, including nurses, nurse practitioners, social workers, pharmacists, dietitians, occupational therapists and other clinicians. In the non-IPC setting, meanwhile, participants were exposed to physician-only primary care.

During a median follow up of 1 year, 17.6% and 17.1% of IPC and non-IPC participants were admitted to long-term care or died.

The researchers reported that during the year following a dementia diagnosis, IPC patients had a 3% higher likelihood of having an ED visit overall (RR = 1.03; 95% CI, 1.01-1.05) and a 22% higher likelihood of having a nonurgent ED visit (RR = 1.22; 95% CI, 1.18-1.28) compared with non-IPC patients.

There were no significant associations between IPC and overall hospitalization outcomes or hospitalizations for an ambulatory care-sensitive condition.

Although the odds of ED visits were statistically significant, it “may not represent a meaningful difference from a health system and clinical perspective,” Sourial and colleagues noted.

Surial and colleagues said there were several potential reasons why a multispecialty care team did not reduce the odds of ED visits.

“It is possible that the observed increase in overall and nonurgent ED use was the result of an increase in appropriate ED use,” they wrote. “Improved patient-centered care in IPC teams may have led to better patient or caregiver awareness of symptoms.”

Other potential barriers included a lack of continuity and function across interprofessional teams, a lack of support and training for dementia and dementia not being prioritized among other chronic conditions.

Heterogeneity in IPC teams was not considered and “may have moderated the effect of IPC on the study outcomes,” Sourial and colleagues wrote. Physician factors, like the number of years with a practice, were also left unexamined.

The researchers concluded that while IPC teams may still benefit patients with dementia, “a better understanding of the optimal characteristics of team-based care and the reasons leading to hospital use for acute care by people with dementia is needed.”

References:

• Emergency department visits more likely for dementia patients with interprofessional primary care team. https://www.eurekalert.org/news-releases/972633. Published Nov. 29, 2022. Accessed Dec. 7, 2022.
• Sourial N, et al. Ann Fam Med. 2022;doi:10.1370/afm.2881.