Use Of Emergency Care Research Articles

A tertiary care ambulatory heart failure pathway managing one-third of all admissions including older patients with similar quality to inpatient management

Heart failure (HF) is the commonest cause of adult hospital admissions in the over 65s, accounting for over 67,000 admissions in England and Wales per year 1.[1][1] The average hospital stay lasts 13 days and costs around £3,800.[2][2] The increased use of same day emergency care (SDEC) services

Internet-based vestibular rehabilitation versus standard care after acute onset vertigo: a study protocol for a randomized controlled trial

BackgroundDizziness and vertigo affect around 15% of adults annually and represent common reasons for contacting health services, accounting for around 3% of all emergency department visits worldwide. Vertigo is also associated with excessive use of diagnostic imaging and emergency care and decreased productivity, primarily because of work absenteeism. Vestibular rehabilitation is an evidence-based treatment for chronic dizziness and supervised group exercise therapy has recently been shown to be effective after vestibular neuritis, a common cause of acute onset vertigo. However, such interventions are not readily available and there is a need for more easily accessible tools. The purpose of this study is to investigate the effects on vestibular symptoms of a 6-week online vestibular rehabilitation tool after acute onset vertigo, with the aim of aiding vestibular rehabilitation by presenting a more accessible tool that can help to reduce recovery time.MethodsThree hundred twenty individuals diagnosed with acute vestibular syndrome (AVS) will be recruited from multiple hospitals in Sweden and the effects of an online vestibular rehabilitation tool, YrselTräning, on vestibular symptoms after acute onset vertigo will be compared to standard care (written instructions leaflet) in a two-armed, evaluator-blinded, multicenter randomized controlled trial. The primary outcome will be the Vertigo Symptom Scale Short Form (VSS-SF) score at 6 weeks after symptom onset. Secondary outcomes include effects of the intervention on activities of daily living, mood and anxiety, vestibular function recovery, mobility measures, health economic effects, and the reliability of the Swedish VSS-SF translation.DiscussionParticipants using the online vestibular rehabilitation tool are expected to recover earlier and to a greater extent from their symptoms as compared to standard care. Since up to 50% of people with AVS without treatment develop persistent symptoms, effective treatment of AVS will likely lead to a higher quality of life and help reduce the societal costs associated with dizziness and vertigo.Trial registrationClinicaltrials.gov NCT05056324. Registered on September 24, 2021.

Long-term effectiveness of a disease management program to prevent diabetic nephropathy: a propensity score matching analysis using administrative data in Japan

BackgroundExisting reviews indicated that disease management for patients with diabetes may be effective in achieving better health outcomes with less resource utilization in the short term. However, the long-term results were inconsistent because of the heterogeneous nature of the study designs. In the present study, we evaluated the 5-year follow-up results of a local disease management program focused on diabetic nephropathy prevention under the universal public health insurance scheme in Japan.MethodsPatients diagnosed with type 2 diabetes who had stage 3 or 4 diabetic kidney disease and were aged between 20 and 75 years were invited to join a disease management program to support self-management and receive a recommended treatment protocol between 2011 and 2013. Follow-up data were collected from an electronic claims database for the public insurance scheme. Considering the non-random selection process, we prepared two control groups matched by estimated propensity scores to compare the incidence of diabetes-related complications, death, and resource utilization.ResultsThe treatment group was more likely to receive clinical management in accordance with the guideline-recommended medication. After propensity score matching, the treatment group had lower incidence of diabetic nephropathy and emergency care use than the control group selected from a beneficiary pool mainly under primary care. Comparisons between the treatment group and the control group with more selected clinical conditions did not show differences in the incidence rate and resource utilization.ConclusionsThe present results demonstrated limited effectiveness of the program for reducing complication incidence and resource utilization during the 5-year follow-up. Further research on the long-term effectiveness of co-management by primary care physicians, subspecialists in endocrinology and nephrology, and nurse educators is required for effective management of diabetes-related nephropathy.

The Role of Social Connections and Support in the Use of Emergency Care in Older Adults

The Role of Social Connections and Support in the Use of Emergency Care in Older Adults

Caregiver Literacy in a Pediatric Orthopedic Population: A Cross-Sectional Study

Background: Approximately 33% of Americans have inadequate health literacy, which is associated with increased hospitalization and use of emergency care, poorer control of chronic diseases, infrequent use of preventative measures, and suboptimal treatment outcomes. Aims and Objectives: The purpose of this study was to evaluate the general and musculoskeletal health literacy of the parents or guardians (caregivers) of pediatric patients presenting to a general pediatric orthopedic clinic and identify risk factors for limited health literacy. Study Design: This cross-sectional study obtained a convenience sample of 200 English speaking caregivers of children presenting with musculoskeletal complaints. Caregivers who were taking their children for either first-time or follow-up visits were included in the study. Participants were excluded if they did not meet the aforementioned criteria, had any cognitive impairment, were unable to read English, or were unable to sign their own consent. Setting: The general pediatric orthopedic clinic of a large children’s hospital. Materials and Methods: Caregivers completed a demographic survey, the Literacy in Musculoskeletal Problems questionnaire, and the Newest Vital Sign to measure musculoskeletal and general health literacy, respectively. Statistics: The data was summarized using frequencies and proportions for categorical variables as well as mean and standard deviation for quantitative variables. In the univariate analysis the group comparisons were conducted using the chi-squared test for categorical variables. Multivariable logistic regression was used to model the odds of adequate musculoskeletal health literacy. Results: Limited musculoskeletal health literacy was seen in 46.7% of participants. Inadequate general health literacy was observed in 18.0% of participants. Non-Hispanics (p = 0.0210), those who worked in a health care (p = 0.0055), and those with a level of education of some college or greater (p = <0.0012) were more likely to have adequate musculoskeletal health literacy on multivariable logistic regression. Only at least some college experience correlated with adequate general health literacy (p = 0.003) upon multivariable logistic regression. Conclusion: Almost half of all caregivers who bring their children to a pediatric orthopedic clinic have limited musculoskeletal health literacy and may lack the necessary comprehension required for making informed decisions about their child’s care. Limited musculoskeletal health literacy is more prevalent than limited general health literacy.

Measuring Health Equity in Emergency Care Using Routinely Collected Data: A Systematic Review.

Introduction: Achieving equity in health care remains a challenge for health care systems worldwide and marked inequities in access and quality of care persist. Identifying health care equity indicators is an important first step in integrating the concept of equity into assessments of health care system performance, particularly in emergency care.Methods: We conducted a systematic review of administrative data-derived health care equity indicators and their association with socioeconomic determinants of health (SEDH) in emergency care settings. Following PRISMA-Equity reporting guidelines, Ovid MEDLINE, EMBASE, PubMed, and Web of Science were searched for relevant studies. The outcomes of interest were indicators of health care equity and the associated SEDH they examine.Results: Among 29 studies identified, 14 equity indicators were identified and grouped into four categories that reflect the patient emergency care pathway. Total emergency department (ED) visits and ambulatory care-sensitive condition-related ED visits were the two most frequently used equity indicators. The studies analyzed equity based on seven SEDH: social deprivation, income, education level, social class, insurance coverage, health literacy, and financial and nonfinancial barriers. Despite some conflicting results, all identified SEDH are associated with inequalities in access to and use of emergency care.Conclusion: The use of administrative data-derived indicators in combination with identified SEDH could improve the measurement of health care equity in emergency care settings across health care systems worldwide. Using a combination of indicators is likely to lead to a more comprehensive, well-rounded measurement of health care equity than using any one indicator in isolation. Although studies analyzed focused on emergency care settings, it seems possible to extrapolate these indicators to measure equity in other areas of the health care system. Further studies elucidating root causes of health inequities in and outside the health care system are needed.

Patterns of healthcare utilisation in children and young people: a retrospective cohort study using routinely collected healthcare data in Northwest London

ObjectivesWith a growing role for health services in managing population health, there is a need for early identification of populations with high need. Segmentation approaches partition the population based on...

Injury patterns of concussion/mild traumatic brain injury in children presenting to a major Australian paediatic trauma centre

Background: Children commonly present to emergency departments for concussion/mild traumatic brain injury(mTBI), yet little is known of this pattern of paediatric injury. The aim of the study was to estimate the incidence, demographics and injury pattern of concussion/mTBI in children coming to a major Australian paediatic trauma centre for emergency care. Methods: This is a single centre retrospective study of children 0-16 years old, with a diagnosis of concussion/mTBI presenting for emergency care over a 6-year period (Jan 2014-Jan 2020). The patient electronic Medical Records (eMR) were accessed using the diagnostic codes S0.09+; these codes being for head and neck injury. Data was retrieved on 37,000 emergency department visits, with only those visits fulfilling criteria for concussion/mTBI being eligible for comprehensive review of the eMR. Simple descriptive statistics were used. Results: Of the 37,000 paediatric visits in the 6-year sample, there were 10,530 concussion/mTBI giving an approximate rate of 1,755 visits annually for concussion/mTBI; 39% being sports-related. The mean age of patients was 12.9 years, with males accounting for 69% of patients and 39% sports-related injuries. Of this total cohort, 28% were discharged without specific instructions to follow-up with an out-patient provider for further management. Three main injury patterns were revealed upon further review. In 70.8% of cases, the injury was a single isolated injury, with rapid symptom recovery and a mean hospital stay of 6.6 hours, and in 1% a parent or caregiver insisted upon imaging. The remaining 29.2% of cases were complex injuries. Of these, approximately one-third of patients were predominantly male and clinically important, having either altered mental state, significant amnesia, symptom spiking and/or a seizure. Almost all cases were imaged and hospitalised with a mean stay of 28.8 hour and needed specialist follow-up. The remaining two-thirds of patients with complex injury had a complicated recovery course marked by high symptom burden with possible co-morbidity; 18.9% were imaged. Almost all cases were hospitalised with a mean stay of 26.5 hours and given specialist follow-up. Discussion: In our institution, approximately 1,800 paediatric patients present with a concussion/mTBI each year for emergency care. Simple injuries are rapidly assessed with little burden placed on the system, while complex injuries place a significant burden on the health system with most needing specialty follow-up care. This construct is being used to form the framework of a common concussion/mTBI pathway for use in paediatric emergency care and enable planning for essential health services. Conflict of interest statement: My co-authors and I acknowledge that we have no conflict of interest of relevance to the submission of this abstract.

Access, Use, and Patient-Reported Experiences of Emergency Care During the COVID-19 Pandemic: Population-Based Survey

BackgroundAn increase in the number of people presenting to emergency departments (EDs) is contributing to ED overcrowding. In the early stages of the COVID-19 pandemic, there was a significant reduction in the number of ED presentations in Australia, creating an opportunity to learn from patients’ experiences of alternative management options.ObjectiveThe aim of this study is to report on the use and experience of health services by Australian adults experiencing a health issue during the COVID-19 pandemic for which they would have presented at an ED prior to the pandemic.MethodsAn online survey was conducted in May 2020. Reported health issues were categorized using an existing classification system. Data collected included demographics, care pathways, levels of concern at times of health issue and survey completion, and patient-reported experiences with care.ResultsA total of 1289 eligible respondents completed the survey. Almost 25% (309/1289) of respondents avoided an ED presentation, of which 58% (179/309) used an alternative form of health care and 42% (130/309) self-managed. Respondents making face-to-face or telehealth appointments with their general practitioner (GP) reported high levels of ED avoidance (135/286, 47%) and mostly positive experiences of care provided by GPs. A high proportion of those who self-managed reported high levels of concern at the time of completing the survey (42/130, 32%).ConclusionsTelehealth consultations with GPs may be a more promotable alternative to the ED beyond the COVID-19 pandemic, providing easier access to a doctor with access to patients’ medical histories than an appointment for a face-to-face consultation. GP telehealth consultations may also address barriers to accessing health care for those with potentially the greatest need. The reported use and positive experiences with GP telehealth appointments should inform further research on their appropriateness as an alternative to the ED.

27662 National estimates and predictors of emergency department utilization for impetigo among the United States pediatric population

Despite the large burden of impetigo in childhood and high frequency of pediatric emergency department (ED) visits for skin conditions, limited information exists on the use of emergency care for impetigo among US pediatrics. Our study aimed to generate national estimates of ED utilization for impetigo and to identify sociodemographic predictors of impetigo-related ED visits. This was a cross-sectional analysis of impetigo-related ED visits in children ages 1-17 using nationally representative data from the Nationwide Emergency Department Sample (2013-2015).

Emergency department utilization for impetigo among the pediatric population: A retrospective study of the national emergency department sample 2013-2015.

Despite the large burden of impetigo in childhood and high frequency of pediatric emergency department (ED) visits for skin conditions, limited information exists on the use of EDs for impetigo among US children. Our study aimed to generate national estimates of ED utilization and to identify sociodemographic predictors of impetigo-related ED visits. This was a retrospective, cross-sectional study of children ages 1-17 presenting to EDs with a primary diagnosis of impetigo using years 2013-2015 of the Nationwide Emergency Department Sample. Impetigo accounted for 163909 of the 71488, 511 pediatric ED visits and was the fourth most common presenting skin diagnosis. Controlling for sociodemographic factors, patients presenting to the ED with impetigo were most likely to be 6-11years old, male, and from lower-income quartiles. Patients were most likely to be uninsured and most likely to present on weekends in the summer. This study provided national-level estimates of ED use for impetigo among US children. Ultimately, the identification of factors associated with increased ED utilization may help in developing targeted interventions to reduce the use of emergency care for impetigo.

Emergency department utilization by gynecologic cancer patients during the COVID-19 pandemic: unintended improvements in the selective use of emergency care?

Objectives:To evaluate the effects of the COVID-19 pandemic on emergency department (ED) utilization by gynecologic oncology patients in a large academic cancer center.Methods:Institutional data were captured from the EMR for the first 4 months of the US COVID-19 pandemic (March-June 2020) and compared to a historical control (March-June 2019). Data were collected from three major hospitals within an urban academic health system. Patients were identified as those with a gynecologic cancer diagnosis and active treatment (chemotherapy and/or radiation) within the prior 180 days of ED encounter, with an outpatient oncology visit within the last 90 days. Data including number and location of emergency department visits, admission outcomes, primary ICD-10 emergency department diagnosis, payer type, and patient demographics were collected. Descriptive statistics were performed.Results:Gynecologic oncology patients were significantly less likely to present to the ED for care during the first 4 months of COVID-19 (n=91) when compared to a historical control (n=144), p<0.01. Patients presenting during COVID were more likely to be admitted (43/91 vs 47/144, p<0.01), and to be kept for observation (18/43 vs 8/47, p=0.01). Of patients who were admitted, those presenting during COVID were significantly more likely to require an ICU stay during admission (12/43 vs 5/47, p=0.04). Six patients admitted during COVID (14%) died during their admission, while 3 patients (6%) died in the control group. There were no differences with respect to race, payor type, diagnosis, length of stay, or need for procedures when comparing patients admitted during COVID versus the control group. Four patients were COVID 19 positive during admission, which contributed to 1 patient death. Utilization of the health system's outpatient oncology urgent care center remained unchanged during COVID-19 (n=19 vs. n=15, p=0.43).Conclusions:Fewer gynecologic cancer patients presented to the ED during the COVID-19 pandemic, and those presenting had increased rates of indicated and complex care requirements. The concurrent stability in the outpatient urgent care center volume highlights a potential role for more stringent patient triaging to improve healthcare utilization in this vulnerable population going forward.

The effect of home visits on healthcare resource utilisation.

Home visits may change patients' healthcare resource utilisation, including hospital admission, medications, outpatient and emergency room visits. The aim of the present study was to report changes in healthcare resource utilisation after the provision of home healthcare services. This was a multicentre follow-up study. Data on health and functional statuses were collected during home visits. Electronic medical records of 12 medical institutions were retrieved (outpatient visits, emergency care use, hospital admissions and prescription medications). The researchers analysed healthcare utilisation and medications before and after enrolment. There were 246 participants. The mean age was 85.5 years (52% men). There was an increase in annual outpatient visits and a decrease in hospital admission days after enrolment (13.7-15.3 visits/year and 17.5-15 days/year, respectively). The number of medical institutions visited increased, but specialties and doctors visited decreased. Oral medications also increased (3.3-4.3 types). Home visits help decrease days of hospital admission, but not medications or outpatient or emergency room visits.

Understanding young adults' reasons for seeking 'clinically unnecessary' urgent and emergency care: A qualitative interview study.

BackgroundStudies have identified young adults as more likely to use emergency departments for ‘clinically unnecessary’ problems, with limited similar evidence for emergency ambulance use. Media portrayals depict young adults as motivated by ‘convenience’, but little research has explored the reasons for their help‐seeking behaviour.MethodsQualitative interviews with 16 young adults (18‐30) considered by clinicians to have made unnecessary use of emergency ambulance, emergency department or an urgent GP appointment. Data analysis was informed by interpretive phenomenological analysis.FindingsA number of interrelated factors contributed to participants’ decisions. They were anxious about the seriousness of their symptoms, sometimes exacerbated by reduced coping capacity due to poor mental health or life stresses. They looked to others to facilitate their decision making, who sometimes encouraged urgent contact. They wanted to avoid impact on existing day‐to‐day commitments including work or study. They had strong views about different health services, sometimes based on frustration with lack of resolution of on‐going health problems. Convenience was not identified as a significant factor, although some actions could be interpreted in this light if the context was not considered.ConclusionsYoung adults make ‘clinically unnecessary’ use of urgent and emergency care for more than convenience. Their decisions need to be understood in relation to the complexity of their experience, including lack of confidence in making health‐related decisions, lowered coping capacity and concern to maintain normal daily life.

Use of health care services among Syrian refugees migrating to Norway: a prospective longitudinal study

BackgroundUnderstanding the differential utilization of healthcare services is essential to address the public health challenges. Through the migration process, refugees move from one set of health risk factors to another and can face multiple healthcare challenges along their journey. Yet how these changing risk factors influence refugees’ use of health care services is poorly understood.MethodsA longitudinal survey assessing health care utilization of 353 adult Syrian refugees was conducted; first in a transit setting in Lebanon and after one year of resettlement in Norway. The main outcomes are the utilization of general practitioner services, emergency care, outpatient and/or specialist care and hospitalization during the previous 12 months. Associations between use of healthcare services and several sociodemographic, migration-related and health status variables at both time points were found using regression analysis. We also analyzed longitudinal changes in utilization rates using generalized estimating equations.ResultsThe use of general practitioner and emergency care increased after resettlement while outpatient/specialist care markedly dropped, and hospitalization rates remained the same. Undocumented status and poor self-rated health (SRH) prior to resettlement were identified as predictors for use of health care after arrival. After resettlement, higher health literacy, higher education, higher social support and poor SRH and quality of life were significantly associated with use of healthcare services.ConclusionsUtilization of health services changes post migration to the destination country and are associated with migration-related and socio-demographic factors. Poor SRH is associated with use of services, both pre-arrival and post-resettlement. Our findings have implications for future resettlements, health care policies and service provision to newly arrived refugees with regard to both health needs as well as delivery of services.

Improving Primary Care Delivery for Patients Receiving Maintenance Hemodialysis

The beneficial impact of primary care, focused on all aspects of a patient's health (rather than a disease-specific focus) is well established. Recognized benefits include greater receipt of preventive care and counseling, lower use of emergency care and hospitalization for ambulatory care-sensitive conditions, and decreased early mortality. Although the importance of primary care and care coordination at the primary care/specialty interface is well recognized, the role of primary care within traditional and emerging care models for patients receiving in-center maintenance hemodialysis remains ill-defined. In this perspective article, we will describe: (1) the role of primary care for patients receiving maintenance hemodialysis and the current evidence regarding the receipt of primary care among these patients; (2) the key challenges to delivery of primary care in these complex cases, including suboptimal care coordination between nephrology and primary care providers, the intensity of dialysis care, and the limited capacity of nephrologists and primary care providers to meet the broad health needs of hemodialysis patients; (3) potential strategies for improving the delivery of primary care for patients receiving hemodialysis; and (4) future research requirements to improve primary care delivery for this high-risk population.

Telehealth use in emergency care during coronavirus disease 2019: a systematic review.

ObjectiveThe coronavirus disease 2019 pandemic has presented emergency departments (EDs) with many challenges to address the acute care needs of patients. Many EDs have leveraged telehealth to innovatively respond to these challenges. This review describes the landscape of telehealth initiatives in emergency care that have been described during the coronavirus disease 2019 pandemic.MethodsWe conducted a comprehensive, systematic review of the literature using PubMed, supplemented by a review of the gray literature (ie, non‐peer reviewed), with input from subject matter experts to identify telehealth initiatives in emergency care during coronavirus disease 2019. We categorized types of telehealth use based on purpose and user characteristics.ResultsWe included 27 papers from our review of the medical literature and another 8 sources from gray literature review. The vast majority of studies (32/35) were descriptive in nature, with the additional inclusion of 2 cohort studies and one randomized clinical trial. There were 5 categories of ED telehealth use during the pandemic: (1) pre‐ED evaluation and screening, (2) within ED (including as a means of limiting staff and patient exposure and facilitating consultation with specialists), (3) post‐ED discharge monitoring and treatment, (4) educating trainees and health care workers, and (5) coordinating resources and patient care.ConclusionTelehealth has been used in a variety of manners during the coronavirus disease 2019 pandemic, enabling innovation in emergency care delivery. The findings from this study can be used by institutions to consider how telehealth may address challenges in emergency care during the coronavirus disease 2019 pandemic and beyond. Because few studies included cost data and given the variability in institutional resources, how organizations implement telehealth programs will likely vary. Future work should further explore barriers and facilitators of innovation, and the impact on care delivery and patient outcomes.

Emergency department admissions for myocardial infarction and stroke in France during the first wave of the COVID-19 pandemic: National temporal trends and regional disparities

The coronavirus disease 2019 (COVID-19) pandemic and the national lockdown have led to significant changes in the use of emergency care by the French population. To describe the national and regional temporal trends in emergency department (ED) admissions for myocardial infarction (MI) and stroke, before, during and after the first national lockdown. The weekly numbers of ED admissions for MI and stroke were collected from the OSCOUR® network, which covers 93.3% of all ED admissions in France. National and regional incidence rate ratios from 02 February until 31 May (2020 versus 2017-2019) were estimated using Poisson regression for MI and stroke, before, during and after lockdown. A decrease in ED admissions was observed for MI (-20% for ST-segment elevation MI and-25% for non-ST-segment elevation MI) and stroke (-18% for ischaemic and-22% for haemorrhagic) during the lockdown. The decrease became significant earlier for stroke than for MI. No compensatory increase in ED admissions was observed at the end of the lockdown for these diseases. Important regional disparities in ED admissions were observed, without correlation with the regional levels of COVID-19 cases. The impact of lockdown on ED admissions was particularly significant in six regions (Ile-de France, Occitanie, Provence-Alpes-Côte d'Azur, Nouvelle Aquitaine, Hauts-de-France and Bretagne). The decrease in ED admissions for MI and stroke observed during the lockdown was probably caused by fear of COVID-19 and augmented by the lockdown, and was heterogeneous across the French territory. ED admissions were slow to return to the usual levels from previous years, without a compensatory increase. These results underline the need to reinforce messages directed at the population to encourage them to seek care without delay in case of cardiovascular symptoms.

Influence of Gender Determinants on Informal Care and Health Service Utilization in Spain: Ten Years after the Approval of the Equality Law

The existence of gender inequalities in health, in the use of health services, and in the development of informal care has been demonstrated throughout scientific literature. In Spain, a law was passed in 2007 to promote effective equality between men and women. Despite this, different studies have shown that the previous gender inequalities are still present in Spanish society. For all these reasons, the objective of this paper is to study the differences by sex in informal care and in the use of emergency care, and to identify the existence of gender inequalities in Spain 10 years after the adoption of the aforementioned equality law. In this case, we development a cross-sectional study based on the 2017 Spanish National Health Survey of the Spanish population aged 16 and over. To analyze the influence of gender determinants on informal care and emergency care utilization, logistic regressions were performed, model 1 was adjusted for age, and model 2 was further adjusted too by the variables of the Andersen care demand model. The results showed that informal care and the use of the emergency care continues to be higher in women than in men. Informal care in women was related to a higher level of education. In emergency care, the older the age, the lower the probability of utilization, and living in a rural municipality was related to a higher probability of utilization for both sexes. Finally, we concluded that there is still a need for studies that analyze gender inequalities in different contexts, such as the informal care and the use of health services. This is especially relevant in Spain, where economic changes have led to a change in roles, mainly for women, and new management strategies are needed to achieve equity in care and effective equality between men and women.

Editors' Note: Characterizing Opioid Use in a US Population With Migraine: Results From the CaMEO Study

Editors' Note: Characterizing Opioid Use in a US Population With Migraine: Results From the CaMEO Study