S.CHUA1, X.H.KOH2, Y.XU1, I.C.G.TAN1, F.B.ALOWENI1, J.YAP2, P.C.TAN2, X. CHUA3, S.LIM3, H.C.OH2, S.S.H.TEO3, S. LIM1
Singapore General Hospital1, Changi General Hospital2, SingHealth HQ3
Community Nursing was established to anchor population health and provide sustainable healthcare beyond hospital to community. Aim: Investigate the effect of 6 months post first community nurse post (CNP) visit on healthcare utilization in older adults.
A single-group pre-post study of older adults enrolled at SingHealth CNPs between 01 April and 30 November 2019 was conducted. Emergency department (ED) visits, unplanned inpatient admissions, length of inpatient stay (LOS), specialist outpatient clinic (SOC) and polyclinic visits at SingHealth institutions six months from first CNP visit were compared to six months prior. Negative binomial generalized estimating equations were used to model healthcare utilization events, adjusting for baseline age, gender and race.
1,561 older adults (median age of 71 years) at 51 CNPs were studied. There was a population-average of 23% lower rate of ED visits (incidence rate ratio 0.77, 95% confidence interval 0.68 to 0.87, p<0.001) and 15% lower rate of unplanned inpatient admissions (0.85, 0.75 to 0.96, p=0.011). There was a trend towards shorter LOS and higher SOC/polyclinic visits. Reduction in acute care utilization was greater among adults with at least one follow-up CNP visit. Adults with no recent polyclinic chronic disease diagnosis had a greater increase in SOC visits.
CNP visits are associated with reduced acute care utilization for older adults with at least one follow-up visit. The trend of a higher rate of SOC visits could be attributed to referrals for new diagnoses and/or suboptimal health issues. There is a role for CNP visit towards a sustainable healthcare system.