Predictors of Recurrent High Emergency Department Use among Patients with Mental Disorders.

Lia Gentil,Christophe Huỳnh,Marie-Josée Fleury,Guy Grenier,Helen-Maria Vasiliadis

doi:10.3390/ijerph18094559

Abstract

Few studies have examined predictors of recurrent high ED use. This study assessed predictors of recurrent high ED use over two and three consecutive years, compared with high one-year ED use. This five-year longitudinal study is based on a cohort of 3121 patients who visited one of six Quebec (Canada) ED at least three times in 2014–2015. Multinomial logistic regression was performed. Clinical, sociodemographic and service use variables were identified based on data extracted from health administrative databases for 2012–2013 to 2014–2015. Of the 3121 high ED users, 15% (n = 468) were recurrent high ED users for a two-year period and 12% (n = 364) over three years. Patients with three consecutive years of high ED use had more personality disorders, anxiety disorders, alcohol or drug related disorders, chronic physical illnesses, suicidal behaviors and violence or social issues. More resided in areas with high social deprivation, consulted frequently with psychiatrists, had more interventions in local community health service centers, more prior hospitalizations and lower continuity of medical care. Three consecutive years of high ED use may be a benchmark for identifying high users needing better ambulatory care. As most have multiple and complex health problems, higher continuity and adequacy of medical care should be prioritized.

Highlights

A small proportion of patients make disproportionate use of emergency departments (ED) [1,2], contributing to overcrowding in ED [3,4], longer length of stay and longer wait time for treatment [5], as well as increased patient dissatisfaction [6] and higher health care costs [4,7]
57% were on stretchers at their third 2014–2015 ED visit
Results confirmed that recurrent high three-year ED users had more cooccurring and complex health and social problems as compared with high one-year ED

Summary

Introduction

A small proportion of patients make disproportionate use of emergency departments (ED) [1,2], contributing to overcrowding in ED [3,4], longer length of stay and longer wait time for treatment [5], as well as increased patient dissatisfaction [6] and higher health care costs [4,7]. According to a Canadian scoping review [8] that assessed 20 studies of frequent ED use (60% from the U.S.), between 4% (from a telephone survey of 800 ED users in Taiwan [9]) and 29% (from a New York City study of 205,139 patients using Medicaid data [10]) of ED users are high users [10], generally defined as those who make 3–4 ED visits yearly [11].

Methods

Results

Discussion

Conclusion