[Evaluation of the functional component underlying the frequent attendance to a hospital emergency service and its economic consequences].
OBJECTIVE
To analyse the psychosocial characteristics of frequent emergency department (ER) users with a relevant non-organic component and estimate the generated costs.


METHODS
Retrospective-descriptive study (Jan 1996-Jun 1997) about overusers (OU) defined as > = 3 visits/6 months during at least two 6 months periods, coming to our hospital's emergency department. Reviewing their medical records and making a psychiatric interview we identified Non-organic OU (NOU). Subsequently we estimated the cost generated by discharge visits during the first six months of 1997.


RESULTS
Sixty six out of 220 OU were identified as NOU. The mean consultation rate was 11.3 +/- 9.4. Clinician-psychiatrist agreement on non-organicity was 72.7%. The most frequent diagnoses were: personality disorders (37.5%) and depression-anxiety (35%). Psychiatric OU were significantly younger (51.7 vs 62.5 years) and attended more often (17.6 vs. 9.9 times). In six months only one of 240 ER consultation cause admission. The mean cost of each discharge episode was 8682.9 +/- 6633.8 pta (25.06% due to variable costs). The cost per minute of emergency room stay was 19.26 ptas. Overall NOU attention cost during the six month period studied was 1,903,775 ptas (0.36% of overall ER costs).


CONCLUSIONS
Compared with the rest of users, NOU entail a higher burden for the ER. Mentally-ill patients are younger and consult more frequently than the rest of OU. Only 25% of the cost per consultation is due to treatments, tests or diets.
Santos Martín
M D
MD
Medicina Familiar y Comunitaria, Hospital Severo Ochoa, Leganés, Madrid.
Bascuñana Morejón de Girón
J
J
Lumbreras García
G
G
Alvarez Martín
E
E
Martínez Pascual
B
B
Sanz Correcher
P
P
Hernando de Larramendi
C
C
Mancebo Aragoneses
L
L
D000367:Age Factors; D001007:Anxiety / Q000191:economics / Q000453:epidemiology; D003863:Depression / Q000191:economics / Q000453:epidemiology; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D006300:Health Services Misuse / Q000191:economics / Q000706:statistics & numerical data*; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000191:economics / Q000453:epidemiology; D008875:Middle Aged
Valoración del componente funcional que subyace al uso reiterado de un servicio de urgencias hospitalario y de sus repercusiones económicas.