Characteristics of highly frequent users of a Swiss academic emergency department

Althaus, Fabrice; Stucki, Stephanie; Guyot, Sophie; Trueb, Lionel; Moschetti, Karine; Daeppen, Jean‐Bernard; Bodenmann, Patrick

doi:10.1097/mej.0b013e32835e078e

Cited by 30 publications

(31 citation statements)

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“…A combination of social and medical factors was markedly associated with frequent ED use, as FUs were 10 times more likely to have three of them (of a total of eight factors; 95% CI = 5.1 to 19.6). This result is confirmed by Althaus et al [56] in a retrospective chart review on hyperfrequent users (12 attendances or more during a year): they were 13 times more likely than non-FUs (65.5 vs 5.0%) to present three or more of the risk factors of vulnerability that Bieler et al referred to [46] and 2.2 times more likely than FUs (62.5 vs 28.4%). Finally, unpublished, local, prospective, cross-sectional data (Bodenmann P. et al, in progress) obtained between November 2009 and June 2010 has demonstrated differences between 226 FUs and 173 infrequent users.…”

Section: Discussionsupporting

confidence: 59%

Case management for frequent users of the emergency department: study protocol of a randomised controlled trial

Bodenmann

Velonaki

Ruggeri

et al. 2014

BMC Health Serv Res

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BackgroundWe devised a randomised controlled trial to evaluate the effectiveness and efficiency of an intervention based on case management care for frequent emergency department users. The aim of the intervention is to reduce such patients’ emergency department use, to improve their quality of life, and to reduce costs consequent on frequent use. The intervention consists of a combination of comprehensive case management care and standard emergency care. It uses a clinical case management model that is patient-identified, patient-directed, and developed to provide high intensity services. It provides a continuum of hospital- and community-based patient services, which include clinical assessment, outreach referral, and coordination and communication with other service providers.Methods/DesignWe aim to recruit, during the first year of the study, 250 patients who visit the emergency department of the University Hospital of Lausanne, Switzerland. Eligible patients will have visited the emergency department 5 or more times during the previous 12 months. Randomisation of the participants to the intervention or control groups will be computer generated and concealed. The statistician and each patient will be blinded to the patient’s allocation. Participants in the intervention group (N = 125), additionally to standard emergency care, will receive case management from a team, 1 (ambulatory care) to 3 (hospitalization) times during their stay and after 1, 3, and 5 months, at their residence, in the hospital or in the ambulatory care setting. In between the consultations provided, the patients will have the opportunity to contact, at any moment, the case management team. Participants in the control group (N = 125) will receive standard emergency care only. Data will be collected at baseline and 2, 5.5, 9, and 12 months later, including: number of emergency department visits, quality of life (EuroQOL and WHOQOL), health services use, and relevant costs. Data on feelings of discrimination and patient’s satisfaction will also be collected at the baseline and 12 months later.DiscussionOur study will help to clarify knowledge gaps regarding the positive outcomes (emergency department visits, quality of life, efficiency, and cost-utility) of an intervention based on case management care.Trial registrationClinicalTrials.gov Identifier: NCT01934322.

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Section: Discussionsupporting

confidence: 59%

Case management for frequent users of the emergency department: study protocol of a randomised controlled trial

Bodenmann

Velonaki

Ruggeri

et al. 2014

BMC Health Serv Res

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“…They also frequently reported social isolation and histories of trauma. Trauma exposure and social isolation have both been associated with greater healthcare utilization and costs [4, 19–23]. Frequent ED users in this sample often connected their health concerns to past traumatic events, a finding that has been noted in other qualitative samples of frequent ED users [24].…”

Section: Discussionmentioning

confidence: 66%

Perceived Case Management Needs and Service Preferences of Frequent Emergency Department Users: Lessons Learned in a Large Urban Centre

et al. 2016

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ObjectivesThis study aimed to explore the service needs and preferences of frequent emergency department users with mental health and addictions concerns who participated in a brief intensive case management intervention.MethodsWe conducted semi-structured individual interviews with 20 frequent emergency department users with mental health and addictions challenges, 13 service providers involved in the delivery of a brief case management intervention, and a focus group with intervention case managers. Thematic analysis was used to explore perceived service user profiles, service needs and preferences of care.ResultsService users experienced complex health and social needs and social isolation, while exhibiting resilience and the desire to contribute. They described multiple instances of stigmatization in interactions with healthcare professionals. Components of the brief intensive case management intervention perceived to be helpful included system navigation, advocacy, intermediation, and practical needs assistance. Frequent service users valued relational responsiveness, a non-judgmental stance, and a recovery orientation in case managers.ConclusionInterventions for frequent service users in mental health may be enhanced by focusing on the engagement of formal and informal social supports, practical needs assistance, system navigation, advocacy and intermediation, and attention to the recovery goals of service users.

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“…However, in order to maximize the generalizability of our findings, we recruited a representative study sample of frequent ED users. 16,45 In addition, the design of the Swiss health system-privatized but with universal coverage-allows for generalization of our findings to North America, Europe and parts of Asia. Second, the enrollment rate of 47.5 % could have biased or contributed to our non-significant results.…”

Section: Discussionmentioning

confidence: 85%

Case Management may Reduce Emergency Department Frequent use in a Universal Health Coverage System: a Randomized Controlled Trial

et al. 2016

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BACKGROUND: Frequent emergency department (ED) users account for a disproportionately high number of ED visits. Studies on case management (CM) interventions to reduce frequent ED use have shown mixed results, and few studies have been conducted within a universal health coverage system. OBJECTIVE: To determine whether a CM intervention--compared to standard emergency care-reduces ED attendance. DESIGN: Randomized controlled trial. PARTICIPANTS: Two hundred fifty frequent ED users (5 or more visits in the prior 12 months) who visited a public urban ED at the Lausanne University Hospital between May 2012 and July 2013 were allocated to either an intervention (n = 125) or control (n = 125) group, and monitored for 12 months. INTERVENTIONS: An individualized CM intervention consisting of concrete assistance in obtaining income entitlements, referral to primary or specialty medical care, access to mental health care or substance abuse treatment, and counseling on at-risk behaviors and health care utilization (in addition to standard care) at baseline and 1, 3, and 5 months. MAIN MEASURES: We used a generalized linear model for count data (negative binomial distribution) to compare the number of ED visits during the 12-month follow-up between CM and usual care, from an intention-to-treat perspective.KEY RESULTS: At 12 months, there were 2.71 (±0.23) ED visits in the intervention group versus 3.35 (±0.32) visits among controls (ratio = 0.81, 95 % CI = 0.63; 1.02). In the multivariate model, the effect of the CM intervention on the number of ED visits approached statistical significance (b = −0.219, p = 0.075). The presence of poor social determinants of health was a significant predictor of ED use in the multivariate model (b = 0.280, p = 0.048). CONCLUSIONS: CM may reduce ED use by frequent users through an improved orientation to the health care system. Poor social determinants of health significantly increase use of the ED by frequent users.

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Characteristics of highly frequent users of a Swiss academic emergency department

Cited by 30 publications

References 0 publications

Case management for frequent users of the emergency department: study protocol of a randomised controlled trial

Case management for frequent users of the emergency department: study protocol of a randomised controlled trial

Perceived Case Management Needs and Service Preferences of Frequent Emergency Department Users: Lessons Learned in a Large Urban Centre

Case Management may Reduce Emergency Department Frequent use in a Universal Health Coverage System: a Randomized Controlled Trial

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