Mental Health and Drivers of Need in Emergent and Non-Emergent Emergency Department (ED) Use: Do Living Location and Non-Emergent Care Sources Matter?

Abstract

Emergency department (ED) utilization has increased due to factors such as admissions for mental health conditions, including suicide and self-harm. We investigate direct and moderating influences on non-emergent ED utilization through the Behavioral Model of Health Services Use. Through logistic regression, we examined correlates of ED use via 2014 New York State Department of Health Statewide Planning and Research Cooperative System outpatient data. Consistent with the primary hypothesis, mental health admissions were associated with emergent use across models, with only a slight decrease in effect size in rural living locations. Concerning moderating effects, Spanish/Hispanic origin was associated with increased likelihood for emergent ED use in the rural living location model, and non-emergent ED use for the no non-emergent source model. ‘Other’ ethnic origin increased the likelihood of emergent ED use for rural living location and no non-emergent source models. The findings reveal ‘need’, including mental health admissions, as the largest driver for ED use. This may be due to mental healthcare access, or patients with mental health emergencies being transported via first responders to the ED, as in the case of suicide, self-harm, manic episodes or psychotic episodes. Further educating ED staff on this patient population through gatekeeper training may ensure patients receive the best treatment and aid in driving access to mental healthcare delivery changes.

Application and Use of Andersen’s Behavioral Model as Theoretical Framework: A Systematic Literature Review from 2012–2021

“…The first group was the studies that applied the Andersen’s behavioral model among different populations, whereas the second group was the studies that applied the three basic factors of the model. The first group involved 6 studies which tested the effect of Andersen’s model concepts on utilization of non-emergent emergency department (ED) ( 10 ), studied the factors that associated with health services utilization by applying the Andersen’s model ( 11 ), identified the main factors that may influence antenatal care utilization through application of Andersen’s model in reproductive-aged women in Eastern Ethiopia ( 12 ), discovered the motives for non-urgent ED presentations and recognized personal characteristics that impact patients’ ED utilization patterns in China ( 9 ), determined factors related to adolescent mother’s utilization of post-natal care in a northern of Malawi ( 13 ), and explored the phenomenon of equity in utilization of out-patient and in-patient health services in Turkey ( 14 ). Totally, these studies added to understanding the application of Andersen’s model among different populations and settings.…”

“…The last group is the reviewed studies that included patients who utilized different health care services. The samples were 10,128 participants used the public mental health services in past 4 years ( 15 ), 190 older adults who used primary health care services ( 19 ), 6,291,158 participants who used the emergency department within the 2014 ( 10 ), 13,734 participants who used outpatient and inpatient services at least once in the past year ( 11 ), 325 adult patients with mental disorders who used mental health care services, aged between 18 and 70 yr ( 22 ), 545 patients who used emergency department services and were triaged as non-urgent ( 9 ), and 7886, 14400, and 9740 homes in 2010, 2012 and 2014, who used out-patient and in-patient treatment services in the previous 12 months ( 14 ). The reviewed studies included a variety of populations with different sample sizes from different settings.…”

“…Explicitly, a face-to-face interview with a structured questionnaire was administered in five of the reviewed studies ( 12 , 13 , 17 , 18 , 22 ). A self-reported questionnaire was used in five of the reviewed studies ( 9 , 10 , 16 , 19 , 20 ). Other reviewed studies used health surveys and household members surveyed.…”

Characterizing behavioral health-related emergency department utilization among children with Medicaid: Comparing high and low frequency utilizers

“…In response to rising levels of BH-related ED utilization among children and the associated increases in health expenditures, health reform efforts have focused on a variety of interventions in order to reduce ED visits, including improvements in care coordination and the promotion of integrated physical and behavioral healthcare in primary care settings (Lynch, Greeno, Teich, & Delany, 2016;McManus, Cramer, Boshier, Akpinar-Elci, & Van Lunen, 2018). In addition, innovative programs that include the establishment of multi-disciplinary teams have been developed in EDs to address the needs of pediatric patients with BH conditions (Roman, Matthews-Wilson, Dickinson, Chenard, & Rogers, 2018).…”

Primary care models and depression outcomes in rural adult populations: A systematic review.

“…Further, rural PCPs report the need to deliver intensive mental health services while patients wait to access a specialist (Gale et al, 2010). Moreover, rurality is also associated with increased nonemergent mental health-related emergency department (ED) visits (McManus et al, 2018), implying that rural PCPs are not able to meet the high demands for mental health care. Thus, supporting the delivery of depression care within rural primary care services is a key to maximizing the use of scarce rural health care resources and ultimately reducing health disparities (Rural Health Information Hub, 2023).…”