Characterizing the vulnerability of frequent emergency department users by applying a conceptual framework: a controlled, cross-sectional study.

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State: Public
Version: Final published version
Serval ID
serval:BIB_377FBBB4F30B
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Characterizing the vulnerability of frequent emergency department users by applying a conceptual framework: a controlled, cross-sectional study.
Journal
International Journal For Equity In Health
Author(s)
Bodenmann P., Baggio S., Iglesias K., Althaus F., Velonaki V.S., Stucki S., Ansermet C., Paroz S., Trueb L., Hugli O., Griffin J.L., Daeppen J.B.
ISSN
1475-9276 (Electronic)
ISSN-L
1475-9276
Publication state
Published
Issued date
2015
Peer-reviewed
Oui
Volume
14
Number
1
Pages
146
Language
english
Notes
Publication types: 7">Clinical Study ; Journal Article ; Research Support, Non-U.S. Gov't
Publication Status: epublish
Abstract
BACKGROUND: Frequent emergency department (ED) users meet several of the criteria of vulnerability, but this needs to be further examined taking into consideration all vulnerability's different dimensions. This study aimed to characterize frequent ED users and to define risk factors of frequent ED use within a universal health care coverage system, applying a conceptual framework of vulnerability.
METHODS: A controlled, cross-sectional study comparing frequent ED users to a control group of non-frequent users was conducted at the Lausanne University Hospital, Switzerland. Frequent users were defined as patients with five or more visits to the ED in the previous 12 months. The two groups were compared using validated scales for each one of the five dimensions of an innovative conceptual framework: socio-demographic characteristics; somatic, mental, and risk-behavior indicators; and use of health care services. Independent t-tests, Wilcoxon rank-sum tests, Pearson's Chi-squared test and Fisher's exact test were used for the comparison. To examine the -related to vulnerability- risk factors for being a frequent ED user, univariate and multivariate logistic regression models were used.
RESULTS: We compared 226 frequent users and 173 controls. Frequent users had more vulnerabilities in all five dimensions of the conceptual framework. They were younger, and more often immigrants from low/middle-income countries or unemployed, had more somatic and psychiatric comorbidities, were more often tobacco users, and had more primary care physician (PCP) visits. The most significant frequent ED use risk factors were a history of more than three hospital admissions in the previous 12 months (adj OR:23.2, 95%CI = 9.1-59.2), the absence of a PCP (adj OR:8.4, 95%CI = 2.1-32.7), living less than 5 km from an ED (adj OR:4.4, 95%CI = 2.1-9.0), and household income lower than USD 2,800/month (adj OR:4.3, 95%CI = 2.0-9.2).
CONCLUSIONS: Frequent ED users within a universal health coverage system form a highly vulnerable population, when taking into account all five dimensions of a conceptual framework of vulnerability. The predictive factors identified could be useful in the early detection of future frequent users, in order to address their specific needs and decrease vulnerability, a key priority for health care policy makers. Application of the conceptual framework in future research is warranted.
Keywords
Adult, Aged, Cross-Sectional Studies, Emergency Service, Hospital/utilization, Female, Health Services/utilization, Humans, Logistic Models, Male, Middle Aged, Retrospective Studies, Risk Factors, Socioeconomic Factors, Surveys and Questionnaires, Switzerland, Universal Coverage/utilization, Vulnerable Populations/statistics & numerical data
Pubmed
Web of science
Open Access
Yes
Create date
04/01/2016 13:58
Last modification date
20/08/2019 13:25
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