title: Psychiatric status, somatisation, and health care utilization of frequent attenders at the emergency department: a comparison with routine attenders.
abstract: Seventy-seven frequent attenders at an emergency department (ED) in an inner-city hospital in the UK (defined as seven or more visits in the previous 12 months) were compared with 182 patients who were attending the same department on a routine basis. Patients completed the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) and the Short Form (SF)-36. Information was obtained on 64% of the frequent attenders and 45% underwent a detailed psychiatric assessment. Of the frequent attenders, 45% had psychiatric disorder and 49% had some form of an alcohol-related disorder. Compared with routine attenders, frequent attenders reported lower health status, had more psychiatric disorder (odds ratio: OR=8.2, 95% confidence interval: CI=3.8--18.1), had more general hospital admissions (OR=19.9, 95% CI=8.3--47.8), more psychiatric admissions (OR=167.5, 95% CI=9.5--2959.0), and more GP visits (95% CI for difference=-10.2 to -5.7). There was no evidence that frequent attenders had more somatisation than routine attenders. Specific treatment and management strategies need to be developed for this group of patients, although a substantial proportion may be difficult to engage in the treatment process.
authors.affiliation: Department of Psychiatry, Manchester Royal Infirmary, University of Manchester, Rawnsley Building, Oxford Road, Manchester M13 9BX, UK.
authors.forename: E R
authors.initials: ER
authors.lastname: Williams
authors.forename: E
authors.initials: E
authors.lastname: Guthrie
authors.forename: K
authors.initials: K
authors.lastname: Mackway-Jones
authors.forename: M
authors.initials: M
authors.lastname: James
authors.forename: B
authors.initials: B
authors.lastname: Tomenson
authors.forename: J
authors.initials: J
authors.lastname: Eastham
authors.forename: D
authors.initials: D
authors.lastname: McNally
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002648:Child; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006304:Health Status; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D008875:Middle Aged; D015995:Prevalence; D012737:Sex Factors; D013001:Somatoform Disorders / Q000453:epidemiology; D006113:United Kingdom / Q000453:epidemiology; D014600:Utilization Review