An exploration of the reasons for frequent readmissions in patients with chronic disease

Abstract

Repeat hospitalisations by frequently readmitted patients (FRPs) are costly and might be avoidable. Many frequent readmissions are due to acute exacerbations of chronic disease treatable outside hospital. FRPs were defined as patients who were admitted three or more times in a year. The aim of this research was to explore the reasons behind frequent readmissions in patients with chronic disease. The study at a regional hospital in NSW, involved analysis of emergency department data to distinguish patient factors associated with three types of frequent hospital users: FRPs, frequent attenders (FAs) with four or more presentations in a year and patients who have an unplanned return visit to hospital within 28 days for the same condition (URVPs). Differences in attitudes to and beliefs about chronic disease self-management were explored by analysing interview data from FRPs compared with data from self-managing patients (SMPs), who had all been FRPs but had adopted self-management. A sample of clinicians treating patients with chronic disease in hospital, general practice and self-management services was interviewed to determine differences in attitudes to and beliefs about self-management. FRPs, FAs and URVPs shared some characteristics, but were discrete groups. The findings confirmed that patients with chronic disease contributed to the FRPs group and provided a basis of developing solutions to frequent use. The qualitative findings indicated that patients adopted self-management in response to encouragement by a proactive clinician. Activation involved acceptance; responding emotionally and changing identity, which was not described by FRPs. Hospital clinicians and general practitioners thought that some patients were resistant to self-management, were less familiar with self-management services and saw their role as being restricted to referral to services. Clinicians involved in self-management had the skills to be proactive and believed that all patients could be activated to self-manage. The findings provide insights into interactions between patients and clinicians leading to patient activation. The implications are that self-management activation in patients presenting to hospital can be increased by improving clinician skills in and understanding of the process of patient activation in self-management. This may help to reduce further reliance on presentation to hospital.