Effectiveness of interventions targeting frequent users of emergency departments: a systematic review.

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State: Public
Version: author
Serval ID
serval:BIB_4FA4E36CCBB3
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Effectiveness of interventions targeting frequent users of emergency departments: a systematic review.
Journal
Annals of Emergency Medicine
Author(s)
Althaus Fabrice, Paroz Sophie, Hugli Olivier, Ghali William A., Daeppen Jean-Bernard, Peytremann-Bridevaux Isabelle, Bodenmann Patrick
ISSN
1097-6760 (Electronic)
ISSN-L
0196-0644
Publication state
Published
Issued date
2011
Peer-reviewed
Oui
Volume
58
Number
1
Pages
41-52.e42
Language
english
Notes
http://www.sciencedirect.com/science/article/pii/S0196064411002125
Abstract
STUDY OBJECTIVE: Frequent users of emergency departments (EDs) are a relatively small group of vulnerable patients accounting for a disproportionally high number of ED visits. Our objective is to perform a systematic review of the type and effectiveness of interventions to reduce the number of ED visits by frequent users. METHODS: We searched MEDLINE, EMBASE, CINAHL, PsychINFO, the Cochrane Library, and ISI Web of Science for randomized controlled trials, nonrandomized controlled trials, interrupted time series, and controlled and noncontrolled before-and-after studies describing interventions targeting adult frequent users of EDs. Primary outcome of interest was the reduction in ED use. We also explored costs analyses and various clinical (alcohol and drug use, psychiatric symptoms, mortality) and social (homelessness, insurance status, social security support) outcomes. RESULTS: We included 11 studies (3 randomized controlled trials, 2 controlled and 6 noncontrolled before-and-after studies). Heterogeneity in both study designs and definitions of frequent users precluded meta-analyses of the results. The most studied intervention was case management (n=7). Only 1 of 3 randomized controlled trials showed a significant reduction in ED use compared with usual care. Six of the 8 before-and-after studies reported a significant reduction in ED use, and 1 study showed a significant increase. ED cost reductions were demonstrated in 3 studies. Social outcomes such as reduction of homelessness were favorable in 3 of 3 studies, and clinical outcomes trended toward positive results in 2 of 3 studies. CONCLUSION: Interventions targeting frequent users may reduce ED use. Case management, the most frequently described intervention, reduced ED costs and seemed to improve social and clinical outcomes. It appears to be beneficial to patients and justifiable for hospitals to implement case management for frequent users in the framework of a clear and consensual definition of frequent users and standardized outcome measures.
Keywords
Adult , Case Management , Emergency Service, Hospital/utilization* , Health Services Misuse* , Homeless Persons , Hospital Costs , Humans , Medically Uninsured , Socioeconomic Factors
Pubmed
Web of science
Open Access
Yes
Create date
22/06/2011 15:51
Last modification date
20/08/2019 14:05
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