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Castellini G, Cassioli E, Rossi E, Marchesoni G, Cerini G, Pastore E, De Bonfioli Cavalcabo' N, Rotella F, Mezzani B, Alterini B, Lucarelli S, Magazzini S, Corazzesi P, Caini S, Ricca V. Use and misuse of the emergency room by patients with eating disorders in a matched-cohort analysis: What can we learn from it? Psychiatry Res 2023; 328:115427. [PMID: 37647700 DOI: 10.1016/j.psychres.2023.115427] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 08/18/2023] [Accepted: 08/19/2023] [Indexed: 09/01/2023]
Abstract
We examined the pattern of access to hospital emergency room (hER) in 2018-2021 among patients with eating disorders (ED) from Florence, Italy, diagnosed during 1994-2018, using a matched cohort design. We included 902 ED patients and an equal number of sex-, age-, and residence-matched individuals. We fitted conditional Poisson regression models with robust variance estimator to estimate incidence rate ratios (IRR) and 95% confidence intervals. ED patients accessed hER more than twice as often as matched individuals: the IRR was 2.11 (1.21-3.70), 2.02 (1.36-3.00), and 2.49 (1.71-3.61) among AN, BN, and BED patients. Factors associated with increased hER use were older age (≥40 years; for AN patients, also younger age, <20 years), BMI ≤ 16 kg/m2 (for AN), and psychopathological severity. The rise in access to hER was particularly marked during the early phases of the COVID-19 pandemic and declined only partially thereafter. Acute psychiatric symptoms and non-specific medical conditions represented the main causes of increased access to hER. Use of hER was more often inappropriate among ED patients than matched individuals. Integration of primary and mental health care may be necessary to counteract the high and often inappropriate use of hER by patients with ED.
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Affiliation(s)
- Giovanni Castellini
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy; Psychiatry Unit, Careggi University Hospital, Florence, Italy
| | - Emanuele Cassioli
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy; Psychiatry Unit, Careggi University Hospital, Florence, Italy
| | - Eleonora Rossi
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy; Psychiatry Unit, Careggi University Hospital, Florence, Italy
| | - Giorgia Marchesoni
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Gabriele Cerini
- Postgraduate School in Hygiene and Preventive Medicine, University of Florence, Florence 50134, Italy
| | - Elisa Pastore
- Clinical Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Nora De Bonfioli Cavalcabo'
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Francesco Rotella
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy; Psychiatry Unit, Careggi University Hospital, Florence, Italy
| | | | - Brunetto Alterini
- Division of Cardiovascular and Perioperative Medicine, Careggi University Hospital, Florence, Italy
| | - Stefano Lucarelli
- Eating Disorders Unit, Central Tuscany Local Health Authority, Florence, Italy
| | - Simone Magazzini
- Emergency Medicine Unit, Ospedale Santo Stefano, Emergency Department ASL Toscana Centro, Prato, Italy
| | - Patrizia Corazzesi
- Emergency Medicine Unit, Ospedale Santo Stefano, Emergency Department ASL Toscana Centro, Prato, Italy
| | - Saverio Caini
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy.
| | - Valdo Ricca
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy; Psychiatry Unit, Careggi University Hospital, Florence, Italy
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