title: Targeting frequent users of emergency departments: Prominent risk factors and policy implications.
abstract: This study investigates the characteristics of frequent users of accident and emergency departments (AEDs) and recommends alternative medical services for such patients. Prominent demographic and clinical risk factors for individuals accessing seven AEDs located in the metropolitan area of Genoa, Italy are identified and analysed. A truncated count data model is implemented to establish the determinants of access, while a multinomial logistic regression is used to highlight potential differences among different user categories. According to previous studies, empirical findings suggest that despite the relevance of demographic drivers, vulnerability conditions (e.g. abuse of alcohol and drugs, chronic conditions, and psychological distress) are the main reasons behind frequent AED use; the analysis seems to confirm an association between AED frequent use and lower level of urgency. Since frequent and highly frequent users are found responsible for disproportionate resource absorption with respect to total amount of AED costs (they represent roughly 10% of the total number of patients, but contribute to more than 19% of the total annual AED cost), policies aiming to reduce frequent use of AEDs could bring significant savings in economic resources. Thus, efficient actions could be oriented toward extending primary care services outside AED and toward instituting local aid services specifically addressed to people under the influence of substances or in conditions of mental distress.
authors.affiliation: Department of Economics, University of Genoa, Via Vivaldi 5, 16126 Genoa, Italy. Electronic address: lucia.leporatti@unige.it.
authors.forename: Lucia
authors.initials: L
authors.lastname: Leporatti
authors.affiliation: Department of Economics, University of Genoa, Via Vivaldi 5, 16126 Genoa, Italy.
authors.forename: Marta
authors.initials: M
authors.lastname: Ameri
authors.affiliation: Department of Political Science, University of Genoa, Largo della Zecca 8, 16124 Genoa, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Trinchero
authors.affiliation: Liguria Region, Health Regional Agency, Piazza della Vittora 15, 16121 Genoa, Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Orcamo
authors.affiliation: Department of Economics, University of Genoa, Via Vivaldi 5, 16126 Genoa, Italy.
authors.forename: Marcello
authors.initials: M
authors.lastname: Montefiori
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data*; D054242:Emigrants and Immigrants; D005260:Female; D017048:Health Care Costs; D006291:Health Policy; D006801:Humans; D007558:Italy; D008297:Male; D000069342:Medical Overuse / Q000191:economics*; D008875:Middle Aged; D011320:Primary Health Care / Q000706:statistics & numerical data; D012307:Risk Factors; D012737:Sex Factors; D019966:Substance-Related Disorders
keywords: Emergency department; Frequent user; Healthcare system sustainability; Inappropriate use; Risk factor