Persistent frequent emergency department users with chronic conditions: A population-based cohort study.
Adolescent
Adult
Aged
Aged, 80 and over
Chronic Disease
/ epidemiology
Emergency Medical Services
/ statistics & numerical data
Emergency Service, Hospital
Female
Humans
Male
Middle Aged
Odds Ratio
Patient Acceptance of Health Care
Patient Outcome Assessment
Population Surveillance
Prevalence
Quebec
/ epidemiology
Retrospective Studies
Young Adult
Journal
PloS one
ISSN: 1932-6203
Titre abrégé: PLoS One
Pays: United States
ID NLM: 101285081
Informations de publication
Date de publication:
2020
2020
Historique:
received:
04
07
2019
accepted:
28
01
2020
entrez:
13
2
2020
pubmed:
13
2
2020
medline:
12
5
2020
Statut:
epublish
Résumé
Frequent emergency department users are patients cumulating at least four visits per year. Few studies have focused on persistent frequent users, who maintain their frequent user status for multiple consecutive years. This study targets an adult population with chronic conditions, and its aims are: 1) to estimate the prevalence of persistent frequent ED use; 2) to identify factors associated with persistent frequent ED use (frequent use for three consecutive years) and compare their importance with those associated with occasional frequent ED use (frequent use during the year following the index date); and 3) to compare characteristics of "persistent frequent users" to "occasional frequent users" and to "users other than persistent frequent users". This is a retrospective cohort study using Quebec administrative databases. All adult patients who visited the emergency department in 2012, diagnosed with chronic conditions, and living in non-remote areas were included. Patients who died in the three years following their index date were excluded. The main outcome was persistent frequent use (≥4 visits per year during three consecutive years). Potential predictors included sociodemographic characteristics, physical and mental comorbidities, and prior healthcare utilization. Odds ratios were computed using multivariable logistic regression. Out of 297,182 patients who visited ED at least once in 2012, 3,357 (1.10%) were persistent frequent users. Their main characteristics included poor socioeconomic status, mental and physical comorbidity, and substance abuse. Those characteristics were also present for occasional frequent users, although with higher percentages for the persistent user group. The number of previous visits to the emergency department was the most important factor in the regression model. The occasional frequent users' attrition rate was higher between the first and second year of follow-up than between the second and third year. Persistent frequent users are a subpopulation of frequent users with whom they share characteristics, such as physical and mental comorbidities, though the former are poorer and younger. More research is needed in order to better understand what factors can contribute to persistent frequent use.
Sections du résumé
BACKGROUND
Frequent emergency department users are patients cumulating at least four visits per year. Few studies have focused on persistent frequent users, who maintain their frequent user status for multiple consecutive years. This study targets an adult population with chronic conditions, and its aims are: 1) to estimate the prevalence of persistent frequent ED use; 2) to identify factors associated with persistent frequent ED use (frequent use for three consecutive years) and compare their importance with those associated with occasional frequent ED use (frequent use during the year following the index date); and 3) to compare characteristics of "persistent frequent users" to "occasional frequent users" and to "users other than persistent frequent users".
METHODS
This is a retrospective cohort study using Quebec administrative databases. All adult patients who visited the emergency department in 2012, diagnosed with chronic conditions, and living in non-remote areas were included. Patients who died in the three years following their index date were excluded. The main outcome was persistent frequent use (≥4 visits per year during three consecutive years). Potential predictors included sociodemographic characteristics, physical and mental comorbidities, and prior healthcare utilization. Odds ratios were computed using multivariable logistic regression.
RESULTS
Out of 297,182 patients who visited ED at least once in 2012, 3,357 (1.10%) were persistent frequent users. Their main characteristics included poor socioeconomic status, mental and physical comorbidity, and substance abuse. Those characteristics were also present for occasional frequent users, although with higher percentages for the persistent user group. The number of previous visits to the emergency department was the most important factor in the regression model. The occasional frequent users' attrition rate was higher between the first and second year of follow-up than between the second and third year.
CONCLUSIONS
Persistent frequent users are a subpopulation of frequent users with whom they share characteristics, such as physical and mental comorbidities, though the former are poorer and younger. More research is needed in order to better understand what factors can contribute to persistent frequent use.
Identifiants
pubmed: 32050010
doi: 10.1371/journal.pone.0229022
pii: PONE-D-19-18906
pmc: PMC7015381
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0229022Déclaration de conflit d'intérêts
Dr Alain Vanasse has received grants for unrelated research from AstraZeneca Canada Inc. This does not alter our adherence to PLOS ONE policies on sharing data and materials. The authors declare no other competing interests.
Références
Health Policy. 2016 Jul;120(7):758-69
pubmed: 27312144
Med J Aust. 2011 Jun 6;194(11):570-3
pubmed: 21644868
Acad Emerg Med. 2000 Jun;7(6):637-46
pubmed: 10905642
J Assoc Acad Minor Phys. 2001 Mar;12(1-2):119-23
pubmed: 11851196
Neurology. 2015 Sep 22;85(12):1031-8
pubmed: 26311752
BMC Health Serv Res. 2016 Oct 20;16(1):594
pubmed: 27765045
BMC Health Serv Res. 2017 Aug 4;17(1):525
pubmed: 28778161
Pain. 2004 Sep;111(1-2):51-8
pubmed: 15327808
Med Care Res Rev. 2017 Jun;74(3):311-327
pubmed: 27030234
J Emerg Med. 2013 Mar;44(3):717-29
pubmed: 23200765
Med Care. 2018 May;56(5):441-447
pubmed: 29578951
Chest. 2005 May;127(5):1579-86
pubmed: 15888831
J Palliat Med. 2013 Jul;16(7):774-9
pubmed: 23676094
Arthritis Care Res (Hoboken). 2019 Nov;71(11):1410-1418
pubmed: 30295422
Med Care Res Rev. 2011 Apr;68(2):131-55
pubmed: 20829235
Am J Emerg Med. 2008 Feb;26(2):155-64
pubmed: 18272094
Pediatrics. 2017 Sep;140(3):
pubmed: 28765381
Health Aff (Millwood). 2017 Oct 1;36(10):1720-1728
pubmed: 28971916
BMC Health Serv Res. 2010 Jul 21;10:216
pubmed: 20663141
BMC Bioinformatics. 2013 Jun 25;14:206
pubmed: 23800244
Pediatr Pulmonol. 2017 Jul;52(7):880-890
pubmed: 28557381
Healthc Policy. 2007 Nov;3(2):72-85
pubmed: 19305782
Ann Emerg Med. 2016 Jun;67(6):721-729
pubmed: 26947801
BMC Med. 2015 Jan 06;13:1
pubmed: 25563062
J Gen Intern Med. 1998 Sep;13(9):614-20
pubmed: 9754517
Emerg Med J. 2016 Mar;33(3):230-6
pubmed: 25953837
Soc Sci Med. 1987;25(7):825-31
pubmed: 3686111
Ann Intern Med. 2015 Jan 6;162(1):W1-73
pubmed: 25560730
BMJ. 2010 Mar 12;340:b5087
pubmed: 20228141
Ann Emerg Med. 2003 Mar;41(3):309-18
pubmed: 12605196
Acad Emerg Med. 2012 Jan;19(1):63-8
pubmed: 22221292
J Ambul Care Manage. 2012 Apr-Jun;35(2):149-58
pubmed: 22415289
Ann Emerg Med. 2017 Apr;69(4):416-425
pubmed: 28169049
Ann Emerg Med. 2006 Jul;48(1):1-8
pubmed: 16781914
CMAJ. 2010 Apr 6;182(6):563-8
pubmed: 20231340
Health Aff (Millwood). 2013 Dec;32(12):2099-108
pubmed: 24301392