Frequent users of emergency departments: developing standard definitions and defining prominent risk factors.
OBJECTIVE
We identify factors that define frequent and highly frequent emergency department (ED) users.


METHODS
Administrative health care records were used to define less frequent (1 to 6 visits), frequent (7 to 17 visits), and highly frequent (≥18 visits) ED users. Analyses were conducted to determine the most unique demographic, disease, and health care use features of these groups.


RESULTS
Frequent users composed 9.9% of all ED visits, whereas highly frequent users composed 3.6% of visits. Compared with less frequent users, frequent users were defined most strongly by their substance abuse challenges and by their many visits to primary care and specialist physicians. Substance abuse also distinguished highly frequent from frequent ED users strongly; 67.3% versus 35.9% of these patient groups were substance abusers, respectively. Also, 70% of highly frequent versus only 17.8% of frequent users had a long history of frequent ED use. Last, highly frequent users did not use other health care services proportionally more than their frequent user counterparts, suggesting that these former patients use EDs as a main source of care.


CONCLUSIONS
This research develops objective thresholds of frequent and highly frequent ED use. Although substance abuse is prominent in both groups, only highly frequent users seem to visit EDs in place of other health care services. Future analyses can investigate these patterns of health care use more closely, including how timely access to primary care affects ED use. Cluster analysis also has value for defining frequent user subgroups who may benefit from different yet equally effective treatment options.
Manitoba Centre for Health Policy, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada. malcolm_doupe@cpe.umanitoba.ca
Malcolm B
MB
Doupe
Wes
W
Palatnick
Suzanne
S
Day
Dan
D
Chateau
Ruth-Ann
RA
Soodeen
Charles
C
Burchill
Shelley
S
Derksen
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D008350:Manitoba; D008875:Middle Aged; D011320:Primary Health Care / Q000706:statistics & numerical data; D012307:Risk Factors; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders; D055815:Young Adult