title: Qualitative exploration of why people repeatedly attend emergency departments for alcohol-related reasons.
abstract: Understanding why people repeatedly attend Emergency Departments (EDs) for alcohol-related reasons is an important prerequisite to identifying ways of reducing any unnecessary demands on hospital resources. We use Andersen's Behavioural Model of Health Services Use to explore factors that contributed to repeat ED attendances.
  
  
  
  Qualitative interviews were conducted with 30 people who repeatedly attended EDs for alcohol-related reasons (≥10 attendances in the past 12 months). We recruited participants from 6 EDs in London, United Kingdom. Data on socio-demographic characteristics, substance use, contact with specialist addiction and other health services, most recent ED attendance, and previous ED attendances were analysed.
  
  
  
  Participants reported long-standing health problems, almost all were unemployed, and many had limited education and unstable housing. Most held positive health beliefs about EDs, despite some negative experiences. They reported limited community resources: poor social support, inaccessible primary care services, dislike or lack of information about specialist addiction services, and difficulties travelling to services. In contrast, EDs offered immediate, sympathetic care and free transport by ambulance. Participants' perceived need for care was high, with physical injury and pain being the main reasons for ED attendance.
  
  
  
  Push' and 'pull' factors contributed to repeated ED use. 'Push' factors included individual-level problems and wider community service failings. 'Pull' factors included positive experiences of, and beliefs about, ED care. Community services need to better engage and support people with complex drinking problems, whilst ED staff can be more effective in referring patients to community-based services.
authors.affiliation: National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience (IOPPN), King's College London, Addictions Sciences Building, 4 Windsor Walk, Denmark Hill, London, SE5 8BB, UK. Thomas.parkman@kcl.ac.uk.
authors.forename: Tom
authors.initials: T
authors.lastname: Parkman
authors.affiliation: National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience (IOPPN), King's College London, Addictions Sciences Building, 4 Windsor Walk, Denmark Hill, London, SE5 8BB, UK.|Centre for Social Research in Health, University of New South Wales, Sydney, NSW 2052, Australia.
authors.forename: Joanne
authors.initials: J
authors.lastname: Neale
authors.affiliation: National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience (IOPPN), King's College London, Addictions Sciences Building, 4 Windsor Walk, Denmark Hill, London, SE5 8BB, UK.
authors.forename: Ed
authors.initials: E
authors.lastname: Day
authors.affiliation: National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience (IOPPN), King's College London, Addictions Sciences Building, 4 Windsor Walk, Denmark Hill, London, SE5 8BB, UK.
authors.forename: Colin
authors.initials: C
authors.lastname: Drummond
mesh_terms: D000328:Adult; D000368:Aged; D019973:Alcohol-Related Disorders / Q000523:psychology / Q000628:therapy*; D002908:Chronic Disease; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008131:London; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012111:Residence Characteristics; D012944:Social Support; D055815:Young Adult
keywords: Alcohol; Andersen’s behavioural model; Emergency departments; Frequent attender; Qualitative research