Care plans reduce ED visits in those with drug-seeking behavior

Interventions to manage use of the emergency and urgent care system by people from vulnerable groups: a mapping review

“…The full texts of 28 papers were screened, with 16 included in the mapping review. [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] Full details of these papers are included in Report Supplementary Material 1.…”

“…None of the study populations was described in terms of being 'vulnerable'. Included studies referred to participants as being frequent users or frequent callers, 14,15,17,[20][21][22][23][24][25][26][27] young people with alcohol-related presentations, 28 people with high opioid use, 22 people at high risk of drug-seeking behaviour 16 or people on a low income. 18 The interventions evaluated in the primary studies included provision of a link worker for young people with an alcohol-related presentation, combined with a brief intervention and referral, 28 and introduction of a system for people on a low income or who were uninsured whereby hospital EDs were linked to local primary care providers and ED staff referred patients to these clinics 18 (both subsequently classified under 'outreach services and teams').…”

“…Interventions also included a care plan initiated by ED staff for patients at high risk of drug-seeking behaviour. 16 Case management, which could include offering additional social support to patients, was described in four studies. 14,15,24,26 The difference between interventions described as case management and those referred to as care plans was not always clearly distinguishable, as establishing a plan was often a main component of management.…”

“…A care plan intervention was reported to have resulted in a significant reduction in mean annual ED visits among the 53 patients in the study group, from 7.6 visits [95% confidence interval (CI) 6.3 to 9.1 visits] to 2.3 visits (95% CI 1.5 to 3.1 visits; p ≤ 0.0001) at 1 year of follow-up and 1.5 visits (95% CI 0.9 to 2.1 visits; p ≤ 0.0001) at 2 years' follow-up. 16 The link worker intervention was evaluated in a RCT. 28 The authors reported no difference at 10 years' follow-up in the cost of ED presentations between the intervention group and the control group (AU$4266 vs. AU$4150; p = 0.916).…”

“…26 A pilot study of frequent ambulance callers suggested that case management was promising as a method to reduce the median call volume, although the authors highlighted the complex range of needs of patients. 15 Of the 16 included studies, there was overall uncertainty regarding the effectiveness of interventions aiming to reduce UEC use, with five studies indicating a reduction in service use 16,17,20,21,23 and six studies suggesting no significant reduction in service use. 18,22,24,[26][27][28] There appeared to be no clear pattern regarding which types of interventions reported positive outcomes, although studies indicating effectiveness tended to be of a non-comparative design.…”