Morbidity diagnosed in an internal medicine department of a secondary care center (Msaken, Sousse, Tunisia)
##plugins.themes.academic_pro.article.main##
Abstract
Introduction: Internal Medicine is an essential component of the clinical platform of regional hospitals (relay between district hospitals and citationsRaw university hospitals).
Objective: To describe the morbidity diagnosed at Medicine department of the regional hospital of Msaken (Sousse, Tunisia), taken as a tracer of intermediate hospitals.
Methods: This descriptive study covered all of the patients hospitalized, during the year 2015, in the Internal Medicine department of the Msaken regional hospital. The data were disseminated through a "Minimum Clinical Summary". Morbidity was classified according to ICD-10. Hospital readmission was tested with citationsRaw to <28 days.
Results: A total of 594 patients were hospitalized in Internal Medicine, with a sex ratio of 0.95 and a median age of 67 years [54-78]. "Diseases of the respiratory system" were the first category of diagnosed morbidity (58%), dominated by acute bronchitis, followed by "endocrine, nutritional and metabolic diseases" in women (including insulin-dependent diabetes) and category of infectious diseases in men (including erysipelas). The former patients of the service (49%) were twice as numerous among people ≥60 years old (57% vs 30% in those under 60 years). The readmission rate was 19% (29% for men versus 8% for women). The mean length of stay was 7 ± 5.7 days. The transfer rates and hospital mortality were 11.3% and 1.2%, respectively.
Conclusion: The morbidity diagnosed at the Internal Medicine department of the Msaken regional hospital was dominated by the triad: acute bronchitis, diabetes mellitus and erysipelas, particularly in the elderly. Hence the need to strengthen the training of future family doctors in pulmonology, diabetology and infectious diseases.
Keywords:
Secondary Care Centers - Internal Medicine - Aged - Bronchitis - Diabetes Mellitus, Type 1 - Erysipelas - Tunisia##plugins.themes.academic_pro.article.details##
References
- 1. Strøm C, Stefansson JS, Fabritius ML, Rasmussen LS, Schmidt TA, Jakobsen JC. Hospitalisation in short-stay units for adults with internal medicine diseases and conditions. Cochrane Database Syst Rev 2018; 8(8): CD012370. 2. Card SE, Clark HD, Elizov M, Kassam N. The Evolution of General Internal Medicine (GIM) in Canada: International Implications. J Gen Intern Med 2017; 32(5): 576-581. 3. République Tunisienne ; Ministère de la Santé Direction des Etudes et Planification; Sous-direction des Statistiques. Santé Tunisie en chiffres 2018. http://www.santetunisie.rns.tn/images/depamel/CCS2018.pdf [consulté le 13 octobre 2020] 4. Meyer J. [Quality assurance in internal medicine]. Internist (Berl) 2000; 41(7): M164-5. 5. Ben Salem K, Ben Abdelaziz A. The Maghreb demographic transition: Tunisia case study. Tunis Med 2018; 96(10-11): 754-759. 6. Ben Abdelaziz A, Melki S, Ben Abdelaziz A, Ben Salem K, Soulimane A, Serhier Z, et al. Profile and evolution of the Global Burden of Morbidity in the Maghreb (Tunisia,Morocco, Algeria). The Triple burden of morbidity. Tunis Med 2018; 96(10-11): 760-773. 7. Borofsky JS, Bartsch JC, Howard AB, Repp AB. Quality of Interhospital Transfer Communication Practices and Association With Adverse Events on an Internal Medicine Hospitalist Service. J Healthc Qual 2017; 39(3): 177-185. 8. Institut National de la Statistique. Recensement général de la population et de l'habitat 2014. Volume 3 : Caractéristiques démographiques et fécondité. Tunis: INS ; 2016. 9. Institut National de la Statistique.URL : http://www.ins.tn/. Consulté le 13 octobre 2020. 10. Goodall RJ, Ellauzi J, Tan MKH, Onida S, Davies AH, Shalhoub J. A Systematic Review of the Impact of Foot Care Education on Self Efficacy and Self Care in Patients With Diabetes. Eur J Vasc Endovasc Surg 2020; 60(2): 282-292. 11. McConachie SM, Raub JN, Yost R, Monday L, Agrawal S, Tannous P. Evaluation of a multidisciplinary approach to reduce internal medicine readmissions using a readmission prediction index. Am J Health Syst Pharm 2020; 77(12): 950-957. 12. Çolak Y, Afzal S, Nordestgaard BG, Vestbo J, Lange P. Prevalence, Characteristics, and Prognosis of Early Chronic Obstructive Pulmonary Disease. The Copenhagen General Population Study. Am J Respir Crit Care Med 2020; 201(6): 671-680. 13. Daldoul H, Denguezli M, Jithoo A, Gnatiuc L, Buist S, Burney P, et al. Prevalence of COPD and tobacco smoking in Tunisia--results from the BOLD study. Int J Environ Res Public Health 2013; 10(12): 7257-71. 14. Maoui A, Bouzid K, Ben Abdelaziz A, Ben Abdelaziz A. Epidemiology of Type 2 Diabetes in the Greater Maghreb. Example of Tunisia. Systematic review of the literature. Tunis Med. 2019; 97(2): 286-295. 15. Dobrică EC, Găman MA, Cozma MA, Bratu OG, Pantea Stoian A, Diaconu CC. Polypharmacy in Type 2 Diabetes Mellitus: Insights from an Internal Medicine Department. Medicina (Kaunas) 2019; 55(8): 436. 16. Roda Â, Pinto AM, Filipe AR, Travassos AR, Freitas JP, Filipe P. [Clinical and Laboratory Factors Associated with Prolonged Hospital Stay among Patients with Cellulitis/Erysipelas]. Acta Med Port 2019; 32(6): 448-452. 17. SoÄan K, SoÄan M. Trends in the epidemiology of erysipelas in Slovenia. Acta Dermatovenerol Alp Pannonica Adriat 2018; 27(1): 1-4. 18. KozÅ‚owska D, MyÅ›liwiec H, Kiluk P, Baran A, Milewska AJ, Flisiak I. Clinical and epidemiological assessment of patients hospitalized for primary and recurrent erysipelas. Przegl Epidemiol 2016; 70(4): 575-584. 19. Zaraa I, Zeglaoui F, Zouari B, Ezzine N, Fazaa B, Kamoun MR. Erysipèle. Etude rétrospective à propos de 647 patients. Tunis Med 2004; 82(11): 990-5. 20. Mokni M, Dupuy A, Denguezli M, Dhaoui R, Bouassida S, Amri M, et al. Risk factors for erysipelas of the leg in Tunisia: a multicenter case-control study. Dermatology 2006; 212(2): 108-12 21. Pitché P, Diatta B, Faye O, Diané BF, Sangaré A, Niamba P et al. Facteurs de risque associés à l'érysipèle de jambe en Afrique subsaharienne: étude multicentrique cas-témoins. Ann Dermatol Venereol 2015; 142(11): 633-8. 22. Klotz C, Courjon J, Michelangeli C, Demonchy E, Ruimy R, Roger PM. Adherence to antibiotic guidelines for erysipelas or cellulitis is associated with a favorable outcome. Eur J Clin Microbiol Infect Dis 2019; 38(4): 703-709 23. Wada M, Nishiyama D, Kawashima A, Fujiwara M, Kagawa K. Effects of Establishing a Department of General Internal Medicine on the Length of Hospitalization. Intern Med 2015; 54(17): 2161-5. 24. Obón Azuara B, MartÃnez-Berganza Asensio A, CÃa Gómez P. [Stays occasioned by patients hospitalized in internal medicine services]. An Med Interna 1999; 16(2): 76-82. 25. Stucki A, Huber G, Schifferli JA. [Prospective study of predicting hospital length of stay for internal medicine patients]. Schweiz Med Wochenschr 1998; 128(49): 1946-8. 26. Carey MR, Sheth H, Braithwaite RS. A prospective study of reasons for prolonged hospitalizations on a general medicine teaching service. J Gen Intern Med 2005; 20(2): 108-15. 27. RodrÃguez-Vera FJ, MarÃn Fernández Y, Sánchez A, Borrachero C, Puyol de la Llave E. [Appropriateness of the admissions and stays in an internal medicine department of a secondary hospital using the current version of the AEP (Appropriateness Evaluation Protocol)]. An Med Interna 2003; 20(6): 297-300 28. Puig J, SupervÃa A, Márquez MA, Flores J, Cano JF, Gutiérrez J. Diabetes team consultation: impact on length of stay of diabetic patients admitted to a short-stay unit. Diabetes Res Clin Pract 2007; 78(2): 211-6. 29. Broquetas JM, Pedreny R, MartÃnez-Llorens JM, Sellarésa J, Gea J. [Short-stay respiratory unit: a new option for inpatient care]. Arch Bronconeumol 2008; 44(5): 252-6. 30. Tak HJ, Ruhnke GW, Meltzer DO. Association of patient preferences for participation in decision making with length of stay and costs among hospitalized patients. JAMA Intern Med 2013; 173(13): 1195-205. 31. Szecket N, Wong HJ, Wu RC, Berman HD, Morra D. Implementation of a continuous admission model reduces the length of stay of patients on an internal medicine clinical teaching unit. J Hosp Med 2012; 7(1): 55-9. 32. Kossovsky MP, Perneger TV, Sarasin FP, Bolla F, Borst F, Gaspoz JM. Comparison between planned and unplanned readmissions to a department of internal medicine. J Clin Epidemiol 1999; 52(2): 151-6 33. Aljishi M, Parekh K. Risk factors for general medicine readmissions and association with mortality. N Z Med J 2014; 127(1394): 42-50. 34. Rasmussen MG, Ravn P, Molsted S, Tarnow L, Rosthøj S. Readmission to hospital of medical patients - A cohort study. Eur J Intern Med 2017; 46: 19-24. 35. Stanley A, Graham N, Parrish A. A review of internal medicine re-admissions in a peri-urban South African hospital. S Afr Med J 2008; 98(4): 291-4. 36. Sicras Mainar A, Navarro Artieda R. [The evaluation of hospital readmissions in the internal medicine service]. Med Clin (Barc) 1993; 101(19): 732-5. 37. Moran J, Colbert CY, Song J, Hull J, Rajan S, Varghees S, Arroliga AC, Reddy SP. Residents examine factors associated with 30-day, same-cause hospital readmissions on an internal medicine service. Am J Med Qual 2013; 28(6): 492-501. 38. Wang Y, Stavem K, Humerfelt S, Dahl FA, Haugen T. Readmissions for COPD: propensity case-matched comparison between pulmonary and non-pulmonary departments. Clin Respir J 2013; 7(4): 375-81. 39. Roy MJ, Herbers JE, Seidman A, Kroenke K. Improving patient satisfaction with the transfer of care. A randomized controlled trial. J Gen Intern Med 2003; 18(5): 364-9. 40. Bowen JL, Ilgen JS, Irby DM, Ten Cate O, O'Brien BC. "You Have to Know the End of the Story": Motivations to Follow Up After Transitions of Clinical Responsibility. Acad Med 2017; 92(11S Association of American Medical Colleges Learn Serve Lead: Proceedings of the 56th Annual Research in Medical Education Sessions):S48-S54. 41. Berthier S, Bonnotte B, Khau Van Kien A, Deboulard A, Benzenine E, Bismuth MJ, et al. Intérêt d'un secteur d'orientation courte dans un service de médecine interne. Presse Med 2004; 33(19 Pt 1): 1319-22. 42. Hallas P, Folkestad L, Brabrand M. Level of training and experience in physicians performing interhospital transfers of adult patients in the internal medicine department. Emerg Med J 2009; 26(10): 743-4. 43. Horwitz LI, Krumholz HM, Green ML, Huot SJ. Transfers of patient care between house staff on internal medicine wards: a national survey. Arch Intern Med 2006; 166(11): 1173-7.