Social and medical vulnerability factors of emergency department frequent users in a universal health insurance system.

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State: Public
Version: author
Serval ID
serval:BIB_6223D2371AA0
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Social and medical vulnerability factors of emergency department frequent users in a universal health insurance system.
Journal
Academic Emergency Medicine
Author(s)
Bieler G., Paroz S., Faouzi M., Trueb L., Vaucher P., Althaus F., Daeppen J.B., Bodenmann P.
ISSN
1553-2712 (Electronic)
ISSN-L
1069-6563
Publication state
Published
Issued date
2012
Peer-reviewed
Oui
Volume
19
Number
1
Pages
63-68
Language
english
Notes
Publication types: Journal Article ; Research Support, Non-U.S. Gov't
Abstract
OBJECTIVES: The objectives were to identify the social and medical factors associated with emergency department (ED) frequent use and to determine if frequent users were more likely to have a combination of these factors in a universal health insurance system.
METHODS: This was a retrospective chart review case-control study comparing randomized samples of frequent users and nonfrequent users at the Lausanne University Hospital, Switzerland. The authors defined frequent users as patients with four or more ED visits within the previous 12 months. Adult patients who visited the ED between April 2008 and March 2009 (study period) were included, and patients leaving the ED without medical discharge were excluded. For each patient, the first ED electronic record within the study period was considered for data extraction. Along with basic demographics, variables of interest included social (employment or housing status) and medical (ED primary diagnosis) characteristics. Significant social and medical factors were used to construct a logistic regression model, to determine factors associated with frequent ED use. In addition, comparison of the combination of social and medical factors was examined.
RESULTS: A total of 359 of 1,591 frequent and 360 of 34,263 nonfrequent users were selected. Frequent users accounted for less than a 20th of all ED patients (4.4%), but for 12.1% of all visits (5,813 of 48,117), with a maximum of 73 ED visits. No difference in terms of age or sex occurred, but more frequent users had a nationality other than Swiss or European (n = 117 [32.6%] vs. n = 83 [23.1%], p = 0.003). Adjusted multivariate analysis showed that social and specific medical vulnerability factors most increased the risk of frequent ED use: being under guardianship (adjusted odds ratio [OR] = 15.8; 95% confidence interval [CI] = 1.7 to 147.3), living closer to the ED (adjusted OR = 4.6; 95% CI = 2.8 to 7.6), being uninsured (adjusted OR = 2.5; 95% CI = 1.1 to 5.8), being unemployed or dependent on government welfare (adjusted OR = 2.1; 95% CI = 1.3 to 3.4), the number of psychiatric hospitalizations (adjusted OR = 4.6; 95% CI = 1.5 to 14.1), and the use of five or more clinical departments over 12 months (adjusted OR = 4.5; 95% CI = 2.5 to 8.1). Having two of four social factors increased the odds of frequent ED use (adjusted = OR 5.4; 95% CI = 2.9 to 9.9), and similar results were found for medical factors (adjusted OR = 7.9; 95% CI = 4.6 to 13.4). A combination of social and medical factors was markedly associated with ED frequent use, as frequent users were 10 times more likely to have three of them (on a total of eight factors; 95% CI = 5.1 to 19.6).
CONCLUSIONS: Frequent users accounted for a moderate proportion of visits at the Lausanne ED. Social and medical vulnerability factors were associated with frequent ED use. In addition, frequent users were more likely to have both social and medical vulnerabilities than were other patients. Case management strategies might address the vulnerability factors of frequent users to prevent inequities in health care and related costs.
Keywords
Adult, Case-Control Studies, Demography, Emergency Service, Hospital/utilization, Female, Health Status, Humans, Male, Mental Health, Middle Aged, Models, Statistical, Retrospective Studies, Risk Factors, Socioeconomic Factors, Switzerland, Universal Coverage, Vulnerable Populations
Pubmed
Web of science
Open Access
Yes
Create date
23/02/2012 8:20
Last modification date
20/08/2019 14:19
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