Abstract
Background:Frequent users of the psychiatric emergency service (PES) place a heavy burden upon the mental health care delivery system. The aim of this study was to identify distinct temporal or geographical patterns of PES use by these patients as potential markers for their early detection.Methods:Diagnostic profiles were obtained for patients making an intermediate (4 to 10) or a high (11 or more) number of visits to a general hospital PES in Montreal (Canada) between 1985 and 2004. Between-group comparisons were made with regards to several parameters. These included the time intervals between consecutive visits, visit clustering (single, repeating, and the time interval to the first cluster) and visits made to three other services where data was similarly acquired from 2002 to 2004.Results:The two multiple visit groups differed with regards to diagnostic profiles and actual time between consecutive visits (significantly shorter in patients with 11 or more visits). Patients with 11 or more visits were more likely to have a single cluster (3 or more visits/3 months) or repeating clusters (4 visits/3 months) in their patterns of use. Personality disorders were more prevalent in patients with single clusters as they were, along with schizophrenia, in those with repeating clusters. In addition, clusters were found to occur sufficiently early so as to be potentially useful as markers for early detection. Ten percent of those with 11 or more visits and 16% of those with an intermediate number of visits frequented at least one other PES. A small number of patients, primarily those with substance abuse, made over 50% of their visits to other services.Conclusion:Temporal and geographical patterns of use differed significantly between the multiple visit groups. These patterns, combined with distinct diagnostic profiles, could potentially lead to the more rapid identification and treatment of specific sub-groups of multiple visit patients.
Highlights
Frequent users of the psychiatric emergency service (PES) place a heavy burden upon the mental health care delivery system
An underlying premise of this study is that long-term data acquisition can lead to a more precise clinical description of the various PES user groups
This could lead to the development of treatment strategies tailored towards the common elements within these groups, rather than strategies geared towards each individual patient
Summary
Frequent users of the psychiatric emergency service (PES) place a heavy burden upon the mental health care delivery system. The aim of this study was to identify distinct temporal or geographical patterns of PES use by these patients as potential markers for their early detection. Several studies have shown that heavy and intermediate PES users possess distinct diagnostic profiles [57]. These profiles become more heavily weighted with chronic and severe psychopathology as the number of visits increases [6]. Distinct, these profiles are by themselves not sufficiently unique to be used as potential markers for early multiple visit patient detection. Correlating them with distinct patterns of PES use, such as temporal or geographical patterns, may provide useful additional information
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