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PubMed1984

Causes for hospitalization of nursing home residents: the role of infection.

Little is known about specific clinical conditions that lead to hospitalization of nursing home patients. To explore this, the authors examined the hospitalizations of 128 nursing home residents and compared them with hospitalizations of 320 patients from the outpatient clinic. Hospitalized nursing home patients were older, were admitted to medical services more frequently, and had more nonspecific complaints on admission. Nursing home patients were hospitalized most frequently for diseases of the circulatory system (16 per cent), respiratory system (14 per cent), and genitourinary system (12 per cent); clinic patients, for diseases of the circulatory system (25 per cent) and nervous system (10 per cent), neoplasms (10 per cent), and signs and symptoms of ill-defined conditions (10 per cent). The most frequent causes of hospitalization for all patients were diseases of the circulatory system (23 per cent), nervous system (10 per cent), and neoplasms (10 per cent). Among patients from the nursing home, infections caused substantially more admissions (27 per cent) than among patients originating from clinic (12 per cent; P less than 0.001). These findings disclose an important opportunity to reduce health care costs and enhance quality of life in the nursing home, particularly through the treatment and control of infections.

Aged↗
PubMed2000

Do diabetes guidelines influence the content of referral letters by general practitioners to a diabetes specialist clinic?

OBJECTIVE: To ascertain whether local guidelines for diabetes management influence the content of GP referral letters to a diabetes specialist clinic. DESIGN: Retrospective survey of hospital outpatient clinic casenotes and GP referral letters of patients with Type 2 diabetes. METHODS: An examination was made of 200 GP referral letters submitted before (Set 1), and 200 GP referral letters submitted after (Set 2), local guidelines on the management of adult diabetes had been issued to GPs in Lothian. The frequency with which micro- and macrovascular complications of diabetes were documented in the GP referral letters was compared with the frequency ascertained at the first attendance to the specialist clinic. MAIN RESULTS: Following the distribution of diabetes guidelines, no significant change was noted in the frequency with which specific conditions were documented in GP referral letters (Set 1 vs Set 2): hypertension (72% vs 79%); cerebrovascular disease (89% vs 80%); ischaemic heart disease (74% vs 79%); peripheral vascular disease (42% vs 64%); cataract (35% vs 44%); retinopathy (18% vs 40%) and peripheral neuropathy (17% vs 12%). At the diabetic clinic many unreported diabetic complications were found in patients who had been referred after varying periods of treatment in primary care. However, the guidelines did appear to have encouraged the active treatment of hyperglycaemia by GPs before referral of newly-diagnosed diabetic patients. CONCLUSIONS: Diabetes guidelines per se appeared to have very little effect on increasing the information provided in GP referral letters on relevant medical problems and did not appear to have influenced screening for complications in patients with Type 2 diabetes by GPs before specialist referral. Methods other than the issue of written guidelines are required to achieve optimal assessment of diabetic patients in the community.

Correspondence as Topic↗