Characteristics and predictors of adult frequent emergency department users in the United States: A systematic literature review

Abstract

Study objective:We conducted a systematic literature review to identify and to update patient characteristics and contextual factors for adult frequent emergency department users (FEDUs) compared with non-FEDU in an era where the US health care system underwent substantial changes. Methods:We searched MEDLINE, CINAHL, and EMBASE to identify all relevant articles after 2010 through July 2018 that describe FEDU. We included US studies on adult FEDU only and excluded studies on specific subgroups of FEDU. We included demographic, clinical, and health care utilization information, and two reviewers independently evaluated the studies using the Joanna Briggs Institute Critical Appraisal tool. Results:The 11 studies included in the review indicated that FEDU were 4% to 16% of total ED users but accounted for 14% to 47% of ED visits, with six to nine visits per year on average. The majority of FEDU were young or middle-aged adults, females, of low socioeconomic status and high school or less education, with public insurance, multiple primary care provider visits, and chronic conditions. Fair or poor self-perceived health status, unemployment, unmet needs from primary care providers (PCPs), mental health, and substance abuse were predictors of FEDU. Conclusion:FEDUs are disproportionally sicker and are also heavy users of non-ED health care service providers. The limited data for non-ED health services use in facility-specific studies of FEDU may contribute to findings in such studies that complex and unmet needs from PCPs contributed to ED visits. This suggests the need for more comprehensive data analysis beyond a few sites that can inform systemic management approaches.

Frequent emergency department use by older adults with ambulatory care sensitive conditions: A population‐based cohort study

“…Indeed, some variables were associated with both frequent adult and geriatric ED use: high past ED use, higher comorbidity index, higher prevalence of COPD, low socioeconomic situation and the presence of common mental health disorders. The number of primary care provider visits, the presence of severe mental health disorders, and alcohol and substance abuse were, however, associated with frequent ED use among the adult population, but not in the present results (older people) . Important differences between these populations should, however, be noted.…”

“…A systematic literature review by Giannouchos et al ., which aimed at identifying the characteristics of frequent adult ED users, presents comparable results . Indeed, some variables were associated with both frequent adult and geriatric ED use: high past ED use, higher comorbidity index, higher prevalence of COPD, low socioeconomic situation and the presence of common mental health disorders.…”

“…Indeed, the geriatric population is more prone to urgent and semi‐urgent ED visits requiring specialized care and to present adverse effects related to their ED visits . In addition, the lower hospital admission rate for frequent adult ED users suggests there might be higher rates of avoidable ED visits and unmet care needs in primary‐care services . Despite similarities, the reported differences show the relevance of developing interventions that take into account each of the population's characteristics and specific healthcare needs.…”

“…12 Considered a proxy for comorbidity, a higher number of prescribed drugs was also an important variable. 6 Finally, living in a rural area (where service availability might differ from urban areas), and higher social and material deprivation (associated with higher unmet healthcare needs) were also pointed out as associated variables 6,11 13 Indeed, some variables were associated with both frequent adult and geriatric ED use: high past ED use, higher comorbidity index, higher prevalence of COPD, low socioeconomic situation and the presence of common mental health disorders. The number of primary care provider visits, the presence of severe mental health disorders, and alcohol and substance abuse were, however, associated with frequent ED use among the adult population, but not in the present results (older people).…”

“…The number of primary care provider visits, the presence of severe mental health disorders, and alcohol and substance abuse were, however, associated with frequent ED use among the adult population, but not in the present results (older people). 13 Important differences between these populations should, however, be noted. The geriatric population accounts for approximately 16% of the Canadian population, but represents up to 40% of ED gurney patients (compared with 26% for the adult population).…”