elderly - Haggai Frid - November 4 2010
Elderly at Rambam Hospital in Haifa. Photo by Haggai Frid
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More than a quarter of all emergency room visits by elderly are for conditions that could have been treated at a health maintenance organization (Kupat Holim ) clinic, a new Health Ministry study has found. The findings, based on data gathered two years ago, also indicate that the chances that patients 75 and older will make an unnecessary visit to a hospital emergency room rather than a community clinic generally depends on their socioeconomic status. Poor elderly citizens are 90 percent more likely to land in an emergency room than other elderly patients. Elderly poor were also found to have higher regard for emergency room medical care than their wealthier counterparts.

The Health Ministry has been especially interested in limiting unnecessary reliance on emergency room treatment because treatment at hospitals costs the system more than treatment at clinics. Under some circumstances, however, when patients come to the emergency room for treatment without a doctor referral, they are charged for the service. As a result of the study's findings, the Health Ministry intends to enhance communication between family doctors and area hospitals in an effort to reduce the number of unnecessary referrals. Overall, according to ministry statistics, 250,000 emergency room visits a year, a tenth of all hospital emergency room visits in Israel, are patients 75 years of age and older, and 80 percent of them arrive during hours of the day in which community HMO clinics are open.

Nonetheless, the elderly are regular visitors to HMO clinics, visiting their general practitioner an average of 16 times a year, compared to an average of eight annual visits by patients in their 20s. A survey in two areas of the country found that 31 percent of all the patient visits to family doctors were by patients 75 years of age or older. At health clinics where patient demand on doctor services is high, patients were 2.9 times more likely to either be referred to the emergency room or to go there without a referral.

Doctors reported that at times they referred patients to the emergency room at problematic times of the day or week, for example when the clinics were about to close for the day or on Fridays when clinic hours are more limited. There were also doctors who acknowledged providing patients with emergency room referrals after relatives of the patients threatened the doctor demanding the referral.

In the study, results of which were released last week at a conference of the Israeli Society for Quality in Medicine, the Health Ministry researchers attempted to look into the reason for the overreliance of the elderly on hospital emergency rooms. Possibly explaining the reliance of the poor elderly on emergency room care, the researchers found that doctors in community HMO clinics spent less time with poor elderly than with middle-class and wealthier elderly: an average of 8.3 minutes with poor senior citizens, 10.7 minutes with middle-class seniors and 13.4 minutes with wealthy elderly. In addition, elderly patients with chronic illnesses were up to 2.4 times more likely to seek emergency room treatment rather than see their family doctor.