Background: The number of people above the age of 65 years is growing in many countries. Taiwan will be a superaged society in 2026, and health care utilization will increase considerably. Our study aimed to evaluate the efficacy of the geriatric integrated outpatient clinic model for reducing health care utilization by in older people.
Methods: This was a retrospective case-control study. Patients aged more than 65 years seen at the geriatric outpatient clinic (Geri-OPD) and non-geriatric outpatient clinics (non-Geri-OPD) at a single medical centre were age- and sex-matched. Data on the number of outpatient clinic visits, emergency department visits, and hospitalizations and medical expenditures were collected in the first and second years. A subgroup analysis by Charlson comorbidity index (CCI) and older age (age≧80 years old) was performed, and the results were compared between the Geri-OPD and non-Geri-OPD groups.
Results: A total of 6723 patients were included (3796 women and 2927 men). The mean age was 80.42 ± 6.39 years. There were 1291 (19.2%) patients from the Geri-OPD group and 5432 (80.8%) patients from the non-Geri-OPD group. After one year of regular follow-up, the Geri-OPD patients showed a significant reduction in the types of drugs included in each prescription (5.62±10.85) and the number of clinic visits per year (18.18 ± 48.85) (P<0.01). After a two-year follow-up, the number of clinic visits, emergent department visits, and hospitalizations and the annual medical costs were still decreased in the Geri-OPD patients. The Geri-OPD patients had more comorbidities and a higher rate of health care utilization than the non-Geri-OPD patients. In the subgroup analysis, patients with more comorbidities (CCI≧2) and older age (≧80 years old) in the Geri-OPD group showed a significant reduction in health care utilization. The Geri-OPD patients also showed a significant decrease in medical utilization in the second year compared to the non-Geri-POD patients.
Conclusion: The Geri-OPD reduced medical costs, the number of drugs prescribed, and the frequency of outpatient clinic visits, emergency department visits and hospitalizations in complicated elderly patients. The effect was even better in the second year.
Trial registration: Not applicable