Frequent attenders to an emergency department: A study of primary health care use, medical profile, and psychosocial characteristics

Byrne, Molly; Murphy, Andrew W.; Plunkett, Patrick K.; McGee, Hannah; Murray, Alistair; Bury, Gerard

doi:10.1067/mem.2003.68

Cited by 279 publications

(232 citation statements)

References 31 publications

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“…1,2 Previous studies have had widely discrepant definitions of frequent use, from 4 to more than 20 visits per year. [1][2][3][4][5][6][7][8][9] Despite varying definitions, high-frequency ED users have been described together as typically poor, male, members of minority groups, chronically ill, socially isolated, and frequently presenting with psychiatric or substance abuse problems. 2,5,10,11 The literature suggests, however, that characteristics differ between frequent users with less than 20 visits per year and those with more than 20 visits.…”

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confidence: 99%

Frequent users of an inner-city emergency department

Geurts

Palatnick²,

Strome³

et al. 2012

CJEM

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Background: Within the emergency department (ED) patient population there is a subset of patients who make frequent visits. This chart review sought to characterize this population and identify strategies to reduce frequent ED visits. Methods: Frequent use at an urban tertiary care centre was defined as 15 or more visits over 1 year. The details of each visit-demographics, entrance complaint, discharge diagnosis, arrival method, Canadian Triage and Acuity Scale (CTAS) score, and length of stay-were analyzed and compared to data from the entire ED population for the same period. Results: Ninety-two patients generated 2,390 ED visits (of 25,523 patients and 44,204 visits). This population was predominantly male (66%) and middle-aged (median 42 years), with no fixed address (27.2%). Patients arrived by ambulance in 59.3% of visits with less acute CTAS scores than the general population. Substance use accounted for 26.9% of entrance complaints. Increased lengths of stay were associated with female gender and abnormal vital signs, whereas shorter stays were associated with no fixed address and substance use (p , 0.05). Admissions were lower than the general population, and women were twice as likely as men to be admitted (p , 0.05). Patients left without being seen in 15.8% of visits. Conclusions: High-frequency ED users are more likely to be male, younger, and marginally housed and to present secondary to substance use. Although admissions among this population are low, the costs associated with these presentations are high. Interventions designed to decrease visits and improve the health of this population appear warranted.

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confidence: 99%

Frequent users of an inner-city emergency department

Geurts

Palatnick²,

Strome³

et al. 2012

CJEM

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“…The reasons for frequent ED visits are plenty. Some of the chief reasons are people`s habits of using ED for simple healthcare problems, ED care being free of charge, acute exacerbations of chronic diseases, behavioral disorders and mental illnesses, alcohol and substance addiction (4,5). Analyzing the data of patients who frequently visit ED of BKHB, we determine that the majority of these patients see ED as the first place to go for general healthcare problems.…”

Section: Quality Measurement In Emergency Departmentmentioning

confidence: 99%

Emergency Department Care Survey

Bektemür¹,

Osmanbeyoglu²,

Cander³

2015

EAJEM

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“…1,2 Frequent users with chronic disease and complex care needs often experience fragmented, uncoordinated, and ineffective health care, resulting in poor health outcomes at considerable costs to the health care system. 3 Although high use may be defined from either a frequency or cost perspective, the former is more convenient and easier to measure when identifying this population in a pragmatic context.…”

Section: Introductionmentioning

confidence: 99%

“…4 Different interventions have been developed and evaluated to improve care for frequent users of health care services, such as case management, individualized care plans, self-management support, and information sharing. 5 Case management is the intervention most supported by evidence on improving appropriate use of health care resources, decreasing undue Catherine Hudon, MD, PhD, CFPC 1,2 Maud-Christine Chouinard, RN, PhD 3,4,5 Marie RN, MSc(c) 3,4 Fatoumata Diadiou, MA(c) …”

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confidence: 99%

Case Management in Primary Care for Frequent Users of Health Care Services: A Mixed Methods Study

et al. 2018

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PURPOSE This study aimed to evaluate the effects of the V1SAGES case management intervention (Vulnerable Patients in Primary Care: Nurse Case Management and Self-management Support) for frequent users of health care services with chronic disease and complex care needs on psychological distress and patient activation. METHODSWe used a 2-phase sequential mixed methods design. The first phase was a pragmatic randomized controlled trial with intention-to-treat analysis that measured the effects of the intervention compared with usual care on psychological distress and patient activation before and after 6 months. The second phase had a qualitative descriptive design and entailed thematic analysis of in-depth interviews (25 patients, 6 case management nurses, 9 health managers) and focus groups (8 patients' spouses, 21 family physicians) to understand stakeholders' perceived effects of the intervention on patients. RESULTSA total of 247 patients were randomized into the intervention group (n = 126) or the control group (n = 121). Compared with usual care, the intervention reduced psychological distress (odds ratio = 0.43; 95% CI, 0.19-0.95, P = .04), but did not have any significant effect on patient activation (P = .43). Qualitative results suggested that patients and their spouses benefitted from the case management intervention, gaining a sense of security, and stakeholders noted better patient self-management of health.CONCLUSIONS Together, our study's quantitative and qualitative results suggest that case management reduces psychological distress, making patients and caregivers feel more secure, whereas impact on self-management is unclear. Case management is a promising avenue to improve outcomes among frequent users of health care with complex needs. Ann Fam Med 2018;16:232-239. https://doi.org/10.1370/afm.2233. INTRODUCTIONF requent use of health care services is often driven by the complex health and social care needs of individuals having chronic physical conditions and, often, mental health comorbidities, sometimes accompanied by social vulnerability.1,2 Frequent users with chronic disease and complex care needs often experience fragmented, uncoordinated, and ineffective health care, resulting in poor health outcomes at considerable costs to the health care system. 3 Although high use may be defined from either a frequency or cost perspective, the former is more convenient and easier to measure when identifying this population in a pragmatic context. Given that primary care is a first point of contact with the health and social care system, it may play a strong role in allowing the implementation of innovations to provide more coordinated care. 4 Different interventions have been developed and evaluated to improve care for frequent users of health care services, such as case management, individualized care plans, self-management support, and information sharing. 5 Case management is the intervention most supported by evidence on improving appropriate use of health care resources, decreasing undue C...

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Frequent attenders to an emergency department: A study of primary health care use, medical profile, and psychosocial characteristics

Cited by 279 publications

References 31 publications

Frequent users of an inner-city emergency department

Frequent users of an inner-city emergency department

Emergency Department Care Survey

Case Management in Primary Care for Frequent Users of Health Care Services: A Mixed Methods Study

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