Profiles of Emergency Department Users with Psychiatric Disorders Related to Barriers to Outpatient Care

Abstract

Emergency department (ED) overcrowding is a growing problem worldwide. High ED users have been historically targeted to reduce ED overcrowding and associated high costs. Patients with psychiatric disorders, including substance-related disorders (SRDs), are among the largest contributors to high ED use. Since EDs are meant for urgent cases, they are not an appropriate setting for treating recurrent patients or replacing outpatient care. Identifying ED user profiles in terms of perceived barriers to care, service use, and sociodemographic and clinical characteristics is crucial to reduce ED use and unmet needs. Data were extracted from medical records and a survey was conducted among 299 ED patients from 2021 to 2022 in large Quebec networks. Cluster algorithms and comparison tests identified three profiles. Profile 1 had the most patients without barriers to care, with case managers, and received the best primary care. Profile 2 reported moderate barriers to care and low primary care use, best quality of life, and more serious psychiatric disorders. Profile 3 had the most barriers to care, high ED users, and lower service satisfaction and perceived mental/health conditions. Our findings and recommendations inform decision-makers on evidence-based strategies to address the unmet needs of these vulnerable populations.

Barriers to Care among High Emergency Department Users with Mental Disorders – A Mixed Methods Study

“…Though several quantitative studies have assessed determinants of unmet needs for care among patients with MD [7,8], few have examined these unmet needs in relation to high ED use [6,9]. Some qualitative studies that explored high ED use among patients with MD found that unmet care needs partly explained high ED use [10][11][12].…”

“…Another mixed methods study found the following needs to be most associated with high ED use: needing to talk to someone, to get medication, to nd relief from psychiatric symptoms or to be hospitalized [5]. A recent study found three pro les of ED users with MD, one of which included high ED users with the greatest barriers to care; these patients also reported the lowest service satisfaction and the poorest perceived mental/physical health conditions [9]. Other qualitative investigations reported a combination of structural and motivational care barriers that justi ed high ED use, with structural barriers being most prevalent [12].…”