Repeated use of psychiatric emergency out‐patient services among new patients: a 3‐year follow‐up study

Abstract

The aim of this study was to examine repeated use of psychiatric emergency out-patient services during the second and third years after the first contact. A 1-year treated incidence cohort of 537 new patients was studied in the Department of Psychiatry in Oulu, Finland. Repeat users were defined as patients belonging to the upper 10th percentile of the emergency out-patient contacts. The median of emergency out-patient contacts among repeaters was 4. The repeaters constituted 8% of the cohort and they used 65% of the cohort's emergency contacts. They were more likely to be male and living alone, and they tended to have more serious diagnoses than non-repeaters. Having hospital admissions, planned out-patient contacts and repeated emergency out-patient contacts also during the first year of follow-up was associated with an increased probability of repeatedly using emergency services during the second and third years. Living alone and having hospital admissions during the follow-up period were associated with being a continuous repeat visitor during the whole follow-up period. It is concluded that the extended repeated use of emergency services is associated with inadequate social support and serious psychiatric problems.

Clinical characteristics of people with mental health problems who frequently attend an Australian emergency department

“…In this study, the following variables were found to predict frequent attendance: male; previous multiple hospital admissions; planned outpatient contacts; and repeated outpatient contacts. 15 The Australian scenario is scarcely described. An analysis of 500 frequent attenders over a 6-year period at an Australian inner-city ED found that 26.5% had primary psychiatric or altered conscious states due to drugs and alcohol.…”

Examining the need profiles of patients with multiple emergency department visits for mental health reasons: a cross-sectional study

“…This literature has identified predictors of repeated ED visits for mental health reasons including several socio-demographic, diagnostic and service use characteristics including: male gender [16,17], younger age [3,12,17,18], black or Hispanic race [12], unemployment [19,20], low income [3,17,18,21], homelessness [21,22], living alone [23], lacking social support [22], schizophrenia [3,12,18,20], psychosis [17,20], personality disorder [19,22,25], substance abuse [12,17,20,25], developmental delay [22], prior hospitalizations [21,22,24], history of detoxification [22], recent and increased use of outpatient treatment [21], current psychiatric treatment [25], and a history of incarceration [21].…”

Predictors of Recurrent Use of Psychiatric Emergency Services

“…Some have defined frequent visits as more than two above the mean standard deviation (1,2), and some have used the upper tenth percentile of the sample (4). Others have defined frequent visits as one visit (3) or six visits (2,7) per year, four visits in a quarter (2), or at least six visits in six years (11).…”

“…Previous studies have indicated that 2% to 18% of adult patients who repeatedly visited psychiatric emergency services generated 21% to 65% (1)(2)(3)(4)(5) of the total clinical activity in these settings. Recurrent use of emergency services is a significant cost burden (6,7).…”