title: Frequent ED users: are most visits for mental health, alcohol, and drug-related complaints?
abstract: OBJECTIVE
  To determine whether frequent emergency department (ED) users are more likely to make at least one and a majority of visits for mental health, alcohol, or drug-related complaints compared to non-frequent users.
  
  
  METHODS
  We performed a retrospective cohort study exploring frequent ED use and ED diagnosis at a single, academic hospital and included all ED patients between January 1 and December 31, 2010. We compared differences in ED visits with a primary International Classification of Diseases, 9th Revision visit diagnosis of mental health, alcohol or drug-related diagnoses between non-frequent users (<4 visits during previous 12-months) and frequent (repeat [4-7 visits], highly frequent [8-18 visits] and super frequent [≥19 visits]) users in univariate and multivariable analyses.
  
  
  RESULTS
  Frequent users (2496/65201 [3.8%] patients) were more likely to make at least one visit associated with mental health, alcohol, or drug-related diagnoses. The proportion of patients with a majority of visits related to any of the three diagnoses increased from 5.8% among non-frequent users (3616/62705) to 9.4% among repeat users (181/1926), 13.1% among highly frequent users (62/473), and 25.8% (25/97 patients) in super frequent users. An increasing proportion of visits with alcohol-related diagnoses was observed among repeat, highly frequent, and super frequent users but was not found for mental health or drug-related complaints.
  
  
  CONCLUSIONS
  Frequent ED users were more likely to make a mental health, alcohol or drug-related visit, but a majority of visits were only noted for those with alcohol-related diagnoses. To address frequent ED use, interventions focusing on managing patients with frequent alcohol-related visits may be necessary.
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA 02114, USA. Electronic address: Sliu1@partners.org.
authors.forename: Shan W
authors.initials: SW
authors.lastname: Liu
authors.forename: John T
authors.initials: JT
authors.lastname: Nagurney
authors.forename: Yuchiao
authors.initials: Y
authors.lastname: Chang
authors.forename: Blair A
authors.initials: BA
authors.lastname: Parry
authors.forename: Peter
authors.initials: P
authors.lastname: Smulowitz
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Atlas
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data; D000328:Adult; D000437:Alcoholism / Q000628:therapy*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006786:Hospitals, Urban / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D019966:Substance-Related Disorders / Q000628:therapy*