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Some social factors contributing to the prolonged hospitalization of chronic disease patients in a general hospital Chatwin, Mary Kathleen

Abstract

In the consideration of chronic illnesses, social, emotional and economic factors are as important as the purely medical ones in determining the needs of the patients. Since hospital personnel believe that prolonged care of chronic patients in a general hospital involves a waste of hospital facilities, it would be of value to discover some of the social factors which are contributing to the prolonged hospitalization of a group of chronic disease patients. Chronic diseases were defined as those which are insidious in onset, progressive, usually long term, and from which there is never complete restoration to normal. Within this meaning of chronic illness, as arrived at through consultation, the three resident interns of the Royal Alexandra Hospital, Edmonton, selected all the chronic disease patients in the medical, surgical and children's services, on July 15, 1946. Data about these eighty patients were collected from their hospital files, through correspondence with the attending physicians, and through a case work interview, adapted to the individual situation. Long term hospitalization was arbitrarily defined as thirty days stay. According to definition forty-two of the eighty patients were long term chronic disease patients. These patients were grouped according to the type of care they required; active medical, nursing or custodial; and the data were then analysed to find what social factors were contributing to their prolonged hospitalization. The greatest single contributing factor to extension of hospitalization was the fact that twenty (fifty percent) of these patients had nowhere else to go. A combination of factors such as, no family, family unwilling, unemployment, old age, lack of early medical care and insufficient community facilities for their care, were found to be contributing to this problem. Although statistical analysis or tabulation was not found possible, grouping according to the needs of the patients was indicated in order to account for prolonged hospitalization, where an adequate medical social plan could not be arranged outside the hospital. Of the fourteen patients requiring active medical care, five were in need of a special, prolonged type of care not available elsewhere; in three cases treatment was not known; and in six instances medical care was not available until too late in the progression of the disease; due largely to the inability of these patients to pay for it. Of the thirteen patients requiring nursing care only; six lacked family facilities for care, and nursing or boarding home placements were not available; the remaining seven had homes but nursing care was not available to them because of the expense and the scarcity. Fifteen patients remained in hospital a prolonged time, though not requiring medical or skilled nursing care. Nine of these patients remained longer than three months, and two of them longer than seven years. These patients required a custodial type of care, not only for medical reasons, but because poverty made home care impossible. In six of the forty-two long term cases, hospitalization was extended because of inappropriate treatment, which was usually due to the failure of the physician to treat the patient as a whole. It was obvious throughout that there is a great need in the community for facilities for the care and treatment of the chronic sick, who do not actually require treatment in a general hospital. Perhaps more important at the present time, is the indication of the need for medical social workers to insure the use of the existing facilities in the community to the best advantage of these patients.

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