A register-based observational cohort study on persistent frequent users of emergency services in a Finnish emergency clinic

Exploring the reliability and profile of frequent mental health presentations using different methods: An observational study using statewide ambulance data over a 4-year period

INTRODUCTION

A disproportionate number of mental health presentations to emergency services are made by frequent presenters. No current consensus definition of a frequent presenter exists. Using a statewide population-based ambulance database, this study (i) applied previous statistical methods to determine thresholds for frequent presenters, (ii) explored characteristics of the identified frequent presenter groups compared to non-frequent presenters and (iii) assessed the reliability of these methods in predicting continued frequent presenter status over time.

METHODS

Statistical methods utilised in previous studies to identify frequent presenters were applied to all ambulance attendances for mental health symptoms, self-harm and alcohol and other drug issues between 1 January 2017 and 31 December 2020 in Victoria, Australia. Differences in characteristics between identified frequent and non-frequent presenter groups were determined by logistic regression analysis. The consistency of agreement of frequent presenter status over time was assessed using intraclass correlation coefficients.

RESULTS

Thresholds for frequent presenters ranged from a mean of 5 to 39 attendances per calendar year, with groups differing in size, service use and characteristics. Compared to non-frequent presenters, frequent presenters had greater odds of being female, presenting with self-harm, experiencing social disadvantage or housing issues, involving police co-attendance and being transported to hospital. All frequent presenter definitions had poor reliability in predicting ongoing frequent presentations over time.

CONCLUSION

A range of methods can define frequent presenters according to thresholds of yearly service use. Reasons for identifying frequent presenters may influence the method chosen. Future studies should explore definitions that capture the dynamic nature of presentations by this group.

Patterns and determinants of cannabis use in youth visiting an urban emergency department in France

BACKGROUND

Cannabis use frequently starts during adolescence and young adulthood and can induce psychosocial and health consequences. Young people constitute hard-to-reach populations. Emergency departments could constitute a key care setting to identify cannabis use and its consequences among young people.

OBJECTIVES

To estimate the rate of cannabis use in the 16- to 25-year-old population visiting the emergency department for any reason and to assess the psychosocial factors associated with cannabis use.

METHODS

This was a cross-sectional study among young people who attended the emergency department, over 5-months. Data were sociodemographic characteristics, self-administered questionnaires for problematic substance use screening, and urine drug screening samples. They were classified in the cannabis use (CU) group if they had a positive urine screen or reported cannabis use in the previous month. Characteristics of individuals in the CU and non-CU groups were compared.

RESULTS

A total of 460 participants were included, of whom 105 were in the CU group. Cannabis users were more likely to be male (aOR = 1.85; [1.18-2.90]), to be unemployed (aOR = 1.77; [1.03-3.04]), to have a lower mental health status score (aOR = 0. 82; [0.75-0.90]), to report a history of sexual abuse (aOR = 2.99; [1.70-5.25]), and to have a positive AUDIT screen (aOR = 4.23; [2.61-6.86]).

CONCLUSIONS

The emergency department is a primary care setting for young people, which is conducive to screening for substance use. Cannabis users can be assessed and referred to adapt their treatment, given their lack of adherence to the traditional addictology care system.

Tracing frequent users of regional care services using emergency medical services data: a networked approach

OBJECTIVES

This study shows how a networked approach relying on 'real-world' emergency medical services (EMS) records might contribute to tracing frequent users of care services on a regional scale. Their tracing is considered of importance for policy-makers and clinicians, since they represent a considerable workload and use of scarce resources. While existing approaches for data collection on frequent users tend to limit scope to individual or associated care providers, the proposed approach exploits the role of EMS as the network's 'ferryman' overseeing and recording patient calls made to an entire network of care providers.

DESIGN

A retrospective study was performed analysing 2012-2017 EMS calls in the province of Drenthe, the Netherlands. Using EMS data, benefits of the networked approach versus existing approaches are assessed by quantifying the number of frequent users and their associated calls for various categories of care providers. Main categories considered are hospitals, nursing homes and EMS.

SETTING

EMS in the province of Drenthe, the Netherlands, serving a population of 491 867.

PARTICIPANTS

Analyses are based on secondary patient data from EMS records, entailing 212 967 transports and 126 758 patients, over 6 years (2012-2017).

RESULTS

Use of the networked approach for analysing calls made to hospitals in Drenthe resulted in a 20% average increase of frequent users traced. Extending the analysis by including hospitals outside Drenthe increased ascertainment by 28%. Extending to all categories of care providers, inside Drenthe, and subsequently, irrespective of their location, resulted in an average increase of 132% and 152% of frequent users identified, respectively.

CONCLUSIONS

Many frequent users of care services are network users relying on multiple regional care providers, possibly representing inefficient use of scarce resources. Network users are effectively and efficiently traced by using EMS records offering high coverage of calls made to regional care providers.