Unplanned hospitalization more likely in people with several illnesses, mental health conditions

People with multiple illnesses are much more likely to be admitted to hospital unexpectedly, and mental health issues and economic hardship further increase the likelihood, according to a study in CMAJ (Canadian Medical Association Journal).

"We provide strong evidence that physical multimorbidity substantially affects the use of acute hospital services, including admissions considered potentially preventable through management of optimal primary care," writes Dr. Rupert Payne, Cambridge Centre for Health Services Research, University of Cambridge, Cambridge, United Kingdom. "This effect was exacerbated by the coexistence of mental illness and socioeconomic deprivation."

Although people with multimorbidity — more than 1 chronic health condition — use more health care services, few studies have examined the link between multimorbidity and unplanned hospital admissions. Researchers in the United Kingdom looked at data on 180 815 people in Scotland to understand the relationship between multimorbidity and unplanned admissions and whether mental health conditions and being from a more deprived background have an effect. More than 10 000 people (10 828, or 6%) had at least 1 unplanned admission. Ten percent of the total population (180 815) had 4 or more health conditions, but accounted for 34% of people with unplanned admissions and 47% of potentially preventable admissions. People in the lowest economic group had a higher rate of unplanned admissions (8%) compared with those in the highest group (4%). Multimorbidity, and especially mental health conditions, increased with lower economic status. The 24% of people with mental health conditions made up 43% and 45% of people with unplanned and potentially preventable unplanned admissions, respectively.

"Even after accounting for physical multimorbidity and mental health conditions, both of which are more common and occur at younger ages among people in socioeconomically deprived areas, the people who are most socioeconomically disadvantaged were still more likely to have an unplanned admission to hospital," write the authors. "This trend may be due to unmeasured social problems creating psychological distress as well to fewer personal and community resources being available to these patients."

The authors call for better coordinated care in the community by family practitioners and in-hospital care by geriatricians and more emphasis on mental health care services.