Socio-demographic and clinical characteristics of re-presentation to an Australian inner-city emergency department: implications for service delivery

Moore, Gaye; Gerdtz, Marie; Manias, Elizabeth; Hepworth, Graham; Dent, Andrew W

doi:10.1186/1471-2458-7-320

Cited by 60 publications

(75 citation statements)

References 49 publications

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“…While our main results do not achieve statistical significance, 19 % fewer ED visits is clinically relevant, given the significant time and resources required to care for frequent ED users. [31][32][33] For example, in the USA (21-28 % of 130 million total visits), a reduction of the magnitude found in our study would translate into 5.1-6.8 million avoided visits annually. 15,34 The non-significant reduction in ED use found in this study underscores the mixed evidence in the literature.…”

Section: Discussionmentioning

confidence: 59%

Case Management may Reduce Emergency Department Frequent use in a Universal Health Coverage System: a Randomized Controlled Trial

et al. 2016

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BACKGROUND: Frequent emergency department (ED) users account for a disproportionately high number of ED visits. Studies on case management (CM) interventions to reduce frequent ED use have shown mixed results, and few studies have been conducted within a universal health coverage system. OBJECTIVE: To determine whether a CM intervention--compared to standard emergency care-reduces ED attendance. DESIGN: Randomized controlled trial. PARTICIPANTS: Two hundred fifty frequent ED users (5 or more visits in the prior 12 months) who visited a public urban ED at the Lausanne University Hospital between May 2012 and July 2013 were allocated to either an intervention (n = 125) or control (n = 125) group, and monitored for 12 months. INTERVENTIONS: An individualized CM intervention consisting of concrete assistance in obtaining income entitlements, referral to primary or specialty medical care, access to mental health care or substance abuse treatment, and counseling on at-risk behaviors and health care utilization (in addition to standard care) at baseline and 1, 3, and 5 months. MAIN MEASURES: We used a generalized linear model for count data (negative binomial distribution) to compare the number of ED visits during the 12-month follow-up between CM and usual care, from an intention-to-treat perspective.KEY RESULTS: At 12 months, there were 2.71 (±0.23) ED visits in the intervention group versus 3.35 (±0.32) visits among controls (ratio = 0.81, 95 % CI = 0.63; 1.02). In the multivariate model, the effect of the CM intervention on the number of ED visits approached statistical significance (b = −0.219, p = 0.075). The presence of poor social determinants of health was a significant predictor of ED use in the multivariate model (b = 0.280, p = 0.048). CONCLUSIONS: CM may reduce ED use by frequent users through an improved orientation to the health care system. Poor social determinants of health significantly increase use of the ED by frequent users.

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Section: Discussionmentioning

confidence: 59%

Case Management may Reduce Emergency Department Frequent use in a Universal Health Coverage System: a Randomized Controlled Trial

et al. 2016

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“…We successfully recruited 30 vulnerable people who had entrenched drinking problems and were very diverse in terms of their age, gender, ethnicity, and other sociodemographic characteristics. Our participants had a similar socio-demographic profile (gender, age, and related health and social problems) of participants in other international surveys and epidemiological studies; thus suggesting that our sample was not unreflective of the population more generally (Curran et al, 2003;Dent et al, 2010;Fleming et al, 2007;Hansagi et al, 2001;Moore et al, 2007;Whiteman et al, 2000;Williams et al, 2001). Nonetheless, the themes and patterns that we identified, and the implications for policy and practice that we suggest, do now need to be studied further via more indepth qualitative research and new quantitative research using larger sample sizes conducted in different countries, regions, and health care systems.…”

Section: Discussionmentioning

confidence: 70%

“…This article focuses on one sub-group of frequent ED attendees-people who repeatedly attend for alcoholrelated reasons. This population has been identified as a concern in Australia (Moore, Gerdtz, Manias, Hepworth, & Dent, 2007); Canada (Brubacher et al, 2008); England (Charalambous, 2002;Dent, Hunter, & Webster, 2010;Williams et al, 2001); Ireland (Hannon & Luke, 2006); Sweden (Hansagi, Olsson, Sjoberg, Tomson, & Goransson, 2001); Switzerland (Fleming et al, 2007); and the United States (Curran et al, 2003;Rockett, Putnam, Jia, Chang, & Smith, 2005;Saleh & Szebenyi, 2005;Whiteman, Hoffman, & Goldfrank, 2000). To date, most information on people who repeatedly attend EDs for alcohol-related reasons has been quantitative and derived from surveys or epidemiological studies that have analyzed hospital databases or patient records to establish the prevalence, socio-demographic characteristics, and/or the costs of treating this population.…”

mentioning

confidence: 99%

“…They are likely to have experienced homelessness and housingrelated problems, use a range of substances, and have been heavy smokers (Fleming et al, 2007;Whiteman et al, 2000). In addition, they tend to have relatively low levels of education; exhibit high levels of psychiatric illness; possess limited social networks; and live in areas of higher socioeconomic deprivation (Curran et al, 2003;Dent et al, 2010;Hansagi et al, 2001;Moore et al, 2007;Williams et al, 2001).…”

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confidence: 99%

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How Do People Who Frequently Attend Emergency Departments for Alcohol-Related Reasons Use, View, and Experience Specialist Addiction Services?

Parkman¹,

Neale

Day³

et al. 2017

Substance Use & Misuse

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Background: People who frequently attend emergency departments (EDs) for alcohol-related reasons, cost health systems greatly. Although specialist addiction services may be more appropriate for their needs, drinkers often experience barriers accessing specialist alcohol-related support. Objectives: This study explores how people who frequently attend EDs for alcohol-related reasons use, view, and experience specialist addiction services. Methods: We conducted semi-structured interviews with 30 individuals recruited from six EDs across London, United Kingdom. Data relating to participants' sociodemographic characteristics and service use were systematically coded using qualitative software, and analyzed following the Framework. Results: ED usage over the last 12 months was high, whereas current use of specialist addiction services was low. We found little evidence that structural barriers were preventing participants from attending specialist services; rather, participants seemed not to require help with their alcohol use. When asked what support they desired for their drinking, only 11/30 participants identified alcohol-specific treatment. More commonly, they wanted help relating to mental health problems; social contact; paid or voluntary work; housing-related issues; or gym access. Women were more likely to be receiving, and to have support from a specialist addiction service. Conclusions/Importance: People who frequently attended EDs for alcohol-related reasons expressed low levels of interest in, and motivation for, alcohol-specific treatment but desired broader psychosocial support. Case management and assertive outreach appear to be valuable models of service delivery for this population (particularly for men). However, further qualitative and quantitative research is now needed to verify these findings in different countries, regions, and health care systems.

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“…Variables of patient characteristics were selected based on earlier studies [2,7,19,22] . Bivariate and multivariate logistic regression analyses were performed using SPSS for Windows (14.0).…”

Section: Discussionmentioning

confidence: 99%

Predictors of Repeated Emergency Department Visits among Persons Treated for Addiction

2011

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Background/Aims: To determine whether frequent emergency department (ED) users who enter specialized treatment programs for alcohol and/or drug problems have any characteristics that predict their future ED use. Methods: Adult patients (783 alcohol users, 405 illicit drug users) were interviewed. Data from the medical database on utilization of ED and the emergency departments’ specific units for addictive diseases (EDAD) 12 months before and 12 months after the interview were linked with patient characteristics in logistic regression models. Results: Among alcohol users, prior ED/EDAD visits predicted repeat future visits to these sites (OR 11.6; 95% CI 6.5–20.5). Prior inpatient hospital care with addiction diagnosis was a predictor of future multiple visits to the EDAD only (OR 3.1; 95% CI 1.5–6.5). Among drug users, predictors of future ED/EDAD visits were use of heroin (OR 2.7; 95% CI 1.4–5.4) and prior ED/EDAD visits (OR 27.3; 95% CI 12.7–58.4). Drug users’ EDAD utilization was also predicted by inpatient hospital care with addiction diagnosis. Conclusion: The strongest predictive factors of visiting ED repeatedly were previous repeat emergency care use and hospitalization with addiction diagnosis. Entering regular addiction treatment does not appear to alter the pattern of ED utilization.

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Socio-demographic and clinical characteristics of re-presentation to an Australian inner-city emergency department: implications for service delivery

Cited by 60 publications

References 49 publications

Case Management may Reduce Emergency Department Frequent use in a Universal Health Coverage System: a Randomized Controlled Trial

Case Management may Reduce Emergency Department Frequent use in a Universal Health Coverage System: a Randomized Controlled Trial

How Do People Who Frequently Attend Emergency Departments for Alcohol-Related Reasons Use, View, and Experience Specialist Addiction Services?

Predictors of Repeated Emergency Department Visits among Persons Treated for Addiction

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