Utilization of Emergency Department Services by the Bedouin Population in Southern Israel

Arnon Dov Cohen,Daniel Aharon Vardy,Jacob Dreiher,Amir Sharf

doi:10.1100/tsw.2007.35

Abstract

Excessive use of the emergency department (ED) is associated with increased costs and workload in the ED, patients' inconvenience and disruption of the continuity of care. The study's goal was to describe trends in ED utilization among Bedouins living in southern Israel. A retrospective cross-sectional study was conducted in primary care clinics in southern Israel. Patients included Bedouin and Jewish patients insured by Clalit Health Services. Data was retrieved from a central database. The number of visits to the ED and age-adjusted rates of ED visits during 2000-2003 were determined in the Bedouin vs. Jewish population. All visits that ended in hospitalization were excluded. Data was stratified according to patients' residence (semi-nomadic vs. urban Bedouins) and referral origin. Age-adjusted rates of ED visits decreased from 42.9/1000 patients/month in 2000 to 38.3/1000 patients/month in 2003. There were more ED visits in the Bedouin as compared to Jewish population (38.3/1000 vs. 21.8/1000 patients/month). The decrease in ED utilization was more prominent among adult semi-nomadic Bedouins (from 60.8/1000 to 40.3/1000 patients/month). The proportion of referrals by the family physician to ED significantly decreased (among urban Bedouins: from 54.3% to 43.2%, p<0.001; among semi-nomadic Bedouins: from 53.9% to 39.9%, p<0.001), while the proportion of selfreferrals and referrals from physicians other than the family physician increased. A decrease in ED utilization by the Bedouin population during the last years was demonstrated. Utilization of ED services is still increased as compared to the non-Bedouin population. Interventions to control excessive use of ED services in the Bedouin population are currently underway.

Highlights

Emergency departments (EDs) in Israeli hospitals deal with an increasing number of visits
The aim of the current study is to describe trends in the utilization of ED services by Bedouins living in the Negev region in southern Israel
The number of age-adjusted ED visits was higher in the Bedouin population as compared to the non-Bedouin population (38.3/1000 patients/month vs. 21.8/1000 patients/month, respectively)

Summary

Introduction

Emergency departments (EDs) in Israeli hospitals deal with an increasing number of visits. Excessive use of ED is associated with increased costs, increased workload in the EDs and patients' inconvenience[1,2,3,4,5,6,7,8,9,10]. The Bedouins in the Negev comprises about 150,000 people. This is a population in transition from nomadic to urban form of life. The transition from a traditional to a western lifestyle, characterized by changes in dietary habits[11] and a reduction in physical activity is associated with substantial changes in morbidity patterns, such as an increase in the rates of hypertension, diabetes mellitus[11,12,13], home accidents[14] and asthma[15]

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Conclusion