Hiperfrequency in mental health hospital emergencies: case-control study
e202105062
Keywords:
Frequent uses, High utilizers, Emergency psychiatry, Mental Health, Crisis intervention, Mental health emergency department, Superutilizers, Case control-studyAbstract
Background: To ensure the efficiency of the operation of the Emergency Department, specific mental health studies are needed. The purpose of the study was to identify and quantify the sociodemographic, clinical and organizational factors associated with the hyperfrequency of hospital Mental Health emergency departments in the three central areas of Asturias.
Methods: A retrospective case-control study was carried out. A total of 110 hyperfrequenters were recorded in 2017, based on a definition of five or more visits to the emergency department. The control group was composed of 170 subjects who attended on one occasion. In addition to descriptive analysis, Chi-square and ANOVA tests were used to identify differences between the two groups. A multivariate study was also carried out using binomial logistic regression.
Results: Hyperfrequent users were more likely to be young adult (30-44 years old), single, living with their family of origin, and with no jobs. The most prevalent diagnoses for these users were “Personality and Behavior Disorder” (F60-69) and “Schizophrenia, Schizotypal Disorders and Delusional Disorders” (F20-29). The most frequent reason for consultation was “anxiety/depression/somatization symptoms”. The destination of the most frequent emergency was “Continue follow-up at scheduled appointments” and most consultations were made in the morning and on weekdays.
Conclusions: Hyperfrequent users continue to demand attention despite being assigned one or more devices. Knowing their needs would help to improve healthcare and use resources more efficiently and effectively.
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References
Toledo Muñoz LM. Las urgencias psiquiátricas hospitalarias: Análisis del contexto clínico, sociodemográfico y económico. Murcia: Departamento de Ciencias Sociosanitarias; 2015.
Planification et organisation des services medicaux d’urgence. Rapport sur la réunion d’un groupe technique de l’OMS. Toulouse: Organisation mondiale de la sante, Bureau regional de l’Europe; 1981.
Oterino de la Fuente D, Baños Pino JF, Fernández Blanco V, Rodríguez Álvarez A y Peiró S. Urgencias hospitalarias y de atención primaria en Asturias: variaciones entre áreas sanitarias y evolución desde 1994 hasta 2001. Gac Sanit. 2007. 21(4): 316-20. Disponible en: http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S0213-91112007000400009
Guzmán-Parra J, Martínez-García A, Guillén-Benítez C, Castro-Zamudio S, Jiménez-Hernández M, Moreno-Küstner B. Factores asociados a las demandas psiquiátricas a los servicios de urgencias prehospitalarios de Málaga (España). Salud mental. 2016;39(6):287-294. doi: 10.17711/SM.0185-3325.2016.033
Nieto R, Iribarne C, Droguett M, Brucher R, Fuentes C, Oliva P. Urgencias psiquiátricas en el hospital general. Rdo. Medicina. Clin. C. 2017;28(6): 914-922. doi: 10.1016/j.rmclc.2017.09.004
Arfken C, Lackman Zeman L, Yeager L, Mischel E, Amirsadri A. Frequent Visitors to Psychiatric Emergency Services. J Behav Health Serv Res. 2002;29(4):490-496. doi: 10.1176/appi.ps.55.3.295
Chaput Y, Lebel M. An examination of the temporal and geographical patterns of psychiatric emergency service use by multiple visit patients as a means for their early detection. Psychiatr. Serv. 2007;7(1): 335-341. doi: 10.1186/1471-244X-7-60
Delcher C, Yang C, Ranka S, Tyndall J, Vogel B, Shenkman E. Variation in outpatient emergency department utilization in Texas Medicaid: a state-level framework for finding “superutilizers”. Int J Emerg Med. 2017;10(1):31. doi: 10.1186/s12245-017-0157-4
Ellison J, Blum N, Barsky A. Repeat Visitors in the Psychiatric Emergency Service: A Critical Review of the Data. Hosp Community Psychiatry. 1986;37(1):37-41. doi: 10.1176/ps.37.1.37
Fleury M, Grenier G, Bamvita J, Caron J. Mental Health Service Utilization Among Patients with Severe Mental Disorders. Community Ment Health J. 2010;47(4):365-377. doi: 10.1007/s10597-010-9320-6
Pasic J, Russo J, Roy-Byrne P. High Utilizers of Psychiatric Emergency Services. Psychiatr Serv. 2005;56(6):678-684. doi: 10.1176/appi.ps.56.6.678
Schmidt M. Frequent visitors at the psychiatric emergency room – A literature review. Psychiatr Q. 2017;89(1):11-32. doi: 10.1007/s11126-017-9509-8
Schmidt M, Ekstrand J, Bengtsson Tops A. Clinical profiles and temporal patterns of psychiatric emergency room visitors in Sweden. Nord J Psychiatry.2017;72(3):197-204. doi: 10.1080/08039488.2017.1417477
Schmoll S, Boyer L, Henry J, Belzeaux R. Patients récurrents aux urgences psychiatriques : analyse démographique et clinique. Encéphale. 2015;41(2):123-129. doi: 10.1016/j.encep.2013.01.002
Wooden M, Air T, Schrader G, Wieland B, Goldney R. Frequent attenders with mental disorders at a general hospital emergency department. Emerg Med Australas. 2009;21(3):191-195. doi: 10.1111/j.1742-6723.2009.01181.x
Boyer L, Dassa D, Belzeaux R, Henry J, Samuelian J, Baumstarck-Barrau K et al. Frequent Visits to a French Psychiatric Emergency Service: Diagnostic Variability in Psychotic Disorders. Psychiatr Serv. 2011;62(8). doi: 10.1176/ps.62.8.pss6208_0966
Okorie E, McDonald C, Dineen B. Patients repeatedly attending accident and emergency departments seeking psychiatric care. The Psychiatrist. 2011;35(02):60-62. doi: 10.1192/PB.BP.108.024455
Bodenmann P, Baggio S, Iglesias K, Althaus F, Velonaki V, Stucki S et al. Characterizing the vulnerability of frequent emergency department users by applying a conceptual framework: a controlled, cross-sectional study. Int J Equity Health. 2015;14(1): 146. doi: 10.1186/s12939-015-0277-5
Poremski D, Harris D, Kahan D, Pauly D, Leszcz M, O’Campo P et al. Improving continuity of care for frequent users of emergency departments: service user and provider perspectives. Gen Hosp Psychiatry. 2016;11(12): 55-59. doi: 10.1016/j.genhosppsych.2016.01.004.
Cano M. Pacientes hiperfrecuentadores en atención primaria y contactos en salud mental. Estudio retrospectivo a cinco años en el departamento de la ribera. [Tesis Doctoral]. [Valencia]: Universidad Cardenal Herrera CEU; 2015.
Aagaard J, Aagaard A, Buus N. Predictors of frequent visits to a psychiatric emergency room: A large-scale register study combined with a small-scale interview study. Int J Nurs Stud. 2014;51(7):1003-1013. doi: 10.1016/j.ijnurstu.2013.11.002
Iglesias K, Baggio S, Moschetti K, Wasserfallen J, Hugli O, Daeppen J et al. Using case management in a universal health coverage system to improve quality of life of frequent Emergency Department users: a randomized controlled trial. Qual Life Res. 2017;27(2):503-513. doi: 10.1007/s11136-017-1739-6
Wise-Harris D, Pauly D, Kahan D, Tan de Bibiana J, Hwang S, Stergiopoulos V. “Hospital was the Only Option”: Experiences of Frequent Emergency Department Users in Mental Health. Adm Policy Ment Health. 2016;44(3):405-412. doi: 10.1007/s10488-016-0728-3
Krieg C, Hudon C, Chouinard M, Dufour I. Individual predictors of frequent emergency department use: a scoping review. BMC Health Serv Res. 2016;16 (1): 525. doi: 10.1186/s12913-016-1852-1
Moe J, Kirkland S, Ospina M, Campbell S, Long R, Davidson A et al. Mortality, admission rates and outpatient use among frequent users of emergency departments: a systematic review. Emerg Med J. 2015;33(3):230-236. doi: 10.1136/emermed-2014-204496
Springer A, Condon J, Li S, Guthridge S. Frequent use of hospital inpatient services during a nine year period: a retrospective cohort study. BMC Health Serv Res. 2017;17(1):348. doi: 10.1186/s12913-017-2285-1
Ledoux Y, Minner P. Occasional and frequent repeaters in a psychiatric emergency room. Soc Psychiatry Epidemiol. 2006;41(2):115-121. doi: 10.1007/s00127-005-0010-6
Saarento O, Kastrup M, Hansson L. The Nordic comparative study on sectorized psychiatry: characteristics of repeat users of emergency outpatient services in two Nordic psychiatric services. A 1-year follow-up study. Eur Psychiatry. 1998;13(1):35-40. doi: 10.1016/S0924-9338(97)86749-1
Sullivan P, Bulik C, Forman S, Mezzich J. Characteristics of Repeat Users of a Psychiatric Emergency Service. Hosp Community Psychiatric.1993;44(4):376-380. doi: 10.1176/ps.44.4.376
Lindamer L, Liu L, Sommerfeld D, Folsom D, Hawthorne W, Garcia P et al. Predisposing, Enabling, and Need Factors Associated with High Service Use in a Public Mental Health System. Adm Policy Ment Health. 2011;39(3):200-209. doi: 10.1007/s10488-011-0350-3
Sirotich F, Durbin A, Durbin J. Examining the need profiles of patients with multiple emergency department visits for mental health reasons: a cross-sectional study. Soc Psychiatry Psychiatr Epidemiol. 2016;51(5):777-786. doi: 10.1007/s00127-016-1188-5
Boyer L, Dassa D, Belzeaux R, Henry J, Samuelian J, Baumstarck-Barrau K et al. Frequent Visits to a French Psychiatric Emergency Service: Diagnostic Variability in Psychotic Disorders. Psychiatr Serv. 2011;62(8):966-970. doi: 10.1176/ps.62.8.pss6208_0966
Hernández JL, Santamarina S, Domper J. Urgencias Psiquiátricas en un Hospital General. Rev. Asoc. Esp. Neuropsiq. 1998; 18 (67): 435-456.
Fernández C, Romero R, Rivas A, Jiménez R., Majo Y, Aguilar JM et al. Proyecto FIDUR: pacientes hiperfrecuentadores fidelizados en servicios de urgencias hospitalarios. Emergencias. 2016; 28:16-20. doi: 10.1176/appi.ps.55.3.295
Hudon C, Chouinard M, Lambert M, Dufour I, Krieg C. Effectiveness of case management interventions for frequent users of healthcare services: a scoping review. BMJ Open. 2016;6(9):e012353. doi: 10.1136/bmjopen-2016-012353
Johnstone L, Boyle M et al. El marco del poder, amenaza y significado [Internet]. 1st ed. Leicester: British Psychological Society; 2018 [consultado 3 de enero de 2019]. Disponible en: http://aen.es/wp-content/uploads/2018/08/El-Marco-de-Poder-Amenaza-y-Significado-1.pdf
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