Here one year, gone the next? Investigating persistence of frequent emergency department attendance: a retrospective study in Australia
Autor: | Rebekah Zingel, Judy Mullan, Victoria J Westley-Wise, Thomas D Carrigan, Kelly Lambert, Kathy Eagar, Wayne Triner, Luise P Lago |
---|---|
Rok vydání: | 2019 |
Předmět: |
Adult
Male Longitudinal study emergency department Population Psychological intervention repeat use 03 medical and health sciences 0302 clinical medicine Humans Medicine 030212 general & internal medicine Social determinants of health education Socioeconomic status Retrospective Studies education.field_of_study business.industry Incidence Research Australia longitudinal study persistent Attendance 030208 emergency & critical care medicine Retrospective cohort study General Medicine Emergency department Middle Aged Hospitalization social determinants of health Emergency Medicine Female Emergencies Emergency Service Hospital business Follow-Up Studies Forecasting Demography |
Zdroj: | BMJ Open BMJ Open, Vol 9, Iss 6 (2019) |
ISSN: | 2044-6055 |
Popis: | ObjectivesPatients are presenting to emergency departments (EDs) with increasing complexity at rates beyond population growth and ageing. Intervention studies target patients with 12 months or less of frequent attendance. However, these interventions are not well targeted since most patients do not remain frequent attenders. This paper quantifies temporary and ongoing frequent attendance and contrasts risk factors for each group.DesignRetrospective population-based study using 10 years of longitudinal data.SettingAn Australian geographic region that includes metropolitan and rural EDs.Participants332 100 residents visited any ED during the study period.Main outcome measureFrequent attendance was defined as seven or more visits to any ED in the region within a 12-month period. Temporary frequent attendance was defined as meeting this threshold only once, and ongoing more than once. Risk factors for temporary and ongoing frequent attenders were identified using logistic regression models for adults and children.ResultsOf 8577 frequent attenders, 80.1% were temporary and 19.9% ongoing (12.9% repeat, 7.1% persistent). Among adults, ongoing were more likely than temporary frequent attenders to be young to middle aged (aged 25–64 years), and less likely to be from a high socioeconomic area or be admitted. Ongoing frequent attenders had higher rates of non-injury presentations, in particular substance-related (OR=2.5, 99% CI 1.1 to 5.6) and psychiatric illness (OR=2.9, 99% CI 1.8 to 4.6). In comparison, children who were ongoing were more likely than temporary frequent attenders to be aged 5–15 years, and were not more likely to be admitted (OR=2.7, 99% CI 0.7 to 10.9).ConclusionsFuture intervention studies should distinguish between temporary and ongoing frequent attenders, develop specific interventions for each group and include rigorous evaluation. |
Databáze: | OpenAIRE |
Externí odkaz: |