Persistently Frequent Emergency Department Utilization Among Persons With Systemic Lupus Erythematosus

Abstract

Objective. In order to identify opportunities to improve outpatient care, we evaluated patients with systemic lupus erythematosus (SLE) who persistently frequent the emergency department (ED).Methods. We conducted a retrospective study of patients with SLE who frequented the ED for ≥3 visits in a calendar year, from 2013 to 2016. Persistent users were those who met criteria for persistent use for at least 2 of the 4 years, and limited users for 1 of the 4 years. Each ED encounter was categorized as SLE-related, infection-related, pain-related, or other. We compared ED use between persistent and limited users, and analyzed factors associated with pain-related encounters among persistent users through multivariate logistic regression.Results. We identified 77 participants who had 1,143 encounters as persistent users, and 52 participants who had 335 encounters as limited users. Persistent users accounted for 77% of ED use by patients with SLE who frequented the ED. Pain-related ED visits were more common among persistent users (32%) than limited users (18%). Among persistent users, most pain-related encounters were discharged from the ED (69%) or within 48 hours of admission (20%). Persistent users with pain-related encounters accounting for >10% of ED use were more likely to be obese, have fewer comorbid conditions, and be on long-term opioid therapy.Conclusion. Pain is a major cause of ED use. Patients with SLE who persistently utilize the ED for pain are likely to be noncritically ill, as evidenced by frequent discharges from the ED and short-stay admissions. Patients with SLE who persistently frequent the ED for pain represent a viable target for interventions to improve outpatient quality of care.

Persistent frequent emergency department users with chronic conditions: A population-based cohort study

“…The variables associated with persistent frequent use found in this study were all reported by previous studies [32,33,35,36], while some studied both occasional frequent use and persistent frequent use [32,33,36]. In those same studies, depending on the studied population, some specific diagnoses were also associated with persistent frequent use, such as COPD diagnosis.…”

“…In those same studies, depending on the studied population, some specific diagnoses were also associated with persistent frequent use, such as COPD diagnosis. Besides, a few studies mentioned race [32,33] and deprivation indices [32,35,36] as significant, though those latter were not necessarily the same indices as ours. Race was not available in our databases and deprivation indices were not significant in our analyses of persistent frequent use.…”

Corticosteroid dosing and opioid use are high in patients with SLE and remain elevated after belimumab initiation: a retrospective claims database analysis

“…In a study using electronic health records, chronic pain was found to be a main cause of emergency room (ER) use among patients with SLE who had frequent ER visits. 31 In addition, long-term opioid use was seen in one out of three patients with SLE who frequented the ER.…”

Health care utilization and costs of systemic lupus erythematosus in the United States: A systematic review

“…Our review from January 2000 to June 2020 identified 9224 abstracts for review; 479 full-text articles were selected for full-text review (Figure 1). Overall, 51 articles met selection criteria and captured the desired outcomes: health care utilization (28 articles), 10, drug utilization (20 articles), 11,24,[28][29][30][32][33][34][35]37,38,41,42,[47][48][49][50][51][52][53] adherence (7 articles), 27,49,51,52,[54][55][56] direct costs (20 articles), 10,11,20,22,24,25,[28][29][30][31][32][33][34][35]40,42,43,[57][58][59] and indire...…”

“…Among the 39 longitudinal studies included, the length of follow-up range was 6 months to 10 years, with the earliest study periods beginning in 1987. 10,11,[20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][37][38][39][40][41][42][43][44][45]47,48,51,53,[56][57][58][59][60]62,68,69 Across all studies, sample sizes varied from fewer than 100 patients up to 340,000 patients, depending on data source, study period, and study objectives. More than 60% of the articles had study populations that were more than 90% female.…”