title: Emergency Department Non-Urgent Visits and Hospital Readmissions Are Associated with Different Socio-Economic Variables in Italy.
abstract: OBJECTIVE
  The aim of this paper was to evaluate socio-economic factors associated to poor primary care utilization by studying two specific subjects: the hospital readmission rate, and the use of the Emergency Department (ED) for non-urgent visits.
  
  
  METHODS
  The study was carried out by the analysis of administrative database for hospital readmission and with a specific survey for non-urgent ED use.
  
  
  RESULTS
  Among the 416,698 sampled admissions, 6.39% (95% CI, 6.32-6.47) of re-admissions have been registered; the distribution shows a high frequency of events in the age 65-84 years group, and in the intermediate care hospitals (51.97%; 95%CI 51.37-52.57). The regression model has shown the significant role played by age, type of structure (geriatric acute care), and deprivation index of the area of residence on the readmission, however, after adjusting for the intensity of primary care, the role of deprivation was no more significant. Non-urgent ED visits accounted for the 12.10%, (95%CI 9.38-15.27) of the total number of respondents to the questionnaire (N = 504). The likelihood of performing a non-urgent ED visit was higher among patients aged <65 years (OR 3.2, 95%CI 1.3-7.8 p = 0.008), while it was lower among those perceiving as urgent their health problem (OR 0.50, 95%CI 0.30-0.90).
  
  
  CONCLUSIONS
  In the Italian context repeated readmissions and ED utilization are linked to different trajectories, besides the increasing age and comorbidity of patients are the factors that are related to repeated admissions, the self-perceived trust in diagnostic technologies is an important risk factor in determining ED visits. Better use of public national health care service is mandatory, since its correct utilization is associated to increasing equity and better health care utilization.
authors.affiliation: Department of Biomedical Science and Public Health, Università Politecnica delle Marche, Ancona, Italy; Hospital Hygiene Service, AOU Ospedali Riuniti, Ancona, Italy.
authors.forename: Pamela
authors.initials: P
authors.lastname: Barbadoro
authors.affiliation: Department of Biomedical Science and Public Health, Università Politecnica delle Marche, Ancona, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Di Tondo
authors.affiliation: Department of Emergency Care, AOU Ospedali Riuniti, Ancona, Italy.
authors.forename: Vincenzo Giannicola
authors.initials: VG
authors.lastname: Menditto
authors.affiliation: Department of Biomedical Science and Public Health, Università Politecnica delle Marche, Ancona, Italy.
authors.forename: Lucia
authors.initials: L
authors.lastname: Pennacchietti
authors.affiliation: Department of Emergency Care, AOU Ospedali Riuniti, Ancona, Italy.
authors.forename: Februa
authors.initials: F
authors.lastname: Regnicoli
authors.affiliation: Department of Biomedical Science and Public Health, Università Politecnica delle Marche, Ancona, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Di Stanislao
authors.affiliation: Department of Biomedical Science and Public Health, Università Politecnica delle Marche, Ancona, Italy; Hospital Hygiene Service, AOU Ospedali Riuniti, Ancona, Italy.
authors.forename: Marcello Mario
authors.initials: MM
authors.lastname: D'Errico
authors.affiliation: Department of Biomedical Science and Public Health, Università Politecnica delle Marche, Ancona, Italy; Hospital Hygiene Service, AOU Ospedali Riuniti, Ancona, Italy.
authors.forename: Emilia
authors.initials: E
authors.lastname: Prospero
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission; D011320:Primary Health Care / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D055815:Young Adult