“Hospital was the Only Option”: Experiences of Frequent Emergency Department Users in Mental Health

Wise-Harris, Deborah; Pauly, Daniel F.; Kahan, Deborah; Bibiana, Jason Tan de; Hwang, Stephen W.; Stergiopoulos, Vicky

doi:10.1007/s10488-016-0728-3

Cited by 102 publications

(180 citation statements)

References 40 publications

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“…The present study adds to the small but growing literature on frequent ED users’ own perceptions of their needs and life circumstances and on service user and providers’ experience of helpful case management ingredients [12, 13 15, 18]. …”

Section: Discussionmentioning

confidence: 95%

“…Stigmatization of service users with mental illness by healthcare professionals is increasingly recognized as a problem, as stigma and discrimination have been linked with negative physical and mental health outcomes [13, 25–29]. Although healthcare professionals’ attitudes towards this population may be explained in part by the commonly held view that ED visits by the frequent user population are inappropriate [2, 3, 5], evidence suggests that frequent ED users generally have higher acuity health concerns and are more likely to be hospitalized compared to non-frequent ED users [2].…”

Section: Discussionmentioning

confidence: 99%

“…There are few qualitative studies highlighting the service users’ actual perspectives, and even less is known of the experiences of mental health and addictions frequent ED users [12, 13]. Qualitative methodology can generated nuanced insights into service users’ experiences and their perspectives on implemented interventions [12, 14, 15].…”

Section: Introductionmentioning

confidence: 99%

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Perceived Case Management Needs and Service Preferences of Frequent Emergency Department Users: Lessons Learned in a Large Urban Centre

et al. 2016

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ObjectivesThis study aimed to explore the service needs and preferences of frequent emergency department users with mental health and addictions concerns who participated in a brief intensive case management intervention.MethodsWe conducted semi-structured individual interviews with 20 frequent emergency department users with mental health and addictions challenges, 13 service providers involved in the delivery of a brief case management intervention, and a focus group with intervention case managers. Thematic analysis was used to explore perceived service user profiles, service needs and preferences of care.ResultsService users experienced complex health and social needs and social isolation, while exhibiting resilience and the desire to contribute. They described multiple instances of stigmatization in interactions with healthcare professionals. Components of the brief intensive case management intervention perceived to be helpful included system navigation, advocacy, intermediation, and practical needs assistance. Frequent service users valued relational responsiveness, a non-judgmental stance, and a recovery orientation in case managers.ConclusionInterventions for frequent service users in mental health may be enhanced by focusing on the engagement of formal and informal social supports, practical needs assistance, system navigation, advocacy and intermediation, and attention to the recovery goals of service users.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Perceived Case Management Needs and Service Preferences of Frequent Emergency Department Users: Lessons Learned in a Large Urban Centre

et al. 2016

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“…The primary reasons for loss-to-follow-up were death (N = 6 for CATCH-ED and N = 3 for TAU participants) and inability to contact or locate the participant (N = 1 for CATCH-ED and N = 4 for TAU participants). Qualitative data collection was completed between August 2013 and December 2013 and reported separately [7]. The baseline characteristics of participants are shown in Table 1.…”

Section: Resultsmentioning

confidence: 99%

“…Although frequent ED users represent a heterogeneous population with diverse health needs [2], studies across jurisdictions have noted several commonalities, including high rates of acute and chronic medical conditions, mental illness and addictions [3, 4], homelessness [5, 6] and perceived unmet mental health needs [7, 8], when compared to non-frequent ED users. According to a systematic review, presenting complaints are likewise varied among frequent ED users and include worsening of existing chronic conditions, pain, substance or mental health related challenges and a variety of different complaints upon each visit [2].…”

Section: Introductionmentioning

confidence: 99%

The effect of brief case management on emergency department use of frequent users in mental health: Findings of a randomized controlled trial

et al. 2017

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Frequent users of hospital emergency departments (EDs) are a medically and socially vulnerable population. The Coordinated Access to Care from Hospital EDs (CATCH-ED) study examined the effectiveness of a brief case management intervention in reducing ED use and improving health outcomes among frequent ED users with mental health or addiction challenges in a large urban centre. Adults (≥18 years of age) who had five or more ED visits in the past 12-months, with at least one visit for mental health or addictions problems were randomized to either brief case management (N = 83) or usual care (N = 83) and followed for 12 months. The primary outcome of effectiveness was the frequency of ED visits during 12 months after study enrolment. Secondary outcomes included days in hospital, mental health and addiction symptom severity and health-related quality of life, measured by the SF-12. Compared to usual care, CATCH-ED participants saw a 14% reduction in frequency of ED visits during the 12-month post-randomization period [rate ratio (RR) = 0.86, 95% CI 0.64–1.15)], however, this finding did not reach statistical significance. There were also no statistically significant differences between the groups at 12 months in the number of days spent in hospital (RR = 1.16, 95% CI 0.59–2.29), physical (1.50, 95% CI -2.15–5.15) or mental (-3.97, 95% CI -8.13–0.19) component scores of the SF-12, severity of psychiatric symptoms (-0.41, 95% CI -2.30–1.49), alcohol (0.053 95% -0.017–0.12) or drug (-0.0027, 95% CI -0.0028–0.023) use. Compared to usual care, a brief case management intervention did not result in significantly reduced ED use or improved health outcomes among frequent ED users with mental health or addictions challenges in a large urban centre in Canada. Future studies need to evaluate the availability and accessibility of community-based resources for individuals with frequent ED use.

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Association of Medicaid Expansion With Emergency Department Visits by Medical Urgency

2022

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Key Points Question Is Medicaid eligibility expansion associated with changes in emergency department (ED) visits based on the medical urgency of the conditions? Findings In this cross-sectional study of 80.6 million ED visits across 4 US states, ED visits per 1000 population decreased for states that expanded Medicaid compared with states that did not. This decrease was associated with decreases in ED visits for less-emergent or nonemergent conditions. Meaning The findings of this study suggest that expanding Medicaid might reduce ED visits for conditions that could be treated in outpatient settings.

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“Hospital was the Only Option”: Experiences of Frequent Emergency Department Users in Mental Health

Cited by 102 publications

References 40 publications

Perceived Case Management Needs and Service Preferences of Frequent Emergency Department Users: Lessons Learned in a Large Urban Centre

Perceived Case Management Needs and Service Preferences of Frequent Emergency Department Users: Lessons Learned in a Large Urban Centre

The effect of brief case management on emergency department use of frequent users in mental health: Findings of a randomized controlled trial

Association of Medicaid Expansion With Emergency Department Visits by Medical Urgency

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