The analysis of the geographical distribution of emergency departments’ frequent users: a tool to prioritize public health policies?

Abstract

Background The individual factors associated to Frequent Users (FUs) in Emergency Departments are well known. However, the characteristics of their geographical distribution and how territorial specificities are associated and intertwined with ED use are limited. Investigating healthcare use and territorial factors would help targeting local health policies. We aim at describing the geographical distribution of ED’s FUs within the Paris region. Methods We performed a retrospective analysis of all ED visits in the Paris region in 2015. Data were collected from the universal health insurance’s claims database. Frequent Users (FUs) were defined as having visited ≥3 times any ED of the region over the period. We assessed the FUs rate in each geographical unit (GU) and assessed correlations between FUs rate and socio-demographics and economic characteristics of GUs. We also performed a multidimensional analysis and a principal component analysis to identify a typology of territories to describe and target the FUs phenomenon. Results FUs accounted for 278,687 (11.7%) of the 2,382,802 patients who visited the ED, living in 232 GUs. In the region, median FUs rate in each GU was 11.0% [interquartile range: 9.5–12.5]. High FUs rate was correlated to the territorial markers of social deprivation. Three different categories of GU were identified with different profiles of healthcare providers densities. Conclusion FUs rate varies between territories and is correlated to territorial markers of social deprivation. Targeted public policies should focus on disadvantaged territories.

One-year emergency department visits for children < 18 years of age, associated factors and frequency of primary general practitioner or pediatrician visits before: a French observational study (2018–19)

“…Children with LTD in our study maybe be considered as similar to medically complex conditions reported in the USA: 0.67% to 11.4% in the population, depending on the definition, and higher for the most deprived children [ 31 – 33 ]. A study reported at least an annual ED visit around 20% [ 33 ].…”

“…Increase and excessive repetition of ED visits generates additional excess costs as inappropriate ED visits, which could be limited by actions on the factors associated with repeated ED visits justified or not [ 18 , 30 ]. Our study identifies factors that are more or less frequently reported associated with one ED visit or more such as younger age, male sex, low social status in the household or the area where the home is located, the existence of certain chronic pathologies, proximity to an ED [ 4 , 5 , 7 , 10 – 12 , 31 ].…”

Social deprivation and the use of healthcare services over one year by children less than 18 years of age in 2018: A French nationwide observational study

“…A specific result of our study is that most deprived people more often live in a municipality with an ED, as they more often have CMUc (half of children), which may facilitate their use. It has been reported that these areas also include frequent users of EDs [ 44 ].…”

“…Thus, the lack of a visit the month before could have occurred. The impact of primary care access on ED utilization has also been discussed but the discussion focused on other factors [42][43][44][45][46].…”

Les patients dits « non urgents » aux urgences

“…Par exemple, certains outils de tri utilisés dans les services d'urgences, s'ils sont performants pour la population générale, se révèlent sous-estimer la sévérité des maladies des personnes âgées [20]. Deux études françaises récentes suggèrent en outre que les passages qui sont jugés « inappropriés » sont corrélés à la vulnérabilité socio-économique des patients (absence de couverture par l'Assurance maladie et par une mutuelle) [21], et sont ainsi plus fréquemment observés dans des territoires qui sont socialement défavorisés [22]. Si la définition de l'urgence et les recommandations la concernant relèvent du champ biomédical, les questions de catégorisation et de tri mobilisent aussi depuis longtemps la sociologie, à la fois sociologie du travail, sociologie des institutions et sociologie de la santé.…”