Emergency department use and barriers to wellness: a survey of emergency department frequent users.

Emergency department use and barriers to wellness: a survey of emergency department frequent users.

Birmingham Lauren E; Cochran Thaddeus; Frey Jennifer A; Stiffler Kirk A; Wilber Scott T

BMC emergency medicine

2017

2017-05

BACKGROUND: There is no common understanding of how needs of emergency department (ED) frequent users differ from other patients. This study sought to examine how to best serve this population. Examinations of why ED frequent users present to the ED, what barriers to care exist, and what service offerings may help these patients achieve an optimal level of health were conducted. METHODS: We performed a prospective study of frequent ED users in an adult only, level 1 trauma center with approximately 90,000 visits per year. Frequent ED users were defined as those who make four or more ED visits in a 12 month period. Participants were administered a piloted structured interview by a trained researcher querying demographics, ED usage, perceived barriers to care, and potential aids to maintaining health. RESULTS: Of 1,523 screened patients, 297 were identified as frequent ED users. One hundred frequent ED users were enrolled. The mean age was 48 years (95% CI 45-51). The majority of subjects were female (64%, 64/100, 95% CI 55-73%), white (61%, 60/98, 95% CI 52-71%) and insured by Medicaid (55%, 47/86, 95% CI 44-65%) or Medicare (23%, 20/86, 95% CI 14-32%). Subjects had a median of 6 ED visits, and 2 inpatient admissions in the past 12 months at this hospital. Most frequent ED users (61%, 59/96, 95% CI 52-71%) stated the primary reason for their visit was that they felt that their health problem could only be treated in an ED. Transportation presented as a major barrier to few patients (7%, 7/95, 95% CI 3-14%). Subjects stated that "after-hours options, besides the ED for minor health issues" (63%, 60/95, 95% CI 53-73%) and having "a nurse to work with you one-on-one to help manage health care needs" (53%, 50/95, 95% CI

*Emergency department; *Frequent user; *Health Services Accessibility/statistics & numerical data; *Survey; Emergency Service; Emergency Service – Utilization; Female; Health Services Accessibility – Statistics and Numerical Data; Health Services Needs and Demand – Statistics and Numerical Data; Health Services Needs and Demand/statistics & numerical data; Hospital/*statistics & numerical data; Human; Humans; Interviews; Interviews as Topic; Male; Middle Age; Middle Aged; Prospective Studies; Surveys and Questionnaires; Trauma Centers – Utilization; Trauma Centers/statistics & numerical data

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