Predictors of Recurrent Use of Psychiatric Emergency Services

Richard-Lepouriel, Hélène; Weber, Kerstin; Baertschi, Marc; DiGiorgio, Sergio; Sarasin, François; Canuto, Alessandra

doi:10.1176/appi.ps.201400097

Cited by 32 publications

(41 citation statements)

References 17 publications

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“…4 Individuals with personality disorders have been associated with high frequency utilisation of emergency departments, [5][6][7][8][9] and recurrent use of emergency room psychiatric services. 10 A recent Canadian study found that individuals who were frequent emergency department presenters had an increased odds of having a primary or comorbid personality disorder diagnosis and that 87% of individuals with antisocial personality disorder or borderline personality disorder (BPD) presented five or more times in one year. 11 Stigma further complicates the interaction between the healthcare system and individuals with personality disorders.…”

Section: Resultsmentioning

confidence: 99%

“…Findings regarding increased frequency of emergency department presentation, increased likelihood of recurrent emergency department visits, and age and gender of individuals with personality disorders presenting to the emergency departments were consistent with previously published studies. 1,[5][6][7][8][9][10][11] Surprisingly, only 6% of mental-health-related presentations in the emergency departments involved individuals with a personality disorder diagnosis. Evidence suggests that personality disorder, in particular BPD, is 'markedly under-diagnosed'.…”

Section: Discussionmentioning

confidence: 99%

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A retrospective analysis of personality disorder presentations in a Canadian university-affiliated hospital's emergency department

et al. 2016

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BackgroundIndividuals with personality disorders often have extensive involvement with healthcare services including frequent utilisation of emergency departments.AimsThe aim of this study was to identify factors associated with emergency department presentations by individuals with personality disorders.MethodA 12-month retrospective data analysis of all mental-health-related emergency department visits was performed. Age, gender, time and season of presentation, length of stay, mode of arrival and discharge arrangements for individuals with personality disorders were compared to individuals with other psychiatric diagnoses.ResultsThere were 336 visits by individuals with personality disorders and 5290 visits by individuals with other psychiatric diagnoses. Individuals with personality disorders were significantly more likely to be female, young adults, brought in by police, arrive in the evening, discharged home and have a longer median length of stay.ConclusionKnowing what factors are associated with emergency department presentations by individuals with personality disorders can help ensure that appropriately trained support staff are available.Declaration of interestNone.Copyright and usage© The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A retrospective analysis of personality disorder presentations in a Canadian university-affiliated hospital's emergency department

et al. 2016

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“…A possible explanation may be that satisfaction with services was lower among frequent public ambulatory health service users due to their more serious needs (Fortin et al, ). According to the literature, frequent health services users are also those who receive inadequate treatment or insufficient continuity of care; they are often high users of emergency departments in particular (Richard‐Lepouriel et al, ). Elevated levels of user satisfaction with services were also associated with better quality of life in previous studies of individuals with serious MHD (Furrer et al, ; Nasrallah, Targum, Tandon, McCombs, & Ross, ; Petkari & Pietschnig, ), which seems reasonable.…”

Section: Discussionmentioning

confidence: 99%

Satisfaction with health and community services among homeless and formerly homeless individuals in Quebec, Canada

Gentil

Grenier

Bamvita

et al. 2019

Health Soc Care Community

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User satisfaction is a crucial quality indicator in health service provision. Few studies have measured user satisfaction among homeless and formerly homeless individuals, despite the high prevalence of mental health disorders (MHD) in this population. The purpose of this study was to assess overall satisfaction among 455 homeless and formerly homeless individuals who were receiving health and community services, and to identify factors associated with user satisfaction. Data collection occurred between January and September 2017. Study participants were 18 years old or over, with experience of homelessness in the current or recent past. They completed a questionnaire eliciting socio‐demographic information, and data on residential history, service use and satisfaction and health profiles. Multivariate linear analysis was performed on overall satisfaction with health and community services in the previous 12 months. Independent variables were organised as predisposing, enabling and needs factors based on the Gelberg–Andersen Behavioral Model. The mean satisfaction score was 4.11 (minimum: 1; maximum: 5). Variables associated with greater user satisfaction included: older age, residence in permanent housing, common MHD (e.g., depression, anxiety), having a family physician, having a case manager, strong social network, good quality of life and, marginally, male sex and having substance use disorders (SUD). By contrast, frequent users of public ambulatory health services were the most dissatisfied. User satisfaction was more strongly associated with enabling factors. Strategies for improving satisfaction include: promoting more tailored primary care programmes (including family physician) adapted to the needs of this population, better integrating primary care with specialised services including SUD integrated treatment and enhancing continuity of care through the reinforcement of case management services. Further efforts aimed at increasing access to permanent housing with supports, and eliciting more active involvement by relatives and friends may also improve user satisfaction with services, and reduce unnecessary service use.

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“…In a recent Swedish study, persons making frequent PES visits constituted 8.1% of the total sample, yet they accounted for 38.3% of all visits made during the investigated 3 years (Schmidt, Ekstrand, & Bengtsson Tops, 2018a). Previous research arrived at similar results, finding that this relatively small group is responsible for a disproportionately high number of visits in both Scandinavian (Aagaard et al, 2014) and international contexts, including North America (Chaput & Lebel, 2007;Lincoln et al, 2016), Europe (Boyer et al, 2011;Ledoux & Minner, 2006;Richard-Lepouriel et al, 2015), and Australia (Wooden, Air, Schrader, Wieland, & Goldney, 2009;Zhang, Harvey, & Andrew, 2011). Thus, it is a global phenomenon regardless of the healthcare system.…”

Section: Introductionmentioning

confidence: 74%

“…This diverse group also reportedly does not receive or has difficulties complying with aftercare (Bruffaerts, Sabbe, & Demyttenaere, 2005), can be uncooperative (Pasic et al, 2005), and has unreliable social support (Pasic et al, 2005). Furthermore, persons who frequently visit PES are more likely to be prematurely discharged (Botha et al, 2010); suffer from personality disorders (Richard-Lepouriel et al, 2015), substance abuse disorder (Bruffaerts et al, 2005;Ledoux & Minner, 2006), and schizophrenia (Aagaard et al, 2014); and have a history of hospitalization (Pasic et al, 2005). While useful in identifying the characteristics of this group, all of these are quantitative studies and have not focused on explaining what aspects apart from demographics and diagnostics could identify the needs of these persons that make them frequently visit PES.…”

Section: Introductionmentioning

confidence: 99%

Professionals’ Perspective on Needs of Persons Who Frequently Use Psychiatric Emergency Services

Schmidt

Garmy

Stjernswärd

et al. 2020

Issues in Mental Health Nursing

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This study explores how professionals experience persons who frequently use psychiatric emergency services (PES) in terms of their needs in Sweden. The data comprise 19 semi-structured individual interviews and one focus group interview with healthcare professionals (i.e., assistant nurses, psychiatric nurses, intern physicians, and resident physicians), which are analyzed using qualitative content analysis. The overall findings suggest that persons who frequently use PES suffer from illness, unfavorable life circumstances, and inadequate care, which together emphasize the need for more sustainable support. The findings indicate that the professionals saw beyond illness-related needs and could also acknowledge patients' needs originating from social, existential, and care-and support-related aspects of life.

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Predictors of Recurrent Use of Psychiatric Emergency Services

Cited by 32 publications

References 17 publications

A retrospective analysis of personality disorder presentations in a Canadian university-affiliated hospital's emergency department

A retrospective analysis of personality disorder presentations in a Canadian university-affiliated hospital's emergency department

Satisfaction with health and community services among homeless and formerly homeless individuals in Quebec, Canada

Professionals’ Perspective on Needs of Persons Who Frequently Use Psychiatric Emergency Services

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