Associations between degree-of-worry, self-rated health and acute hospitalisation after contacting a medical helpline: a Danish prospective cohort study

Andrea Nedergaard Jensen; Maria Kristiansen; Janne Schurmann Tolstrup; Hejdi Gamst-Jensen

doi:10.1136/bmjopen-2020-042287

Associations between degree-of-worry, self-rated health and acute hospitalisation after contacting a medical helpline: a Danish prospective cohort study

BMJ Open. 2021 May 27;11(5):e042287. doi: 10.1136/bmjopen-2020-042287.

Authors

Andrea Nedergaard Jensen¹, Maria Kristiansen², Janne Schurmann Tolstrup³, Hejdi Gamst-Jensen⁴

Affiliations

¹ Department of Clinical Research, Hvidovre Hospital, Hvidovre, Zealand, Denmark andrea.nedergaard.jensen@regionh.dk.
² Center for Healthy Aging & Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Zealand, Denmark.
³ Department of Population Health and Morbidity, National Institute of Public Health, University of Southern Denmark, Odense, Syddanmark, Denmark.
⁴ Department of Clinical Research and the Emergency Department, Hvidovre Hospital, Hvidovre, Zealand, Denmark.

Abstract

Objectives: Self-rated health (SRH) is a strong predictor for healthcare utilisation among chronically ill patients. However, its association with acute hospitalisation is unclear. Individuals' perception of urgency in acute illness expressed as degree-of-worry (DOW) is however associated with acute hospitalisation. This study examines DOW and SRH, respectively, and their association with acute hospitalisation within 48 hours after calling a medical helpline.

Design: A prospective cohort study.

Setting: The Medical Helpline 1813 (MH1813) in the Capital Region of Denmark, Copenhagen.

Participants: Adult (≥18 years of age) patients and relatives/close friends calling the MH1813 between 24 January and 9 February 2017. A total of 6812 callers were included.

Outcome measures: The primary outcome measure was acute hospitalisation. Callers rated their DOW (1=minimum worry, 5=maximum worry) and SRH (1=excellent, 5=poor). Covariates included age, sex, Charlson Comorbidity Score and reason for calling. Logistic regression was conducted to measure the associations in three models: (1) crude; (2) age-and-sex-adjusted; (3) full fitted model (age, sex, comorbidity, reason for calling, DOW/SRH).

Results: Of 6812 callers, 492 (7.2%) were acutely hospitalised. Most callers rated their health as being excellent to good (65.3%) and 61% rated their worry to be low (DOW 1-3). Both the association between DOW and acute hospitalisation and SRH and acute hospitalisation indicated a dose-response relationship: DOW 1=ref, 3=1.8 (1.1;3.1), 5=3.5 (2.0;5.9) and SRH 1=ref, 3=0.8 (0.6;1.4), 5=1.6 (1.1;2.4). The association between DOW and acute hospitalisation decreased slightly, when further adjusting for SRH, whereas the estimates for SRH weakened markedly when including DOW.

Conclusions: DOW and poor SRH were associated with acute hospitalisation. However, DOW had a stronger association with hospitalisation than SRH. This suggests that DOW may capture acutely ill patients' perception of urgency better than SRH in relation to acute hospitalisation after calling a medical helpline.

Trial registration number: NCT02979457.

Keywords: accident & emergency medicine; health & safety; public health.

Publication types

Clinical Study
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Anxiety*
Chronic Disease
Denmark
Health Status
Hospitalization*
Humans
Prospective Studies

Associated data

ClinicalTrials.gov/NCT02979457