Abstract
BackgroundSeveral recent studies have reported a significant increase in medical emergency department (ED) use for reasons of mental health. The diagnostic profile of these patients however differs from that usually described for patients visiting the psychiatric emergency service (PES). Few studies have specifically focused upon long-term PES utilization rates. Those that do typically present data from the early 80s, suggesting that deinstitutionalization may be an important contributing factor to the increases found. The aim of this study was to assess PES use using a more recent time frame and, the effects of non-specific factors, such as population growth, on this use.MethodsVisits per year at several different types of PESs were obtained; (a) for an 11-year period at a general hospital PES while the surrounding population remained stable, (b) at that same PES while the catchment area population doubled over a period of a few years, (c) for an 11-year period at two PESs without catchment areas while the surrounding population increased and (d-) for a 12-year period at a PES in a mental health facility while the surrounding population increased. Moderately conservative criteria were used to define either a trend or, a significant increase in utilization rates.ResultsEach site had an inherent, 7 to 15% yearly variability in the number of PES visits. Over time however, only those where the surrounding population increased (either by an increase in the catchment area size or a regional increase in the population census) showed a trend or, a significant increase in utilization rates. These increases however were modest and of the order of 12 to 19%.ConclusionLong observation periods are required in order to detect stable changes in PES utilization rates over time. As such, population growth may be but one of several factors underlying these increases. Organizational changes in mental health care delivery in the vicinity of the services that showed an increase could also have contributed. These latter would simply have redistributed (to the PES) the pre existing pool of mental health care patients, resulting in an increase that is more apparent than real.
Highlights
IntroductionA recent, nationwide "National Hospital Ambulatory Medical Care Survey (NHAMCS)" for the 1992 to 2001 period in the United-States reported a substantial increase (17.1 to 23.6 per 1000 population) in the number of medical emergency department (ED) visits for psychiatricrelated reasons (PREDV) [1]
Several recent studies have reported a significant increase in medical emergency department (ED) use for reasons of mental health
In the present study we examined but a single factor, population growth, on psychiatric emergency service (PES) use
Summary
A recent, nationwide "National Hospital Ambulatory Medical Care Survey (NHAMCS)" for the 1992 to 2001 period in the United-States reported a substantial increase (17.1 to 23.6 per 1000 population) in the number of medical emergency department (ED) visits for psychiatricrelated reasons (PREDV) [1] This rise was disproportionate in comparison to the overall rate of ED use during the same time period [1,2]. Increases in psychiatric emergency service (PES) utilization rates over time in the United-States have been reported [7,8,9] These data are typically local (or regional) and emanate from the 70s and early 80s. Generalizing from these studies is difficult as they typically present data from a single-site, use relatively short (6year) observation periods and factors such as variations in the surrounding population census are not reported
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