Examining the need profiles of patients with multiple emergency department visits for mental health reasons: a cross-sectional study

Sirotich, Frank; Durbin, Anna; Durbin, Janet

doi:10.1007/s00127-016-1188-5

“…Class 3, which included individuals with moderate emergency department use, also differed from class 2 in terms of all predisposing and enabling factors, and several needs factors (drug use disorders, depression, schizophrenia and bipolar disorder). Regarding predisposing factors, individuals from class 3 showed several characteristics negatively associated with frequent emergency department use, such as female gender, 18 , 29 , 30 younger and middle age 34 – 36 and economic advantage. 22 , 29 Moreover, in terms of needs, class 3 individuals were mainly affected by common MDs (depression, anxiety), but relatively less affected by serious MDs or SUDs.…”

Section: Discussionmentioning

confidence: 99%

“…22,[30][31][32] Regarding predisposing factors, an association was found between higher frequency of emergency department use and male gender, 18,29,30 whereas the association between emergency department use and age categories was not consistent. 29,[33][34][35][36][37] Some studies have found that individuals with frequent emergency department use were more likely to have low incomes 29,38 and to be unemployed. 26,38 One study assessing hospital service use among people with SUDs found an association between emergency department use and lower levels of education.…”

mentioning

confidence: 99%

Typology of patients who use emergency departments for mental and substance use disorders

Fleury

¹

,

Bamvita

²

,

Ferland

³

2020

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Background Identifying profiles of people with mental and substance use disorders who use emergency departments may help guide the development of interventions more appropriate to their particular characteristics and needs. Aims To develop a typology for the frequency of visits to the emergency department for mental health reasons based on the Andersen model. Method Questionnaires were completed by patients who attended an emergency department (n = 320), recruited in Quebec (Canada), and administrative data were obtained related to sociodemographic/socioeconomic characteristics, mental health diagnoses including alcohol and drug use, and emergency department and mental health service utilization. A cluster analysis was performed, identifying needs, predisposing and enabling factors that differentiated subclasses of participants according to frequency of emergency department visits for mental health reasons. Results Four classes were identified. Class 1 comprised individuals with moderate emergency department use and low use of other health services; mostly young, economically disadvantaged males with substance use disorders. Class 2 comprised individuals with high emergency department and specialized health service use, with multiple mental and substance use disorders. Class 3 comprised middle-aged, economically advantaged females with common mental disorders, who made moderate use of emergency departments but consulted general practitioners. Class 4 comprised older individuals with multiple chronic physical illnesses co-occurring with mental disorders, who made moderate use of the emergency department, but mainly consulted general practitioners. Conclusions The study found heterogeneity in emergency department use for mental health reasons, as each of the four classes represented distinct needs, predisposing and enabling factors. As such, interventions should be tailored to different classes of patients who use emergency departments, based on their characteristics.

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“…On the other hand, more flexible office hours could help diminish the need for ER service use. Many of the psychosocial reasons for seeking help at the ER are non-urgent (22), which is reflected in this study e.g. by the lack of emergency referrals to psychiatric inpatient care in the context of these visits.…”

Section: Discussionmentioning

confidence: 92%

A register-based observational cohort study on persistent frequent users of emergency services in a Finnish emergency clinic.

Levola

¹

,

Sailas

²

,

Säämänen

³

et al. 2019

Preprint

0

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Background: The focus of emergency room (ER) treatment is on acute medical crises, but frequent users of ER services often present with various needs. The objectives of this study were to obtain information on persistent frequent ER service users and to determine reasons for their ER service use. We also sought to determine whether psychiatric diagnoses or ongoing use of psychiatric or substance use disorder treatment services were associated with persistent frequent ER visits. Methods: A cohort (n=138) of persistent frequent ER service users with a total of 2585 ER visits during a two-year-period was identified. A content analysis was performed for 10% of these visits. Register data including International Classification of Primary Care 2 (ICPC-2) –codes and diagnoses were analyzed and multivariable models were created in order to determine whether psychiatric diagnoses and psychosocial reasons for ER service use were associated with the number of ER visits after adjusting for covariates. Results: Patients who were younger, had a psychiatric diagnosis and engaged in ongoing psychiatric and other health services, had more ER visits than those who were not. Having a psychiatric diagnosis was associated with the frequency of ER visits in the multivariable models after adjusting for age, gender and ongoing use of psychiatric or substance use disorder treatment services. Reasons for ER-service use according to ICPC-2 –codes were inadequately documented. Conclusions: Patients with psychiatric diagnoses are overrepresented in this cohort of persistent frequent ER service users. More efficient treatments paths are needed for patients to have their medical needs met through regular appointments.

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“…On the other hand, more flexible office hours could help diminish the need for ER service use. Many of the psychosocial reasons for seeking help at the ER are non-urgent, such as reasons related to insufficient housing or financial difficulties (22), which is reflected in this study e.g. by the lack of emergency referrals to psychiatric inpatient care.…”

Section: Discussionmentioning

confidence: 93%

A register-based observational cohort study on persistent frequent users of emergency services in a Finnish emergency clinic.

Levola

¹

,

Sailas

²

,

Säämänen

³

et al. 2019

Preprint

0

View full text Add to dashboard Cite

Background: The focus of emergency room (ER) treatment is on acute medical crises, but frequent users of ER services often present with various needs. The objectives of this study were to obtain information on persistent frequent ER service users and to determine reasons for their ER service use. We also sought to determine whether psychiatric diagnoses or ongoing use of psychiatric or substance use disorder treatment services were associated with persistent frequent ER visits. Methods: A cohort (n=138) of persistent frequent ER service users with a total of 2585 ER visits during a two-year-period was identified. A content analysis was performed for 10% of these visits. Register data including International Classification of Primary Care 2 (ICPC-2) –codes and diagnoses were analyzed and multivariable models were created in order to determine whether psychiatric diagnoses and psychosocial reasons for ER service use were associated with the number of ER visits after adjusting for covariates. Results: Patients who were younger, had a psychiatric diagnosis and engaged in ongoing psychiatric and other health services, had more ER visits than those who were not. Having a psychiatric diagnosis was associated with the frequency of ER visits in the multivariable models after adjusting for age, gender and ongoing use of psychiatric or substance use disorder treatment services. Reasons for ER-service use according to ICPC-2 –codes were inadequately documented. Conclusions: Patients with psychiatric diagnoses are overrepresented in this cohort of persistent frequent ER service users. More efficient treatments paths are needed for patients to have their medical needs met through regular appointments.

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Examining the need profiles of patients with multiple emergency department visits for mental health reasons: a cross-sectional study

Cited by 28 publications

References 42 publications

Typology of patients who use emergency departments for mental and substance use disorders

Typology of patients who use emergency departments for mental and substance use disorders

A register-based observational cohort study on persistent frequent users of emergency services in a Finnish emergency clinic.

A register-based observational cohort study on persistent frequent users of emergency services in a Finnish emergency clinic.

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