Frequent use of emergency departments and chronic conditions in ageing societies: a retrospective analysis based in Italy

Abstract

Background Most western countries are facing relevant demographic changes, and the percentage of older people is destined to rise in the next decades. This fact is likely to affect the sustainability of healthcare systems significantly, mainly due to the connected issue of chronicity. Methods In this paper, using an extensive and comprehensive administrative dataset, we analyse the phenomenon of frequent use of emergency departments (ED) in the oldest region in Europe (i.e. Liguria) over 4 years (2013–2016). Two alternative approaches are used to define categories of ED users based on the intensity and frequency of accesses and splitting patients into different age groups. Results Results allow identifying clinical and socio-demographic risk-factors connected to different levels of ED utilisation and highlight the influential role played by chronic conditions (particularly mental disorders, respiratory diseases) and by multiple chronic conditions. Conclusions The study aims at representing an informative tool to support policy-makers in setting proper policies addressed, on the one side, towards the potentially preventable frequent users and, on the other, towards those accessing due to complex medical conditions. The results can help in building a warning system to help general practitioners in the identification of potential frequent users and to develop preventive policies.

Appropriateness of frequent use of emergency departments: A retrospective analysis in Rome, Italy

“…The demographic characteristics describe the FU as most likely male subjects, aged < 65, in agreement with other studies ( 10 , 23 , 32 , 33 ). Most FUs accessed the ED by EMS but were not assigned an urgent triage code or diagnosed with an urgent condition that required hospitalization, confirming international trends, which also pertained during the COVID-19 pandemic ( 2 , 10 , 12 , 25 , 47 – 49 ). There has been scarce evidence about the impact of the COVID-19 pandemic on the use of ED services among frequent ED users.…”

“…An OECD proposal to meet population health needs outside the hospital setting has already been accepted in a number of countries ( 51 ), and some studies have shown how the strengthening of primary care services (e.g., extending primary care opening hours or timely palliative care) ( 52 , 53 ) may mitigate the FU phenomenon and help to reduce the use of EDs ( 2 , 54 , 55 ), especially among older adults and frail members of the population, who may have to cope with different levels of functional limitation ( 56 ). Previous systematic reviews of interventions for frequent ED users have described patient-centered programs predicated on interdisciplinary team approaches.…”

“…In recent decades, the progressive aging of the population and the higher levels of urbanization and pollution are increasing the number of patients suffering from chronic diseases, which has a significant impact on the use of healthcare services, in particular emergency departments (EDs) ( 1 , 2 ). In Italy, despite significant improvements in the emergency care system, the reduction in the number of hospital beds over the last 30 years, and the increase in the number of fragile patients have led to an increase in ED attendance ( 3 , 4 ).…”

“…In Italy, the availability of beds in the hospital for acute patients and outside the hospital for post-acute assistance is a major issue for the National Health System, especially in metropolitan areas such as Rome, the most populous municipality in Italy, where three large Local Health Authorities administer healthcare services. Various Italian studies have investigated the problem by analyzing some of the characteristics of the FU ( 2 , 12 , 24 , 28 ) but, despite the importance of the issue, there is still insufficient consideration in the literature of the following points: number of attendance, usage of EMS, level of urgency, and appropriateness of attendance. The COVID-19 diagnosis was also investigated for a possible influence on ED attendance.…”

Effect of Comorbid Diseases on Hospitalization and In-Hospital Mortality of Elderly Patients Who Reapplied to the Emergency Department Within 72 Hours

“…Patients with chronic diseases use the ED repeatedly [ 14 ]. Chronic conditions (particularly mental disorders and respiratory diseases) and the presence of multiple chronic conditions, according to Di Bella et al [ 15 ], were associated with repeated use of the ED. Similarly, Ko et al [ 16 ] investigated the effect of comorbidities on repeat visits to the ED and reported that congestive heart failure, chronic obstructive pulmonary disease (COPD), peptic ulcer, liver disease, cancer, and psychiatric disorders increased the risk of frequent use of the ED.…”