Abstract
BackgroundA small proportion of patients utilizes a disproportionately large amount of emergency department (ED) resources. Being able to properly identify chronic frequent ED users, i.e. frequent ED users over a multiple-year period, would allow healthcare professionals to intervene before it occurs and, if possible, redirect these patients to more appropriate health services. The objective of this study was to explore the factors associated with chronic frequent ED utilization in a population with diabetes.MethodsA population-based retrospective cohort study using administrative data was conducted on 62,316 patients with diabetes living in metropolitan areas of Quebec (Canada), having visited an ED during 2006, and still alive in 31 December 2009. The dependant variable was being a chronic frequent ED user, defined as having at least 3 ED visits per year during three consecutive years (2007–2009). Independent variables, measured during 2006, included age, sex, neighbourhood deprivation, affiliation to a general practitioner, and number of physical and mental health comorbidities. Logistic regression and tree-based method were used to identify factors associated with chronic frequent ED use.ResultsA total of 2.6% of the cohort (patients with diabetes and at least one ED visit in 2006) was identified as chronic frequent ED users. These patients accounted for 16% of all ED visits made by the cohort during follow-up. The cumulative effect of a high illness burden combined with mental health disorders was associated with an increased risk of chronic frequent ED use.ConclusionsInterventions must target the population at higher risk of becoming chronic frequent ED users and should be designed to manage the complex interaction between high illness burden and mental health.
Highlights
A small proportion of patients utilizes a disproportionately large amount of emergency department (ED) resources
Emergency department (ED) overcrowding has become a critical issue for many hospitals [1] and it is well acknowledged that a small proportion of patients uses a disproportionately large amount of ED resources [1, 2]
To determine if a patient was affiliated to a General practitioner (GP), we considered all ambulatory visits to GPs during the 2-year period (2005–2006) before follow-up
Summary
The use of ED services by frequent users can often be perceived as inappropriate and non-urgent [15, 16], resulting in uncoordinated and less effective care as compared to what these patients would receive in primary care [17, 18]. This situation generates substantial costs to the health care system [19, 20], it decreases ED efficiency [2], and contributes to ED overcrowding [21, 22].
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
