Frequent Attendees Research Articles

Shift in emergency department utilization by frequent attendees with sickle cell disease during the COVID-19 pandemic: Amulticentre cohort study.

While the coronavirus disease-2019 (COVID-19) might have increased acute episodes in people living with sickle cell disease (SCD), it may also have changed their reliance on emergency department (ED) services. We assessed the impact of the COVID-19 pandemic and lockdowns on ED visits in adult SCD people followed in five French reference centres, with a special focus on 'high users' (≥10 visits in 2019). We analysed the rate of ED visits from 1 January 2015 to 31 December 2021, using a self-controlled case series. Among 1530 people (17 829 ED visits), we observed a significant reduction in ED visits during and after lockdowns, but the effect vanished over time. Compared to pre-pandemic, incidence rate ratios for ED visits were 0.59 [95% CI 0.52-0.67] for the first lockdown, 0.66 [95% CI 0.58-0.75] for the second and 0.85 [95% CI 0.73-0.99] for the third. High users (4% of people but 33.7% of visits) mainly drove the reductions after the first lockdown. COVID-19 lockdowns were associated with reduced ED visits. While most people returned to their baseline utilization by April 2021, high users had a lasting decrease in ED visits. Understanding the factors driving the drop in ED utilization among high users might inform clinical practice and health policy.

183 Pathfinder emergency response to urgent urinary catheter issues in older adults; a service profile

Abstract Background Older adults are frequent attendees at the Emergency Department (ED) and experience high rates of adverse outcomes following ED presentation. There is growing evidence for alternative care pathways at the time of a low acuity Emergency Medical Services (EMS) call. The Pathfinder service is a collaboration between the National Ambulance Service and acute hospital Occupational Therapy and Physiotherapy Departments. The service responds to low acuity 999/112 calls for people aged 365 years within the hospitals catchment area, including low acuity calls for blocked or dislodged indwelling urinary catheters. Methods A retrospective analysis of the service’s database was completed (1/1/22–26/5/23). All of the patients seen where the reason for 999 call was recorded as ‘blocked catheter’, ‘dislodged catheter’ or ‘urinary issues’, were identified and analysed. Results One hundred patients were identified, with urinary catheter related issues. Of these patients, 70% were male. The average age was 81 years. The average Clinical Frailty Scale score was 7 (severely frail). Ninety One percent of these patients remained at home as a result of the services’ intervention at the time of the 999 call. Of these 91 patients, 54% were classified as ‘treat and discharge’ (no further input or onward referral required), and 37% were ‘treat and refer’ (with onward referral to other services including Hospital Urodynamics Team, Public Health Nursing, GP). Seventy five percent remained at home without representation at 24 hours; 90% at 7 days and 75% at 28 days. Conclusion The Pathfinder service is safely and effectively managing urgent indwelling catheter issues, at the time of a 999 call, in older peoples’ homes instead of the ED. This upskilling project was made possible by excellent cross-organisational collaboration with the Hospital Urology and Urodynamics Department. The next phase of upskilling will focus on the management of urgent suprapubic catheter related issues.

Understanding the effects of comorbidity severity among high-need, high-cost alcohol-related frequent attenders: A cross-sectional study

Objectives: Alcohol dependence (AD) imposes a significant economic burden and frequently cooccurs with other mental disorders. This study aimed to determine the impact of comorbidity severity among high-need, high-cost (HNHC) alcohol-related frequent attendees. (ARFAs). Methods: In a cross-sectional study, 128 participants filled out questionnaires. Assessing patients with the TLFB, APQ, SF-12, and Adult Service Use Schedule. Results: a) Psychiatric comorbidities are common in patients with AD. b) Comorbidity severity significantly predicts alcohol-related problems (APQ), quality of life (QoL), and emergency department (ED) attendance and admission after controlling for the influence of age and gender. c) Daily alcohol intake significantly modifies the relationship between comorbidity severity and emergency department attendance. Conclusions: When treating patients with AD, evaluating and considering the severity of comorbidity is essential.

224 “OLDER PEOPLE WANT TO BE IN THEIR OWN HOMES”: THEMATIC ANALYSIS- PATIENT AND CARER FEEDBACK AFTER PATHFINDER EMERGENCY CALL RESPONSE

Abstract Background Older adults are frequent attendees at the Emergency Department (ED) and experience high rates of adverse outcomes following ED presentation. There is a growing evidence base for alternative care pathway models at the time of a low acuity emergency medical services (EMS) call. Previous research has found a high level of patient satisfaction with the Pathfinder model, in which an Advanced Paramedic and a Physiotherapist or Occupational Therapist respond to EMS calls [1]. However, the reasons underpinning this from a patient perspective have not previously been reported. Methods This is a qualitative study employing thematic analysis of open-ended responses recorded in 429 telephone interviews with service users (patients or their next-of-kin), who had been attended by the Pathfinder service following an EMS call. Results Five primary themes were identified: (1) the professionalism of the interdisciplinary clinical team; (2) “the right service, in the right place at the right time”; (3) the role of Pathfinder in “getting the ball rolling” through following up and co-ordinating referrals and services; (4) the lasting impact of the experience on the patient and their next-of-kin; (5) the value of skilled communication with the older person, as well as smooth and “tuned-in” communication across the team. Conclusion Older people voiced a clear preference for hospital avoidance, and strongly valued the opportunity to be assessed and treated in their homes at the time of an EMS call rather than automatic conveyance to the ED. They recognised the value of a skilled interdisciplinary team, with a follow-up service, that effectively positions itself between the acute hospital and community services. Reference 1. Bernard P, Corcoran G, Kenna L, et al. Is Pathfinder a safe alternative to the emergency department for older patients? An observational analysis. Age Ageing 2021; 50(5):1854–1858.

The Long-Term Impact of Postoperative Educational Programs on Weight Loss After Roux-en-Y Gastric Bypass

PurposeRoux-en-Y gastric bypass (RYGB) is a well-documented treatment of severe obesity. Attending postoperative educational programs may improve the outcome. The aim of this study was to evaluate whether participation in educational programs lasting 2–3 years after RYGB influences long-term weight loss, weight regain, physical activity, and compliance to multivitamin supplements.Materials and MethodsThe Bariatric Surgery Observation Study (BAROBS) is a multicenter retrospective, cross-sectional study 10–15 years after primary RYGB. Four hundred and ninety-seven participants answered questions regarding participation in postoperative educational programs. Participants were divided into frequent attendees (FA) and infrequent attendees (IFA) at the educational programs.ResultsTen to 15 years after surgery, a total weight loss (TWL) of 23.2 ± 11.6% were seen in the FA group vs 19.5 ± 12.6% in the IFA group, p < 0.001. Percent excess weight loss (%EWL) was 55.7 ± 28.9% vs 46.0 ± 31.1%, p < 0.001. Weight regain in percent of maximal weight loss for the FA was 32.1 ± 32.8% vs IFA 38.4 ± 40.0%, p = 0.052. No difference between the groups in compliance to multivitamin and physical activity.ConclusionParticipants with frequent participation in group-based educational programs had better weight loss outcomes 10–15 years after RYGB and tended to have less weight regain. There was no difference between the two groups in participants compliance to recommended multivitamin supplements and physical activity.Graphical abstract

GECCO 2021

The 2021 Genetic and Evolutionary Computation Conference (GECCO 2021) was planned to be held in hybrid mode in Lille, France, on July 10th-14th, 2021. After a careful analysis of the evolution of the pandemic and the results of a poll to frequent attendees on the preferred form of attendance, a decision was made in mid-December to run GECCO'21 in online/virtual mode only. This report provides statistics about submissions and authorship, and some comments about the evolution and growth of GECCO.

GECCO 2021

The 2021 Genetic and Evolutionary Computation Conference (GECCO 2021) was planned to be held in hybrid mode in Lille, France, on July 10th-14th, 2021. After a careful analysis of the evolution of the pandemic and the results of a poll to frequent attendees on the preferred form of attendance, a decision was made in mid-December to run GECCO'21 in online/virtual mode only. This report provides statistics about submissions and authorship, and some comments about the evolution and growth of GECCO.

Religiosity and substance use in U.S. adults: Findings from a large-scale national survey

BackgroundIn recent decades, the US religious landscape has undergone considerable change such as a decline in religious service attendance. These changes may indicate that religious social support structures have deteriorated, possibly leading to a decrease in strengths of associations with substance use. Considering this, and given limitations of past studies (e.g., limited control for potential confounders), large-scale general population studies are needed to reexamine associations between religiosity domains and substance use. MethodsThis cross-sectional study used data from the 2012–2013 National Epidemiologic Survey on Alcohol and Related Conditions-III (N = 36,309). In unadjusted and adjusted models, controlling for religiosity domains and other covariates, we examined associations between three religiosity domains (importance of religiosity/spirituality, service attendance, and religious affiliation) and DSM-5 SUD. Focusing on service attendance, we also examined associations with other substance use-related outcomes. ResultsAmong religiosity domains, only frequency of service attendance was associated with SUD across most substances. Frequent service attendees had lower odds of alcohol use disorder (adjusted OR [aOR] = 0.4, 95 % CI 0.33,0.51), tobacco use disorder (aOR = 0.3, 95 % CI 0.22,0.33) and cannabis use disorder (aOR = 0.4, 95 % CI 0.24,0.68), compared to non-service attendees. For alcohol and tobacco, the protective effect of frequent service attendance was more robust for SUD than for respective substance use. ConclusionsDespite decreasing rates of religious belief and practice in the US, service attendance independently lowered the odds of substance use and SUD across multiple substances. Results may inform religious leaders and clinicians about the value of utilizing religious social support structures in the prevention and treatment of substance use and SUD.

Frequent attendees to the emergency department: Perspectives for trainee preparedness.

Frequent attendees to the emergency department: Perspectives for trainee preparedness.

Sociodemographic Factors Associated with Loss to Follow-Up After Bariatric Surgery.

Despite the importance of follow-up and multidisciplinary care after bariatric surgery, many patients do not attend postoperative appointments, particularly those with the medical team. The present study aimed to identify factors associated with loss to follow-up after bariatric surgery. We recruited patients who underwent bariatric surgery between 01/01/2012 and 31/12/2013. Data were collected on demographic and socioeconomic information and comorbidities. Ten baseline psychological evaluations were blindly reviewed to evaluate the relationship between emotions and compliance with follow-up. During the 3-year postoperative period, we defined frequent attendees as those who attended at least two visits, whereas non-attendees were those who attended one visit or none. We evaluated baseline variables associated with non-adherence with follow-up schedules. Among 92 patients, 41 patients (44.6%) attended at least two postoperative appointments, while 51 (55.4%) were classified as non-attendees. Among the non-attendees, significantly more were younger than 45 years compared with attendees. No other statistically significant differences were found in terms of socioeconomic variables. Multivariate logistic regression revealed male gender and psychological issued related to obesity to be independent predictors of poor compliance with follow-up. Blinded psychological evaluation of ten patients did not suggest that psychological factors are predictive of follow-up attendance. Identifying factors associated with loss to follow-up after bariatric surgery is challenging. However, this is important in order to enable the design of personalized follow-up plans, especially for younger patients and those with psychological issues.

When the arts are not your cup of tea: Participation frequency and experience in cultural activities

Expressive cultural activities, such as viewing visual art, drama, or dance, are perceived as beneficial to individuals and societies, justifying public funding. However, not everyone benefits and participates equally. We intentionally sampled infrequent and frequent attendees among young adults in the Netherlands. Results indicated that infrequent and frequent attendees differed in expressive cultural activity constraints and socialization, though not on demographic background. Their cultural, social, and emotional experience through self-report and physiological data revealed no significant differences between the groups’ experience of a dramatic performance. These outcomes suggest that, as an example of expressive cultural activity, a dramatic performance experience can be equally emotionally beneficial to frequent and infrequent attendees, an important prerequisite to broader appeal and intergroup contact. Implications of the use of physiological data in leisure experience research are discussed.

Incentivizing and re-engaging lapsed health club members

PurposeThis quantitative research paper examined factors influencing re-engagement intentions and re-engagement behavior of lapsed health club members and identified which sales promotion incentives are most effective in re-engaging this lapsed member market. While previous studies examined re-engagement intentions and re-engagement behavior in isolation, no research could be located which examined both simultaneously and the impact of promotion incentives in the health and fitness industry.Design/methodology/approachStudy A (mail survey) examined re-engagement intentions of one hundred lapsed members of a medium size suburban health club. Study B (an experimental field study) measured actual true re-engagement behavior using price and gift token as incentives to re-engage 300 lapsed members of the same health club. Ten hypotheses were tested using chi-square, logistic regression and correlation analysis.FindingsResults indicate that price is the most influential incentive in promoting re-engagement intentions, while the experimental field study tested this survey finding and reported that although incentives were more effective than nonincentives in terms of re-engagement behavior, price played a far greater significant role than gift token in actual re-engagement behavior of lapsed members. Highly satisfied customers are likely to have stronger re-engagement intentions with frequent attendees more influenced by price in terms of re-engagement intentions, while those who lapsed most recently demonstrated stronger re-engagement behavior.Research limitations/implicationsStudy A: While acknowledging that the sample size was limited, a respectable response rate of 49% was recorded for the mail survey in Study A but a greater response rate and larger sample size would have allowed for a more comprehensive analysis. However, the study is primarily exploratory in nature and serves to achieve the objectives of the research. The study was based on a medium size suburban health club, therefore no comparisons can be drawn between the results of this study and that involving larger health clubs, chains, urban clubs or those outside of Ireland. Although the inclusion of moderating effects was considered, it was not feasible to develop these interactions due to the limited sample size. Study B: Generalization of the findings in this study with other international markets is not possible due to differences in demographic factors, promotions and differences in the health and fitness industry. No comparison can be drawn either between health clubs which operate in a different environment, such as public or nonmembership-based clubs, urban clubs or those constituting a chain. While the offer incentives were of equal value, it is recognized that the gift token may have appealed more to females than to males.Practical implicationsHealth clubs should consider changing strategic focus, from being overly concentrated on new customer acquisition to actively re-engaging the lapsed member market by finding out why they left and offer an incentive such as price to re-engage. Although loyalty, duration, age, gender and income were found not to be significant in this study, satisfaction, frequency and recency of lapse were significant. Therefore, health clubs should strive to keep members satisfied, monitor and increase frequency of attendance with creative programming and commence the re-engagement process prior to the membership expiry so as to maximize re-engagement and customer retention using price discount as an incentive.Originality/valueThe originality of this study is that is tests statistically consumer re-engagement intentions and actual re-engagement behavior simultaneously in a health club setting using a mail survey in Study A and Experimental Design in Study B.

Community event sustainability: why don’t people volunteer?

Every Saturday, thousands of runners worldwide participate in parkrun – a free five-kilometre run/walk event. Delivery relies on volunteers, and parkrunners are encouraged to volunteer regularly. However, volunteer recruitment is often difficult, and this study aimed to investigate the underpinning reasons for this. Data were collected from 6,749 parkrunners using an online survey, including 860 who had never volunteered. In addition to demographic information and views on incentives, non-volunteers were asked to rate agreement level for 18 statements about not volunteering. Main reasons were preferring to run or walk and not having got round to it. Principal component analysis indicated four underlying factors: inertia, self-interest, lack of knowledge and anxiety. Non-volunteers were younger, slower runners and walkers, less frequent parkrun attendees and had become involved more recently than volunteers. Ease of signing up to volunteer and being unsure of the commitment required were barriers. It is recommended that these two issues are addressed to help volunteer recruitment.

Impact of an extracurricular, student-led journal club on evidence-based practice among baccalaureate nursing students.

Objective Journal clubs are accepted as an effective strategy for promoting evidence-based practice (EBP). However, journal clubs are underutilized in nursing education, and little is known about the impact of extracurricular, student-led journal clubs on EBP implementation among baccalaureate nursing students. The purpose of this study was to estimate the impact of journal club attendance on EBP implementation. Methods A web-based survey was conducted in April 2019 following eight sessions of monthly journal club among senior nursing students (n=78). Results Fifteen students attended four or more extracurricular, student-led journal club sessions (19.2%). EBP practice score was significantly higher among frequent journal club attendees. In multivariate analysis, journal club attendance was the significant predictor of EBP practice (β=0.34; p=0.006). Conclusion Graduating senior nursing students who attend extracurricular, student-led journal club sessions are more likely to carry out EBP practice. Participation in journal clubs may help increase their EBP competencies.

How Religion Predicts Pet Ownership in the United States

AbstractOver 60 percent of Americans have some sort of family pet. Although studies have explored the personality and demographic correlates of pet ownership, none have considered whether religious characteristics may influence not only pet ownership, but the kind of pet Americans own. Drawing on data from the 2018 General Social Survey, we examine the religious antecedents of pet ownership in general as well as owning a cat or a dog, taking into account factors previously associated with owning certain pets (e.g., urban vs. rural residence, political affiliation). Although religious tradition and biblical literalism generally do not predict pet ownership, frequent worship attendees and the most conservative evangelicals report owning fewer pets. Religious characteristics also predict Americans’ ownership of particular pets. Most notably, we find a strong, negative association between worship attendance and cat ownership. We theorize potential mechanisms. On the one hand, certain personality types might simultaneously attract some Americans toward religious participation and away from pets, and cats in particular. Alternatively, to the extent that pet ownership is a partial substitute for human bonding and interaction, Americans more deeply embedded within a religious community may have less need (or time) for pets generally, and specifically more independent “roommate pets,” like cats.

Implementing an allied health team intervention to improve the care of older adults in the emergency department: protocol for a process evaluation

IntroductionHealth and social care professionals (HSCPs) have increasingly contributed to enhance the care of patients in emergency departments (EDs), particularly for older adults who are frequent ED attendees with significant...

Exploring Intimate Partner Violence Among Women Attending Malaysian Primary Care Clinics.

Victims of intimate partner violence (IPV) are frequent attendees at health care facilities. Although most literature on this subject focuses on developed or Western countries, there is a dearth of information from Asian countries. This study aims to estimate the prevalence of IPV among women attending urban primary care services in Malaysia and to identify the risk factors associated with IPV. Six out of 15 available public primary care clinics in the federal territory of Kuala Lumpur, Malaysia, were randomly selected. The sampling size for each clinic was conducted proportionate to the clinic's average daily patient attendance. A total of 882 women participated in this study via a self-administered questionnaire. We administered the women's experience with battering scale (WEB-scale) to estimate the prevalence of psychological violence and included a screening question for physical and sexual assault. The results showed that 22.0% of the women surveyed reported experiencing IPV. Ethnicity appears to be a significant predictor, with Chinese and Indian women reporting IPV at a higher rate than Malay women. Women with IPV are more likely to come from lower income households, have witnessed parental IPV, receive less social support, and have poorer psychological well-being. Our findings indicate that the prevalence of IPV among women attending urban public primary care clinics is high. Health care providers should pay close attention during clinical encounters for any sign of IPV, particularly among those presenting with risk factors.

Frequent ED attendees could gain from more personalised help

Frequent ED attendees could gain from more personalised help

The “Frequent Attendee” Project: A Multidisciplinary Approach to Identifying Important Factors, which Influence Frequent Attendances to the Emergency Department

Abstract Background: During routine emergency department (ED) patient attendance validation, a trend began to emerge, related to the reason for frequent attendance among individuals. Dialogue among staff in the department who referred to this client group as “regulars” was concerning, as it was believed that it might lead to a degree of unintentional complacency that might result in a potentially vulnerable group slipping through the net. The aim was to examine the unique profile of frequent attendees, establish preventative factors, and develop action plans to offer more specific support. A multidisciplinary team was formed to examine the profiles of these cases and develop specific action plans to address their unique needs in an attempt to prevent unnecessary admissions to the ED at Cwm Taf University Health Board, South Wales. Materials and Methods: Using a Plan–Do–Study–Act methodology over 18 months, a trend analysis identified specific demographic characteristics of age and sex of the sample group (n = 11). The main reasons for attendance were related to alcohol, substance misuse, and learning disabilities. Results: Results showed that the group included eight males, five of which fell into the 18–25 age group and attended on weekdays, with peak times between 9 am and 5 pm. The other three men fell into the 26–35 age group and attended most frequently after 5 pm, with the peak day being Thursdays. Weekend activity was sustained among the 18–25 age group, and the 26–35 age group had the highest attendances on Sundays. Three females from this group fell into the 26–35 age group and reflected no difference in attendance patterns. Common factors of the sample were unemployment and a socially deprived location. Conclusion: The project resulted in a 75% reduction in visits to the ED from this group of patients. Networking with other hospitals in the area yielded reports that only one of the patients had changed areas and attended another department.

Characteristics of Elderly Frequent Attendees in Slovene Family Medicine Practices - a Cross-sectional Study

Introduction:Frequent attendance in family medicine practices is associated with elderly patients and those with chronic diseases. Longstanding frequent attendees have more social and psychiatric problems, medically unexplained conditions, and chronic diseases, and are prescribed more psychotropic drugs and analgesics.Aim:To fill the lack of data on the factors associated with frequent attendance at family medicine practices by the elderly.Methods:Forty family physicians (FPs) participated in this cross-sectional study in 2017 and randomly recruited up to 20 of their patients; 624 patients were recruited. From the patients’ health records, the FPs collected demographic data, lifestyle factors, all the patients’ diagnoses, all the drugs prescribed in the previous 12 months, multi-morbidity (CIRS-G index), the quality of life index (EQ-5D) and the number of visits to the family medicine practice in the previous 12 months. The Self-Rating Depression Scale was administered to the patients. Statistical analysis was carried out using the IBM SPSS 20.0 package, with appropriate non-parametric tests (Mann-Whitney U test, chi-square test) to check significant differences between groups of patients. Multivariate modelling was carried out to evaluate the associations between the number of visits to the FP and independent variables.Results:The number of prescribed drugs (p=0.026), haematological problems (p=0.005) and genitourinary problems (p=0.001) were associated with frequent attendance. Patients with borderline depression were approximately three times more likely to be frequent attendees than non-depressed patients.Conclusion:Polypharmacy, haematological and genitourinary problems are associated with frequent attendance in elderly patients. Further longitudinal studies are required to validate our findings.