Patients in B.C. hospitals are having more complex medical needs, study finds

A new study conducted by researchers at the University of British Columbia has found that patients arriving in B.C. hospitals are older, have more complex medical needs, and are on more prescription medications than two decades ago.

The study, published in the JAMA Internal Medicine journal on Monday, analyzed 3.4 million urgent hospitalizations in the province over a 15-year period, from 2002 to 2017.

Dr. John Staples, a physician at Vancouver General Hospital and co-author of the study, said the findings confirm what many frontline medical workers have long known.

"I think for most clinicians this is a very satisfying thing to see because many doctors in the hospital have an intuitive sense that patients have become more complicated," he told CBC News.

"I think what is surprising was how consistent it was over many different measures of complexity, and how consistent it was over time."

The study found that patients coming to the emergency room were 2.7 times more likely to be hospitalized and 2.1 times more likely to have multiple medical issues in 2017, compared to 2002.

Over that same period, patients were 1.8 times more likely to be taking 10 or more medications, and were also more likely to be 75 years or older and to have an adverse event — such as complications from a surgery, adverse reactions to a drug, or a hospital-acquired infection — in hospital.

Staples said the findings are partially a result of Canada's aging population, but also due to advances in medicine that have allowed patients to live longer even with severe illnesses.

"Maybe 20 years ago, patients with organ failure or advanced metastatic cancer wouldn't be able to survive very long," he said. 

"These days we have medications, surgeries, and other technologies that can help people stay alive."

Policymakers need to anticipate health-care demands: author

The study also found that the increasing complexity of patients' health isn't necessarily leading to more serious outcomes for them.

Patients have become less likely to die while in hospital, or be admitted to intensive care, the study found. 

Staples says the health system is likely adapting well to their needs.

However, the study author says policymakers will have to anticipate for growing demand, as well as more complex patient conditions in the years to come.

"One aspect of this is making sure that we are training medical students and nurses and other health-care workers to deal with very complex patients," Staples said.

"Another aspect is that we need to better support clinicians who are dealing with these most complex patients."

Staples adds that some of those health-care adaptations may also include moving away from the fee-for-service model, and improving access to non-emergency health-care systems, like primary care.

"Policymakers will need to consider whether physician and hospital remuneration adequately accounts for the time and expertise required to provide high-quality care for medically complex inpatients," the paper reads.

The data analyzed was collected three years prior to the onset of COVID-19, hence the effect of the pandemic is not reflected in the results.