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Johnson RD, North L, Alrouh B, John A, Jones K, Akbari A, Smart J, Thompson S, Hargreaves C, Doebler S, Cusworth L, Broadhurst K, Ford DV, Griffiths LJ. A population level study into health vulnerabilities of mothers and fathers involved in public law care proceedings in Wales, UK between 2011 and 2019. Int J Popul Data Sci 2022; 7:1723. [PMID: 35520100 PMCID: PMC9053134 DOI: 10.23889/ijpds.v6i1.1723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Introduction Under section 31 of the Children Act 1989, public law care proceedings can be issued if there is concern a child is subject to, or at risk of significant harm, which can lead to removal of a child from parents. Appropriate and effective health and social support are required to potentially prevent some of the need for these proceedings. More comprehensive evidence of the health needs and vulnerabilities of parents will enable enhanced response from family courts and integrated other services. Objective To examine health vulnerabilities of parents involved in care proceedings in the two-year period prior to involvement. Methods Family court data provided by Cafcass Cymru were linked to population-based health records held within the Secure Anonymised Information Linkage Databank. Linked data were available for 8,821 parents of children involved in care proceedings between 2011 and 2019. Findings were benchmarked with reference to a comparison group of parents matched on sex, age, and deprivation (n = 32,006), not subject to care proceedings. Demographic characteristics, overall health service use, and health profiles of parents were examined. Descriptive and statistical tests of independence were used. Results Nearly half of cohort parents (47.6%) resided in the most deprived quintile. They had higher levels of healthcare use compared to the comparison group across multiple healthcare settings, with the most pronounced differences for emergency department attendances (59.3% vs 37.0%). Health conditions with the largest variation between groups were related to mental health (43.6% vs 16.0%), substance use (19.4% vs 1.6%) and injuries (41.5% vs 23.6%). Conclusion This study highlights the heightened socioeconomic and health vulnerabilities of parents who experience care proceedings concerning a child. Better understanding of the needs and vulnerabilities of this population may provide opportunities to improve a range of support and preventative interventions that respond to crises in the community.
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Affiliation(s)
- Rhodri D. Johnson
- Population Data Science, Swansea University Medical School, Swansea, SA2 8PP
| | - Laura North
- Population Data Science, Swansea University Medical School, Swansea, SA2 8PP
| | - Bachar Alrouh
- Centre for Child and & Family Justice Research, Lancaster University, Lancaster, LA1 4YW
| | - Ann John
- Population Data Science, Swansea University Medical School, Swansea, SA2 8PP
| | - Kerina Jones
- Population Data Science, Swansea University Medical School, Swansea, SA2 8PP
| | - Ashley Akbari
- Population Data Science, Swansea University Medical School, Swansea, SA2 8PP
| | - Jon Smart
- Population Data Science, Swansea University Medical School, Swansea, SA2 8PP
| | - Simon Thompson
- Population Data Science, Swansea University Medical School, Swansea, SA2 8PP
| | - Claire Hargreaves
- Centre for Child and & Family Justice Research, Lancaster University, Lancaster, LA1 4YW
| | - Stefanie Doebler
- Centre for Child and & Family Justice Research, Lancaster University, Lancaster, LA1 4YW
| | - Linda Cusworth
- Centre for Child and & Family Justice Research, Lancaster University, Lancaster, LA1 4YW
| | - Karen Broadhurst
- Centre for Child and & Family Justice Research, Lancaster University, Lancaster, LA1 4YW
| | - David V. Ford
- Population Data Science, Swansea University Medical School, Swansea, SA2 8PP
| | - Lucy J. Griffiths
- Population Data Science, Swansea University Medical School, Swansea, SA2 8PP
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Tastad K, Koh J, Goodridge D, Stempien J, Oyedokun T. Unidentified patients in the emergency department: a historical cohort study. CAN J EMERG MED 2021; 23:772-777. [PMID: 34403119 DOI: 10.1007/s43678-021-00165-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 06/08/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To characterize unidentified patients presenting to a single, urban emergency department (ED) in Canada. We report their demographics, ED course, post-ED discharge outcomes, and mode of identification. METHODS We performed a retrospective chart review using descriptive analyses to assess unidentified patients admitted to Royal University Hospital and St. Paul's Hospital EDs between May 1, 2018, and April 30, 2019, in Saskatoon, Saskatchewan, Canada. We assessed demographic data, clinical presentation, mode of identification, discharge information, and major clinical outcomes. RESULTS Unidentified patients were disproportionately male (64.9%), and mostly presented as Canadian Triage and Acuity Scale (CTAS) 1 (41.6%) and CTAS 2 (44.2%). Most patients arrived via emergency medical services (80.7%). The most common presenting complaints were substance misuse (33.3%) and trauma (24.6%). The average ED length of stay was 8.7 h (SD 18.6). Many patients received an inpatient consult (58.8%), and 22.3% received support services (e.g., social work). The 30-day mortality of all patients was 13.2%. Of those patients who survived to ED discharge, common dispositions included: home (36.0%), police services (3.5%), or emergency shelters (3.5%). Four (3.5%) patients returned to the hospital unidentified within the study period, and 6.7% of patients discharged from the ED returned within 48 hours. CONCLUSION Unidentified patients are a high-needs demographic that present mostly with substance misuse or trauma. Repeat ED attendance, sometimes as unidentified patients again, calls for initiatives that facilitate prompt identification, better discharge planning, and linkage to social supports.
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Affiliation(s)
- Kara Tastad
- College of Medicine, University of Saskatchewan, 107 Wiggins Rd, Saskatoon, SK, Canada, S7N 5E5.
| | - Justin Koh
- Department of Emergency Medicine, Royal University Hospital, Room 2646, 103 Hospital Drive, Saskatoon, SK, S7N 0W8, Canada
| | - Donna Goodridge
- College of Medicine, University of Saskatchewan, 107 Wiggins Rd, Saskatoon, SK, Canada, S7N 5E5
| | - James Stempien
- Department of Emergency Medicine, Royal University Hospital, Room 2646, 103 Hospital Drive, Saskatoon, SK, S7N 0W8, Canada
| | - Taofiq Oyedokun
- Department of Emergency Medicine, Royal University Hospital, Room 2646, 103 Hospital Drive, Saskatoon, SK, S7N 0W8, Canada
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Srivastava A, Clarke S, Hardy K, Kahan M. Facilitating rapid access to addiction treatment: a randomized controlled trial. Addict Sci Clin Pract 2021; 16:34. [PMID: 34034821 DOI: 10.1186/s13722-021-00240-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 05/08/2021] [Indexed: 11/10/2022] Open
Abstract
Background Obtaining timely access to addiction medicine treatment for patients with substance use disorders is challenging and patients often have to navigate complex referral pathways. This randomized controlled trial examines the effect of providing an expedited pathway to addiction medicine treatment on initial treatment engagement and health care utilization. Methods Individuals with possible alcohol or opioid use disorder were recruited from three residential withdrawal management services (WMS). Subjects randomized to the Delayed Intervention (DI) group were given contact information for a nearby addiction medicine clinic; those randomized to the Rapid Intervention (RI) group were given an appointment at the clinic within 2 days and were accompanied to their first appointment. Results Of the 174 individuals who were screened, 106 were randomized to either the DI or RI group. The two groups were similar in demographics, housing status, and substance use in the last 30 days. In the 6-month period following randomization, 85% of the RI group attended at least one clinic appointment, compared to only 29% in the DI group (p < 0.0001). The RI group had a mean of 6.39 ED visits per subject in the 12 months after randomization, while the DI group had a mean of 13.02 ED visits per subject in the same 12-month period (p = 0.0469). Other health utilization measures did not differ between the two groups. Conclusion Providing immediate facilitated access to an addiction medicine service resulted in greater initial engagement and reduced emergency department visits at 6 months. Trial registration This trial is registered at the National Institutes of Health (ClinicalTrials.gov) under identifier #NCT01934751. Supplementary Information The online version contains supplementary material available at 10.1186/s13722-021-00240-y.
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Alvial X, Rojas A, Carrasco R, Durán C, Fernández-Campusano C. Overuse of Health Care in the Emergency Services in Chile. Int J Environ Res Public Health 2021; 18:3082. [PMID: 33802727 DOI: 10.3390/ijerph18063082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 03/07/2021] [Accepted: 03/09/2021] [Indexed: 11/10/2022]
Abstract
The Public Health Service in Chile consists of different levels of complexity and coverage depending on the severity and degree of specialization of the pathology to be treated. From primary to tertiary care, tertiary care is highly complex and has low coverage. This work focuses on an analysis of the public health system with emphasis on the healthcare network and tertiary care, whose objectives are designed to respond to the needs of each patient. A review of the literature and a field study of the problem of studying the perception of internal and external users is presented. This study intends to be a contribution in the detection of opportunities for the relevant actors and the processes involved through the performance of Triage. The main causes and limitations of the excessive use of emergency services in Chile are analyzed and concrete proposals are generated aiming to benefit clinical care in emergency services. Finally, improvements related to management are proposed and the main aspects are determined to improve decision-making in hospitals, which could be a contribution to public health policies.
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Abstract
Background Little is known about the prognostic differences between older emergency department (ED) patients who present with different formal support requirements in the community. We set out to describe and compare the patient profiles and patterns of health service use among three older ED cohorts: home care clients, nursing home residents and those receiving no formal support. Methods We conducted a secondary analysis of the Canadian cohort from the interRAI multinational ED study. Data were collected using interRAI ED contact assessment on patients 75 years of age and older (n = 2,274), in eight ED sites across Canada. A series of descriptive statistics were reported. Adjusted associations were determined using logistic regression. Results Older adults receiving no formal support services were most stable. However, they were most likely to be hospitalized. Older home care clients were most likely to report depressive symptoms and distressed caregivers. They also had the greatest odds of frequent ED visitation post-discharge (OR=1.9; 95% CI=1.39–2.59). Older adults transferred from a nursing home were the frailest but had the lowest odds of hospital admission (OR=0.14; 95% CI=0.09–0.23). Conclusion We demonstrated the importance of inquiring about community-based formal support services and provide data to support decision-making in the ED.
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Affiliation(s)
- Fabrice I Mowbray
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON
| | - Komal Aryal
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON
| | - Eric Mercier
- Département de Médecine Familiale et Médecine d'Urgence, Faculté de Médecine, Université Laval, Quebec City, QC.,Centre d'excellence sur le vieillissement, Centre de recherche sur les soins de première ligne de l'Université Laval, Quebec City, QC
| | - George Heckman
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON
| | - Andrew P Costa
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON.,Michael G. DeGroote School of Medicine, Waterloo Regional Campus, Waterloo, ON, Canada
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Chen A, Fielding S, Hu XJ, McLane P, McRae A, Ospina M, Rosychuk RJ. Frequent users of emergency departments and patient flow in Alberta and Ontario, Canada: an administrative data study. BMC Health Serv Res 2020; 20:938. [PMID: 33046071 PMCID: PMC7552544 DOI: 10.1186/s12913-020-05774-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 09/29/2020] [Indexed: 11/16/2022] Open
Abstract
Background This paper describes and compares patient flow characteristics of adult high system users (HSUs) and control groups in Alberta and Ontario emergency departments (EDs), Canada. Methods Annual cohorts of HSUs were created by identifying patients who made up the top 10% of ED users (by count of ED presentations) in the National Ambulatory Care Reporting System during 2011–2016. Random samples of patients not in the HSU groups were selected as controls. Presentation (e.g., acuity) and ED times (e.g., time to physician initial assessment [PIA], length of stay) data were extracted and described. The length of stay for 2015/2016 data was decomposed into stages and Cox models compared time between stages. Results There were 20,343,230 and 18,222,969 ED presentations made by 7,032,655 and 1,923,462 individuals in the control and HSU groups, respectively. The Ontario groups had higher acuity than the Alberta groups: about 20% in the Ontario groups were from the emergent level whereas Alberta had 11–15%. Time to PIA was similar across provinces and groups (medians of 60 min to 67 min). Lengths of stay were longest for Ontario HSUs (median = 3 h) and shortest for Alberta HSUs (median = 2.2 h). HSUs had shorter times to PIA (hazard ratio [HR] = 1.03; 95% confidence interval [CI] 1.02,1.03), longer times from PIA to decision (HR = 0.84; 95%CI 0.84,0.84), and longer times from decision to leaving the ED (HR = 0.91; 95%CI 0.91,0.91). Conclusions Ontario HSUs had higher acuity and longer ED lengths of stay than the other groups. In both provinces, HSU had shorter times to PIA and longer times after assessment.
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Affiliation(s)
- Anqi Chen
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, 3-524 Edmonton Clinic Health Academy, Edmonton, Alberta, T6G 1C9, Canada
| | - Scott Fielding
- Emergency Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, T5J 3E4, Canada
| | - X Joan Hu
- Department of Statistics and Actuarial Science, Simon Fraser University, Burnaby, British Columbia, V5A 1S6, Canada
| | - Patrick McLane
- Emergency Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, T5J 3E4, Canada.,Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, T6G 2R7, Canada
| | - Andrew McRae
- Department of Emergency Medicine, University of Calgary, Calgary, Alberta, T2N 2T9, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Alberta, T2N 4Z6, Canada
| | - Maria Ospina
- Department of Obstetrics & Gynecology, University of Alberta, Edmonton, Alberta, T6G 2S2, Canada.,School of Public Health, University of Alberta, Edmonton, Alberta, T6G 1C9, Canada
| | - Rhonda J Rosychuk
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, 3-524 Edmonton Clinic Health Academy, Edmonton, Alberta, T6G 1C9, Canada. .,Department of Statistics and Actuarial Science, Simon Fraser University, Burnaby, British Columbia, V5A 1S6, Canada. .,Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, Alberta, T6G 2G1, Canada.
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Shannon B, Pang R, Jepson M, Williams C, Andrew N, Smith K, Bowles KA. What is the prevalence of frequent attendance to emergency departments and what is the impact on emergency department utilisation? A systematic review and meta-analysis. Intern Emerg Med 2020; 15:1303-1316. [PMID: 32557095 DOI: 10.1007/s11739-020-02403-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 06/06/2020] [Indexed: 11/26/2022]
Abstract
Patients who frequently attend to emergency departments are a varying group and have complex health care needs. This systematic review and meta-analysis aimed to determine the prevalence of patients who have frequent attendance to emergency departments. A systematic review was performed in line with PRISMA guidelines. A database search was conducted, and studies were included in the final review if they analysed a population of frequent attendance. Meta-analysis was performed only on population-based studies to estimate prevalence. The search yielded 2922 nonduplicate publications, of which 27 were included in the meta-analysis. The most common definition used for frequent attendance was greater than three presentations a year. The proportion of people who frequently attended as a percentage of the total study population ranged from 0.01 to 20.9%, with emergency department presentations from frequent attenders ranging from 0.2 to 34%. When limiting the definition of frequent attendance to greater than three visits in a 12-month period, people who frequently attended contributed between 3 and 10% [pooled estimate 6%; CI 4-7%] of emergency department presentations and between 12 and 34% [pooled estimate 21%; CI 15-27%] of total emergency department presentations. Meta-analysis found substantial heterogeneity between estimates [I2 > 50%]. The prevalence of frequent attendance compared to the total population of patients seeking emergency care was small, but the impact on emergency department utilisation is significant. Early identification of people attending for frequent care at an emergency department provides the opportunity to implement alternative models of care.
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Affiliation(s)
- Brendan Shannon
- Department of Paramedicine, Monash University, Peninsula Campus, McMahons Road, PO Box 527, Frankston, Melbourne, VIC, 3199, Australia.
- Ambulance Victoria, Melbourne, VIC, Australia.
| | - Rebecca Pang
- Peninsula Health, Allied Health, Frankston, VIC, Australia
- Peninsula Clinical School-Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Megan Jepson
- Department of Paramedicine, Monash University, Peninsula Campus, McMahons Road, PO Box 527, Frankston, Melbourne, VIC, 3199, Australia
| | - Cylie Williams
- Peninsula Health, Allied Health, Frankston, VIC, Australia
- Department of Physiotherapy, Monash University, Melbourne, VIC, Australia
| | - Nadine Andrew
- Peninsula Health, Allied Health, Frankston, VIC, Australia
- Peninsula Clinical School-Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Karen Smith
- Department of Paramedicine, Monash University, Peninsula Campus, McMahons Road, PO Box 527, Frankston, Melbourne, VIC, 3199, Australia
- Ambulance Victoria, Centre for Research and Evaluation, Melbourne, VIC, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Kelly-Ann Bowles
- Department of Paramedicine, Monash University, Peninsula Campus, McMahons Road, PO Box 527, Frankston, Melbourne, VIC, 3199, Australia
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Shergill Y, Rice D, Smyth C, Tremblay S, Nelli J, Small R, Hebert G, Singer L, Rash JA, Poulin PA. Characteristics of frequent users of the emergency department with chronic pain. CAN J EMERG MED 2020; 22:350-358. [PMID: 32213214 DOI: 10.1017/cem.2019.464] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVES To identify the proportion of high-frequency users of the emergency department (ED) who have chronic pain. METHODS We reviewed medical records of adult patients with ≥ 12 visits to a tertiary-care, academic hospital ED in Canada in 2012-2013. We collected the following demographics: 1) patient age and sex; 2) visit details - number of ED visits, inpatient admissions, length of inpatient admissions, diagnosis, and primary location of pain; 3) current and past substance abuse, mental health and medical conditions. Charts were reviewed independently by two reviewers. ED visits were classified as either "chronic pain" or "not chronic pain" related. RESULTS We analyzed 4,646 visits for 247 patients, mean age was 47.2 years (standard deviation = 17.8), and 50.2% were female. This chart review study found 38% of high-frequency users presented with chronic pain to the ED and that women were overrepresented in this group (64.5%). All high-frequency users presented with co-morbidities and/or mental health concerns. High-frequency users with chronic pain had more ED visits than those without and 52.7% were prescribed an opioid. Chronic abdominal pain was the primary concern for 54.8% of high-frequency users presenting with chronic pain. CONCLUSIONS Chronic pain, specifically chronic abdominal pain, is a significant driver of ED visits among patients who frequently use the ED. Interventions to support high-frequency users with chronic pain that take into account the complexity of patient's physical and mental health needs will likely achieve better clinical outcomes and reduce ED utilization.
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Affiliation(s)
- Yaadwinder Shergill
- The Ottawa Hospital Research Institute, Ottawa, ON
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON
- One Elephant Integrative Health Team Inc., Oakville, ON
| | - Danielle Rice
- The Ottawa Hospital Research Institute, Ottawa, ON
- Department of Psychology, McGill University, Montreal, QC
| | - Catherine Smyth
- The Ottawa Hospital Research Institute, Ottawa, ON
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, ON
| | - Steve Tremblay
- Department of Psychology, McGill University, Montreal, QC
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON
| | - Jennifer Nelli
- Department of Anesthesiology, Hamilton Health Sciences, Hamilton, ON
| | - Rebecca Small
- Faculty of Medicine, Memorial University, St. John's, NL
| | - Guy Hebert
- Department of Emergency Medicine, The Ottawa Hospital, Ottawa, ON
| | - Lesley Singer
- Canadian Pain Network Patient Representative
- Patient Representative, Chronic Pain Network, Montreal, QC
| | - Joshua A Rash
- Department of Psychology, Memorial University, St. John's, NL
| | - Patricia A Poulin
- The Ottawa Hospital Research Institute, Ottawa, ON
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON
- Department of Psychology, The Ottawa Hospital, Ottawa, ON
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Penzenstadler L, Gentil L, Huỳnh C, Grenier G, Fleury MJ. Variables associated with low, moderate and high emergency department use among patients with substance-related disorders. Drug Alcohol Depend 2020; 207:107817. [PMID: 31887605 DOI: 10.1016/j.drugalcdep.2019.107817] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 12/12/2019] [Accepted: 12/14/2019] [Indexed: 11/27/2022]
Abstract
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.
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Affiliation(s)
- Louise Penzenstadler
- Douglas Mental Health University Institute (Research Centre), McGill University, Department of Psychiatry, 6875 LaSalle Boulevard, Montréal, Québec H4H 1R3, Canada; Service d'addictologie, Département de psychiatrie, Hôpitaux Universitaires Genève, Rue du Grand-Pré 70c, 1202 Genève, Switzerland
| | - Lia Gentil
- Douglas Mental Health University Institute (Research Centre), McGill University, Department of Psychiatry, 6875 LaSalle Boulevard, Montréal, Québec H4H 1R3, Canada; Institut universitaire sur les dépendances, Centre intégré universitaire de santé et des services sociaux du Centre-Sud-de-l'Île-de-Montréal, 950 Louvain East, Montréal, Québec H2M 2E8, Canada
| | - Christophe Huỳnh
- Institut universitaire sur les dépendances, Centre intégré universitaire de santé et des services sociaux du Centre-Sud-de-l'Île-de-Montréal, 950 Louvain East, Montréal, Québec H2M 2E8, Canada
| | - Guy Grenier
- Douglas Mental Health University Institute (Research Centre), McGill University, Department of Psychiatry, 6875 LaSalle Boulevard, Montréal, Québec H4H 1R3, Canada
| | - Marie-Josée Fleury
- Douglas Mental Health University Institute (Research Centre), McGill University, Department of Psychiatry, 6875 LaSalle Boulevard, Montréal, Québec H4H 1R3, Canada.
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Abstract
OBJECTIVE Frequent users represent a small proportion of emergency department users, but they account for a disproportionately large number of visits. Their use of emergency departments is often considered suboptimal. It would be more efficient to identify and treat those patients earlier in their health problem trajectory. It is therefore essential to describe their characteristics and to predict their emergency department use. In order to do so, adequate statistical tools are needed. The objective of this study was to determine the statistical tools used in identifying variables associated with frequent use or predicting the risk of becoming a frequent user. METHODS We performed a scoping review following an established 5-stage methodological framework. We searched PubMed, Scopus and CINAHL databases in February 2019 using search strategies defined with the help of an information specialist. Out of 4534 potential abstracts, we selected 114 articles based on defined criteria and presented in a content analysis. RESULTS We identified four classes of statistical tools. Regression models were found to be the most common practice, followed by hypothesis testing. The logistic regression was found to be the most used statistical tool, followed by χ2 test and t-test of associations between variables. Other tools were marginally used. CONCLUSIONS This scoping review lists common statistical tools used for analysing frequent users in emergency departments. It highlights the fact that some are well established while others are much less so. More research is needed to apply appropriate techniques to health data or to diversify statistical point of views.
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Affiliation(s)
- Yohann Chiu
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - François Racine-Hemmings
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Isabelle Dufour
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Alain Vanasse
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | | | - Mathieu Bisson
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Catherine Hudon
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
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Slankamenac K, Zehnder M, Langner TO, Krähenmann K, Keller DI. Recurrent Emergency Department Users: Two Categories with Different Risk Profiles. J Clin Med 2019; 8:jcm8030333. [PMID: 30857294 PMCID: PMC6463097 DOI: 10.3390/jcm8030333] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 03/04/2019] [Accepted: 03/05/2019] [Indexed: 11/16/2022] Open
Abstract
Recurrent emergency department (ED) visits are responsible for an increasing proportion of overcrowding. Therefore, our aim was to investigate the characteristics and prevalence of recurrent ED visitors as well as to determine risk factors associated with multiple ED visits. ED patients visiting the ED of a tertiary care hospital at least four times consecutively in 2015 were enrolled. Of 33,335 primary ED visits, 1921 ED visits (5.8%) were performed by 372 ED patients who presented in the ED at least four times within the one-year period. Two different categories of recurrent ED patients were identified: repeated ED users presenting always with the same symptoms and frequent ED visitors who were suffering from different symptoms on each ED visit. Repeated ED users had more ED visits (p < 0.001) and needed more hospital admissions (p < 0.010) compared to frequent ED users. Repeated ED users visited the ED more likely due to symptoms from chronic obstructive pulmonary diseases (p < 0.001) and mental disorders (p < 0.001). In contrast, frequent ED patients showed to be at risk for multiple ED visits when being disabled (p = 0.001), had an increased Charlson co-morbidity index (p = 0.004) or suffering from rheumatic diseases (p < 0.001). A small number of recurrent ED visitors determines a relevant number of ED visits with a relevance for and impact on patient centred care and emergency services. There are two categories of recurrent ED users with different risk factors for multiple ED visits: repeated and frequent. Therefore, multi-professional follow-up care models for recurrent ED patients are needed to improve patients’ needs, quality of life as well as emergency services.
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Affiliation(s)
- Ksenija Slankamenac
- Emergency Department, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland.
| | - Meret Zehnder
- Emergency Department, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland.
| | - Tim O Langner
- Emergency Department, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland.
| | - Kathrin Krähenmann
- Emergency Department, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland.
| | - Dagmar I Keller
- Emergency Department, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland.
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