Frequent hospital admissions in Singapore: clinical risk factors and impact of socioeconomic status

<p><b>INTRODUCTION</b>Frequent admitters to hospitals are high-cost patients who strain finite healthcare resources. However, the exact risk factors for frequent admissions, which can be used to guide risk stratification and design effective interventions locally, remain unknown. Our study aimed to identify the clinical and sociodemographic risk factors associated with frequent hospital admissions in Singapore.</p><p><b>METHODS</b>An observational study was conducted using retrospective 2014 data from the administrative database at Singapore General Hospital, Singapore. Variables were identified a priori and included patient demographics, comorbidities, prior healthcare utilisation, and clinical and laboratory variables during the index admission. Multivariate logistic regression analysis was used to identify independent risk factors for frequent admissions.</p><p><b>RESULTS</b>A total of 16,306 unique patients were analysed and 1,640 (10.1%) patients were classified as frequent admitters. On multivariate logistic regression, 16 variables were independently associated with frequent hospital admissions, including age, cerebrovascular disease, history of malignancy, haemoglobin, serum creatinine, serum albumin, and number of specialist outpatient clinic visits, emergency department visits, admissions preceding index admission and medications dispensed at discharge. Patients staying in public rental housing had a 30% higher risk of being a frequent admitter after adjusting for demographics and clinical conditions.</p><p><b>CONCLUSION</b>Our study, the first in our knowledge to examine the clinical risk factors for frequent admissions in Singapore, validated the use of public rental housing as a sensitive indicator of area-level socioeconomic status in Singapore. These risk factors can be used to identify high-risk patients in the hospital so that they can receive interventions that reduce readmission risk.</p>

RESPIRATORY SUPPORT FOR HOME CARE PATIENTS

Home respiratory support for patients in the home care setting can range from simple oxygen supplementation, non-invasive ventilation, to home ventilation support via a tracheostomy. A home care doctor may not be able to know everything about ventilator support, but he should be familiar with the medical care of patients requiring one, and know who to refer to should patients require ventilator adjustments or troubleshooting. The management of such patients is challenging outside the hospital setting and usually requires a multidisciplinary team effort from the doctors, nurses, medical social worker, respiratory therapists, vendor of the ventilator and, most importantly, dedicated and well-trained caregivers. This article will cover two other important topics that Family Physicians should know when managing patients who require home respiratory support: home oxygen therapy and tracheostomy care.