RT Journal Article
SR Electronic
T1 People who make frequent emergency department visits based on persistence of frequent use in Ontario and Alberta: a retrospective cohort study
JF CMAJ Open
JO CMAJ
FD Canadian Medical Association
SP E220
OP E231
DO 10.9778/cmajo.20210131
VO 10
IS 1
A1 Jessica Moe
A1 Elle (Yuequiao) Wang
A1 Margaret J. McGregor
A1 Michael J. Schull
A1 Kathryn Dong
A1 Brian R. Holroyd
A1 Corinne M. Hohl
A1 Eric Grafstein
A1 Fiona O’Sullivan
A1 Johanna Trimble
A1 Kimberlyn M. McGrail
YR 2022
UL http://www.cmajopen.ca/content/10/1/E220.abstract
AB Background: The factors that underlie persistent frequent visits to the emergency department are poorly understood. This study aimed to characterize people who visit emergency departments frequently in Ontario and Alberta, by number of years of frequent use.Methods: This was a retrospective cohort study aimed at capturing information about patients visiting emergency departments in Ontario and Alberta, Canada, from Apr. 1, 2011, to Mar. 31, 2016. We identified people 18 years or older with frequent emergency department use (top 10% of emergency department use) in fiscal year 2015/16, using the Dynamic Cohort from the Canadian Institute of Health Information. We then organized them into subgroups based on the number of years (1 to 5) in which they met the threshold for frequent use over the study period. We characterized subgroups using linked emergency department, hospitalization and mental health–related hospitalization data.Results: We identified 252 737 people in Ontario and 63 238 people in Alberta who made frequent visits to the emergency department. In Ontario and Alberta, 44.3% and 44.7%, respectively, met the threshold for frequent use in only 1 year and made 37.9% and 38.5% of visits; 6.8% and 8.2% met the threshold for frequent use over 5 years and made 11.9% and 13.2% of visits. Many characteristics followed gradients based on persistence of frequent use: as years of frequent visits increased (1 to 5 years), people had more comorbidities, homelessness, rural residence, annual emergency department visits, alcohol- and substance use–related presentations, mental health hospitalizations and instances of leaving hospital against medical advice.Interpretation: Higher levels of comorbidities, mental health issues, substance use and rural residence were seen with increasing years of frequent emergency department use. Interventions upstream and in the emergency department must address unmet needs, including services for substance use and social supports.See related research article by Moe and colleagues at www.cmajopen.ca/lookup/doi/10.9778/cmajo.20210132