Factors associated with emergency department use for mental health reasons among low, moderate and high users

Barriers and Facilitators to High Emergency Department Use Among Patients with Mental Disorders: A Qualitative Investigation

This qualitative study explored reasons for high emergency department (ED) use (3 + visits/year) among 299 patients with mental disorders (MD) recruited in four ED in Quebec, Canada. A conceptual framework including healthcare system and ED organizational features, patient profiles, and professional practice guided the content analysis. Results highlighted insufficient access to and inadequacy of outpatient care. While some patients were quite satisfied with ED care, most criticized the lack of referrals or follow-up care. Patient profiles justifying high ED use were strongly associated with health and social issues perceived as needing immediate care. The main barriers in professional practice involved lack of MD expertise among primary care clinicians, and insufficient follow-up by psychiatrists in response to patient needs. Collaboration with outpatient care may be prioritized to reduce high ED use and improve ED interventions by strengthening the discharge process, and increasing access to outpatient care.

Unveiling the patterns: exploring social and clinical characteristics of frequent mental health visits to the emergency department-a comprehensive systematic review

BACKGROUND

Frequent presenters (FPs) are a group of individuals who visit the hospital emergency department (ED) frequently for urgent care. Many among the group present with the main diagnosis of mental health conditions. This group of individual tend to use ED resources disproportionally and significantly affects overall healthcare outcomes. No previous reviews have examined the profiles of FPs with mental health conditions.

AIMS

This study aims to identify the key socio-demographic and clinical characteristics of patients who frequently present to ED with a mental health primary diagnosis by performing a comprehensive systematic review of the existing literature.

METHOD

PRISMA guideline was used. PubMed, PsycINFO, Scopus and Web of Science (WOS) were searched in May 2023. A manual search on the reference list of included articles was conducted at the same time. Covidence was used to perform extraction and screening, which were completed independently by two authors. Inclusion and exclusion criteria were defined.

RESULTS

The abstracts of 3341 non-duplicate articles were screened, with 40 full texts assessed for eligibility. 20 studies were included from 2004 to 2022 conducted in 6 countries with a total patient number of 25,688 (52% male, 48% female, mean age 40.7 years old). 27% were unemployed, 20% married, 41% homeless, and 17% had tertiary or above education. 44% had a history of substance abuse or alcohol dependence. The top 3 diagnoses are found to be anxiety disorders (44%), depressive disorders (39%) schizophrenia spectrum and other psychotic disorders (33%).

CONCLUSION

On average, FPs are middle-aged and equally prevalent in both genders. Current data lacks representation for gender-diverse groups. They are significantly associated with high rates of unemployment, homelessness, lower than average education level, and being single. Anxiety disorder, depressive disorder, and schizophrenia spectrum disorders are the most common clinical diagnoses associated with the group.

Profiles of quality of life among patients using emergency departments for mental health reasons

BACKGROUND

This study identified profiles associated with quality of life (QoL) and sociodemographic and clinical characteristics of patients using emergency departments (ED) for mental health reasons and associated these profiles with patient service use.

METHODS

Recruited in four Quebec (Canada) ED networks, 299 patients with mental disorders (MD) were surveyed from March 1st, 2021, to May 13th, 2022. Data from medical records were collected and merged with survey data. Cluster analysis was conducted to identify QoL profiles, and comparison analyses used to assess differences between them.

RESULTS

Four QoL profiles were identified: (1) Unemployed or retired men with low QoL, education and household income, mostly having substance-related disorders and bad perceived mental/physical health conditions; (2) Men who are employed or students, have good QoL, high education and household income, the least personality disorders, and fair perceived mental/physical health conditions; (3) Women with low QoL, multiple mental health problems, and very bad perceived mental/physical health conditions; (4) Mostly women with very good QoL, serious MD, and very good perceived mental/physical health conditions.

CONCLUSION

The profiles with the highest QoL (4 and 2) had better overall social characteristics and perceived their health conditions as superior. Profile 4 reported the highest level of satisfaction with services used. To improve QoL programs like permanent supportive housing, individual placement and support might be better implemented, and satisfaction with care more routinely assessed in response to patient needs - especially for Profiles 1 and 3, that show complex health and social conditions.

The impact of mental health stigma in a young Malaysian lady with recurrent suicidal ideations and moribund presentations to the Emergency Department: a case report

Introduction

Mental health stigma (MHS) has been a pervasive social issue and a significant barrier to treatment seeking behavior. The treatment pathways and outcomes for people with mental illness, specifically those with recurrent suicidal ideations and attempts have been influenced by how MHS was experienced in clinical practice.

Methods

We reported a case of a young lady diagnosed with bipolar II disorder, obsessive-compulsive disorder and borderline personality disorder who had recurrent visits to various emergency departments (ED) of tertiary hospitals in Malaysia for suicidality; each time presenting with increased mortality risk and escalating near-lethal outcomes. Among the multiple ED visits after her alleged overdoses of psychotropic medications, thrice she was near-unconscious and had to be intubated for airway protection, subsequently requiring ventilatory support and ICU care. These near-lethal presentations in ED were due to her delays in seeking treatment for fear of re-experiencing the stigmatizing environment among healthcare staff and professionals in the ED.

Discussion

The impact of MHS is detrimental. Effective interventions at various levels in the clinical setting is of utmost importance to prevent the negative consequences of suicidality against MHS.

Driven by need, shaped by access: Heterogeneity in patient profiles and patterns of service utilization in patients with alcohol use disorders

BACKGROUND

Patients with alcohol-use disorders (AUDs) are highly heterogenous and account for an increasing proportion of general medical hospital visits. However, many patients with AUDs do not present with severe medical or psychiatric needs requiring immediate attention. There may be a mismatch between some patients' needs and the available services, potentially driving re-admissions and re-encounters. The current study aims to identify subgroups of AUD patients and predict differences in patterns of healthcare service use (HSU) over time.

METHODS

Latent class analysis (LCA) was conducted using hospital data incorporating sociodemographic, health behavior, clinical, and service use variables to identify subtypes of AUD patients, then class membership was used to predict patterns of HSU.

RESULTS

Four classes were identified with the following characteristics: (1) Patients with acute medical injuries (30 %); (2) Patients with socioeconomic and psychiatric risk factors, (11 %); (3) Patients with chronic AUD with primarily non-psychiatric medical needs (18 %); and (4) Patients with primary AUDs with low medical-treatment complexity (40 %). Negative binomial models showed that Class 4 patients accounted for the highest frequency of service use, including significantly higher rates of emergency department reencounters at 30 days and 12 months.

CONCLUSIONS

The profile and patterns of HSU exhibited by patients in class 4 suggest that these patients have needs which are not currently being addressed in the emergency department. These have implications for how resources are allocated to meet the needs of patients with AUDs, including those who make frequent visits to the emergency department without high acuity medical needs.

Profiles of patients using emergency departments or hospitalized for suicidal behaviors

OBJECTIVES

This study identified profiles of patients with suicidal behaviors, their sociodemographic and clinical correlates, and assessed the risk of death within a 12-month follow-up period.

METHODS

Based on administrative databases, this 5-year study analyzed data on 5064 patients in Quebec who used emergency departments (ED) or were hospitalized for suicidal behaviors over a 2-year period. Latent class analysis was used for patient profiles, bivariate analysis for patient correlates over 2 years, and survival analysis for risk of death within a 12-month follow-up.

RESULTS

Four profiles were identified: high suicidal behaviors and high service use (Profile 1: 23%); low suicidal behaviors and moderate service use (Profile 2: 46%); low suicidal behaviors and low service use (Profile 3: 25%); and high suicidal behaviors and high acute care, but low outpatient care (Profile 4: 6%). Profiles 1 and 4 patients had more serious conditions, with a higher risk of death in Profile 1 versus Profiles 2 and 3. Profile 2 patients had relatively more common mental disorders, and Profile 3 patients had less severe conditions. Profiles 3 and 4 included more men and younger patients.

CONCLUSION

Programs better adapted to patient profiles should be deployed after ED use and hospitalization in coordination with outpatient services.

Profiles, Correlates and Outcomes Among Patients Experiencing an Onset of Mental Disorder Based on Outpatient Care Received Following Index Emergency Department Visits

OBJECTIVE

This 5-year longitudinal study evaluated patients with an onset of mental disorder (MD) following index emergency department (ED) visits, in terms of (1) patient profiles based on 12-month outpatient follow-up care received, (2) sociodemographic and clinical correlates, and (3) adverse health outcomes for the subsequent 2 years.

METHODS

Data from administrative databases were collected for 2541 patients with an onset of MD, following discharge from Quebec ED. Latent class analysis was performed to identify patient profiles based on the adequacy of follow-up care after ED discharge. Bivariate analyses examined associations between class membership and sociodemographic and clinical correlates, high ED use (3 + visits/yearly), hospitalizations, and suicidal behaviors.

RESULTS

Five classes of patients were identified. Class 1, the smallest, labeled "patient psychiatrist only," included mainly young patients with serious MD. Classes 2 and 3, roughly 20%, were labeled "high use of patient general practitioner (GP) and psychiatrist" and "low use of patient GP and psychiatrist," respectively. Both included patients with complex MD, but Class 2 had more women and older patients with chronic physical illnesses. The 2 largest classes were labeled "no usual patient service provider" (Class 5) and "patient GP only" (Class 4). Class 5 included more younger men with substance-related disorders, while Class 4 had the older patients living in rural areas, many with common MD and chronic physical illnesses. Class 3 patients had the poorest outcomes, followed by Classes 1 and 2, while Classes 4 and 5 had the best outcomes.

CONCLUSIONS

Results revealed that nearly 40% of patients experiencing an onset of MD received little or no outpatient care following ED discharge. Higher severity or complexity of MD and, to a lesser extent, no or low GP follow-up may explain these adverse outcomes. More adequate, continuous care, including collaborative care, is needed for these vulnerable, high-needs patients.

Predictors of Emergency Department Use for Suicidal Behaviors among Patients with Substance-Related Disorders

OBJECTIVE

This study aimed to identify predictors of emergency department (ED) use for suicide ideation or suicide attempt compared with other reasons among 14,158 patients with substance-related disorders (SRD) in Quebec (Canada).

METHODS

Longitudinal data on clinical, sociodemographic, and service use variables for patients who used addiction treatment centers in 2012-13 were extracted from Quebec administrative databases. A multinomial logistic regression was produced, comparing predictors of suicide ideation or attempts to other reasons for ED use in 2015-16.

RESULTS

Patients using ED for both suicide ideation and attempt were more likely to have bipolar or personality disorders, problems related to the social environment, 4+ previous yearly outpatient consultations with their usual psychiatrist, high prior ED use, and dropout from SRD programs in addiction treatment centers in the previous 7 years, compared with those using ED for other reasons. Patients with alcohol- or drug-related disorders other than cannabis and living in the least materially deprived areas, urban territories, and university healthcare regions made more suicide attempts than those using ED for other reasons. Patients with common mental disorders, 1-3 previous yearly outpatient consultations with their usual psychiatrist, one previous treatment episode in addiction treatment centers, and those using at least one SRD program experienced more suicide ideation than patients using ED for other reasons.

CONCLUSION

Clinical variables most strongly predicted suicidal behaviors, whereas completion of SRD programs may help to reduce them. SRD services and outreach strategies should be reinforced, particularly for patients with complex issues living in more advantaged urban areas. HIGHLIGHTSOver 10% of ED visits were for suicidal behaviors among patients with SRD.ED use for suicidal behaviors was mainly associated with clinical variables.Addiction treatment centers may help reduce ED use for suicidal behaviors.

The relationship between outpatient service use and emergency department visits among people treated for mental and substance use disorders: analysis of population-based administrative data in British Columbia, Canada

Background

Research findings on the association between outpatient service use and emergency department (ED) visits for mental and substance use disorders (MSUDs) are mixed and may differ by disorder type.

Methods

We used population-based linked administrative data in British Columbia, Canada to examine associations between outpatient primary care and psychiatry service use and ED visits among people ages 15 and older, comparing across people treated for three disorder categories: common mental disorders (MDs) (depressive, anxiety, and/or post-traumatic stress disorders), serious MDs (schizophrenia spectrum and/or bipolar disorders), and substance use disorders (SUDs) in 2016/7. We used hurdle models to examine the association between outpatient service use and odds of any ED visit for MSUDs as well count of ED visits for MSUDs, stratified by cohort in 2017/8.

Results

Having had one or more MSUD-related primary care visit was associated with lower odds of any ED visit among people treated for common MDs and SUDs but not people treated for serious MDs. Continuity of primary care was associated with slightly lower ED use in all cohorts. One or more outpatient psychiatrist visits was associated with lower odds of ED visits among people treated for serious MDs and SUDs, but not among people with common MDs.

Conclusion

Findings highlight the importance of expanded access to outpatient specialist mental health services, particularly for people with serious MDs and SUDs, and collaborative models that can support primary care providers treating people with MSUDs.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-07759-z.

Predictors of no, low and frequent emergency department use for any medical reason among patients with cannabis-related disorders attending Quebec (Canada) addiction treatment centres

INTRODUCTION

Patients with substance-related disorders and mental disorders (MD) contribute substantially to emergency department (ED) overcrowding. Few studies have identified predictors of ED use integrating service use correlates, particularly among patients with cannabis-related disorders (CRD). This study compared predictors of low (1-2 visits/year) or frequent (3+ visits/year) ED use with no ED use for a cohort of 9836 patients with CRD registered at Quebec (Canada) addiction treatment centres in 2012-2013.

METHODS

This longitudinal study used multinomial logistic regression to evaluate clinical, sociodemographic and service use variables from various databases as predictors of the frequency of ED use for any medical reason in 2015-2016 among patients with CRD.

RESULTS

Compared to non-ED users with CRD, frequent ED users included more women, rural residents, patients with serious MD and chronic CRD, dropouts from programs in addiction treatment centres and with less continuity of physician care. Compared with non-users, low ED users had more common MD and there more workers than students.

DISCUSSION AND CONCLUSIONS

Multimorbidity, including MD, chronic physical illnesses and other substance-related disorders than CRD, predicted more ED use and explained frequent use of outpatient services and prior specialised acute care, as did being 12-29 years, after controlling for all other covariates. Better continuity of physician care and reinforcement of programs like assertive community or integrated treatment, and chronic primary care models may protect against frequent ED use. Strategies like screening, brief intervention and treatment referral, including motivational therapy for preventing treatment dropout may also be expanded to decrease ED use.

Mental health service use in a national sample of college students with co-occurring depression or anxiety and substance use

INTRODUCTION

Campus health systems can provide timely and accessible resources for students with co-occurring substance use and mental illness, but little is known about the degree to which students use these systems. This study examined mental health service utilization among students with symptoms of anxiety or depression, stratified by substance use.

METHODS

This cross-sectional study used data came from the 2017-2020 Healthy Minds Study. Mental health service use was examined among students with clinically significant anxiety or depression (N = 65,969), stratified by substance use type (no use, alcohol or tobacco use, marijuana use, other drug use). We performed a series of weighted logistic regressions to assess the adjusted association of substance use type with past year use of campus, off-campus outpatient, emergency department, and hospital mental health services.

RESULTS

Among students, 39.3% reported exclusive use of alcohol or tobacco, 22.9% reported use of marijuana, and 5.9% reported use of other drugs. Use of alcohol or tobacco was not associated with mental health service utilization, while students who use marijuana faced increased odds of campus (OR 1.10, 95% CI 1.01, 1.20) and off-campus outpatient mental health service utilization (OR 1.27, 95% CI 1.17, 1.37). Other drug use was associated with increased odds of off-campus outpatient (OR 1.28, 95% CI 1.14, 1.48), emergency department (OR 2.13, 95% CI 1.50, 3.03) and hospital service utilization (OR 1.52, 95% CI 1.13, 2.04).

CONCLUSIONS

Universities should consider screening for substance use and common mental illnesses to support the health of high-risk students.

Profiles of individuals with cannabis-related disorders

Background: Profiles of individuals with cannabis-related disorders (CRD) in specialized addiction treatment centers serving high-need patients have not been identified. This longitudinal study developed a typology for 9,836 individuals with CRD attending Quebec (Canada) addiction treatment centers in 2012-2013. Methods: Data on sociodemographic, clinical and service use variables were extracted from several databases for the years 1996-1997 to 2014-2015. Individual profiles were produced using Latent Class Analysis and compared predicting health outcomes on emergency department (ED) use, hospitalizations and suicidal behaviors for 2015-2016. Results: Six profiles were identified: 1-Older individuals, many living in couples and working, with moderate health problems, receiving intensive general practitioner (GP) care and high continuity of physician care; 2-Older individuals with chronic CRD, multiple social and health problems, and low health service use (chronic CRD referred to experiencing CRD for several years; social problems related to homelessness, unemployment, having criminal records or living alone); 3-Students with few social and health problems, and low health service use; 4-Young adults, many working, with few health problems, least health service use and continuity of physician care; 5-Youth, many working but some criminal offenders, with 1 or 2 years of CRD, few health problems and high addiction treatment center use; and 6-Older individuals with chronic CRD and multiple social and health problems, high health service use and continuity of physician care. Profiles 6 and 2 had the worst health outcomes. Conclusions: For Profiles 2 to 5, outreach and motivational services should be prioritized, integrated health and criminal justice services for profile 5 and, for Profiles 2 and 6, assertive community treatments. Screening, brief intervention and referrals to addiction treatment centers may also be encouraged for individuals with CRD, particularly those in Profile 2. This cohort had high social and health needs relative to services received, suggesting continued need for care.

Predictors of clinical severity in subjects attending the Emergency Department for substance use: a ten-year cross-sectional study

OBJECTIVE

Substance-related referrals to the Emergency Department (ED) are rising. Multiple substance use is frequent, and psychiatric patients represent a high-risk population. Our study aimed at identifying risk factors for increased severity in ED attendances for substance use.

METHODS

We retrospectively evaluated consecutive patients attending the ED over ten years for substance-related problems, subdivided according to the triage code as having a life-threatening (LT), potentially life-threatening (P-LT), and non-life-threatening (N-LT) condition.

RESULTS

Substance/drug intake for deliberate self-harm was a risk factor for being classified as LT compared to both P-LT (OR = 6.357; p ≤ 0.001) and N-LT (OR = 28.19; p ≤ 0.001). Suicide attempts (OR = 4.435; p = 0.022) and multiple substance use (OR = 1.513; p = 0.009) resulted as risk factors for P-LT, compared to N-LT. Psychiatric diagnosis (OR = 1.942; p = 0.042) and multiple substance use (OR = 1.668; p = 0.047) were risk factors for being classified as LT rather than N-LT.

CONCLUSIONS

In our sample, self-harming overdoses were the strongest risk factor for highest overall severity in a real-world setting. Psychiatric disorders and multiple substance use also increased the risk for greater severity at presentation. Substance use worsens patients' clinical picture and management, suggesting the need for consultation-liaison psychiatry services in emergency contexts and highlighting the role of EDs as key sites for identification and early intervention.

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

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.

Impact of Co-occurring Mental Disorders and Chronic Physical Illnesses on Frequency of Emergency Department Use and Hospitalization for Mental Health Reasons

Background: Patients with mental disorders (MD) are at high risk for a wide range of chronic physical illnesses (CPI), often resulting in greater use of acute care services. This study estimated risk of emergency department (ED) use and hospitalization for mental health (MH) reasons among 678 patients with MD and CPI compared to 1,999 patients with MD only. Methods: Patients visiting one of six Quebec (Canada) ED for MH reasons and at onset of a MD in 2014-15 (index year) were included. Negative binomial models comparing the two groups estimated risk of ED use and hospitalization at 12-month follow-up to index ED visit, controlling for clinical, sociodemographic, and service use variables. Results: Patients with MD, more severe overall clinical conditions and those who received more intensive specialized MH care had higher risks of frequent ED use and hospitalization. Continuity of medical care protected against both ED use and hospitalization, while general practitioner (GP) consultations protected against hospitalization only. Patients aged 65+ had lower risk of ED use, whereas risk of hospitalization was higher for the 45-64- vs. 12-24-year age groups, and for men vs. women. Conclusion: Strategies including assertive community treatment, intensive case management, integrated co-occurring treatment, home treatment, and shared care may improve adequacy of care for patients with MD-CPI, as well as those with MD only whose clinical profiles were severe. Prevention and outreach strategies may also be promoted, especially among men and older age groups.

Risk factors of hospitalization for any medical condition among patients with prior emergency department visits for mental health conditions

BACKGROUND

This longitudinal study identified risk factors for frequency of hospitalization among patients with any medical condition who had previously visited one of six Quebec (Canada) emergency departments (ED) at least once for mental health (MH) conditions as the primary diagnosis.

METHODS

Records of n = 11,367 patients were investigated using administrative databanks (2012-13/2014-15). Hospitalization rates in the 12 months after a first ED visit in 2014-15 were categorized as no hospitalizations (0 times), moderate hospitalizations (1-2 times), and frequent hospitalizations (3+ times). Based on the Andersen Behavioral Model, data on risk factors were gathered for the 2 years prior to the first visit in 2014-15, and were identified as predisposing, enabling or needs factors. They were tested using a hierarchical multinomial logistic regression according to the three groups of hospitalization rate.

RESULTS

Enabling factors accounted for the largest percentage of total variance explained in the study model, followed by needs and predisposing factors. Co-occurring mental disorders (MD)/substance-related disorders (SRD), alcohol-related disorders, depressive disorders, frequency of consultations with outpatient psychiatrists, prior ED visits for any medical condition and number of physicians consulted in specialized care, were risk factors for both moderate and frequent hospitalizations. Schizophrenia spectrum and other psychotic disorders, bipolar disorders, and age (except 12-17 years) were risk factors for moderate hospitalizations, while higher numbers (4+) of overall interventions in local community health service centers were a risk factor for frequent hospitalizations only. Patients with personality disorders, drug-related disorders, suicidal behaviors, and those who visited a psychiatric ED integrated with a general ED in a separate site, or who visited a general ED without psychiatric services were also less likely to be hospitalized. Less urgent and non-urgent illness acuity prevented moderate hospitalizations only.

CONCLUSIONS

Patients with severe and complex health conditions, and higher numbers of both prior outpatient psychiatrist consultations and ED visits for medical conditions had more moderate and frequent hospitalizations as compared with non-hospitalized patients. Patients at risk for frequent hospitalizations were more vulnerable overall and had important biopsychosocial problems. Improved primary care and integrated outpatient services may prevent post-ED hospitalization.

Typology of patients who use emergency departments for mental and substance use disorders

BACKGROUND

Identifying profiles of people with mental and substance use disorders who use emergency departments may help guide the development of interventions more appropriate to their particular characteristics and needs.

AIMS

To develop a typology for the frequency of visits to the emergency department for mental health reasons based on the Andersen model.

METHOD

Questionnaires were completed by patients who attended an emergency department (n = 320), recruited in Quebec (Canada), and administrative data were obtained related to sociodemographic/socioeconomic characteristics, mental health diagnoses including alcohol and drug use, and emergency department and mental health service utilization. A cluster analysis was performed, identifying needs, predisposing and enabling factors that differentiated subclasses of participants according to frequency of emergency department visits for mental health reasons.

RESULTS

Four classes were identified. Class 1 comprised individuals with moderate emergency department use and low use of other health services; mostly young, economically disadvantaged males with substance use disorders. Class 2 comprised individuals with high emergency department and specialized health service use, with multiple mental and substance use disorders. Class 3 comprised middle-aged, economically advantaged females with common mental disorders, who made moderate use of emergency departments but consulted general practitioners. Class 4 comprised older individuals with multiple chronic physical illnesses co-occurring with mental disorders, who made moderate use of the emergency department, but mainly consulted general practitioners.

CONCLUSIONS

The study found heterogeneity in emergency department use for mental health reasons, as each of the four classes represented distinct needs, predisposing and enabling factors. As such, interventions should be tailored to different classes of patients who use emergency departments, based on their characteristics.

Variables associated with low, moderate and high emergency department use among patients with substance-related disorders

AIMS

This study identified factors associated with frequency of emergency department (ED) use for medical reasons among patients with substance-related disorders (SRD) in Quebec (Canada) for 2014-15.

METHODS

Participants (n = 4731) were categorized as: 1) low (1 visit/year), 2) moderate (2 visits/year), and 3) high (3+ visits/year) ED users. Independent variables included predisposing, enabling and needs factors based on the Andersen Behavioral Model. Multinomial logistic regression identified associated variables.

RESULTS

Factors positively associated with moderate and high ED use included adjustment disorders, suicidal behavior, alcohol-induced disorders, less urgent to non-urgent illness acuity, referral to local health community services centers (LHCSC) at discharge, and living in a materially deprived area. Factors positively associated with high ED use only included anxiety disorders, alcohol use disorders, drug use disorders, chronic physical illness, subacute problems, prior ED use for MD and/or SRD, prior LHCSC medical interventions, physician consultation within one month after discharge, living in very deprived or middle-class areas, and, negatively, being hospitalized for medical reasons in second ED visit. Moderate ED use only was negatively associated with alcohol intoxication and being referred to a GP at ED discharge.

CONCLUSIONS

Compared to low ED users, most high users with SRD were men presenting more complex and severe conditions. They visited ED mainly for subacute or non-urgent problems. Compared to low ED users, most moderate users had alcohol-induced disorders, less alcohol intoxication, and acute common MD. They visited ED mainly for non-urgent care. Diverse strategies should be implemented to reduce ED visits, targeting each group.