Reducing frequent visits to Emergency Departments
DOI:
https://doi.org/10.11157/anzswj-vol28iss4id202Keywords:
Frequent attenders, emergency department attendance, brief interventionAbstract
BACKGROUND: The Health and Wellbeing Connection (HWC) pilot study was undertaken by Richmond Services in partnership with Pegasus Health, Partnership Health and the Canterbury District Health Board.
OBJECTIVE: To explore whether a brief intervention offered to frequent attenders to hospital emergency department (ED) was successful in reducing inappropriate attendance.
METHODS: Administration of the Kessler Depression and Anxiety (K10) scale; the World Health Organization Quality of Life Measure (WHOQOL-BREF); extracted de-identified rates of attendance at an ED of a general hospital and general practice, and follow up telephone interviews with study participants were used.
RESULTS: By the end of the project, a total of 53 participants had completed the programme. On average, these participants reduced their attendance at the ED significantly while demonstrating no change in their attendance rates at general practice. Additionally, they reported a decrease in psychological distress and a positive increase in their quality of life.
CONCLUSION: Although the number of participants in this study does not allow for robust analysis of efficacy of the program offered, it does indicate that there is merit in continuing to develop brief intervention case management models to support behaviour change programmes in hospital EDs.
References
Adams, J. G. (2013). Emergency department overuse perceptions and solutions: Perceptions of ED overuse. Journal of the American Medical Association, 309(11), 2.
Aigner, M., Förster-Streffleur, S., Prause, W., Freidl, M., Weiss, M., & Bach, M. (2006). What does the WHOQOL-BREF measure? Measurement overlap between quality of life and depressive symptomatology in chronic somatoform pain disorder. Social Psychiatry and Psychiatric Epidemiology, 41(1), 81–86. doi: 10.1007/s00127-005-0997-8
Althaus, F., Paroz, S., Hugli, O., Ghali, W. A., Daeppen, J.-B., Peytremann-Bridevaux, I., & Bodenmann, P. (2011). Effectiveness of interventions targeting frequent users of emergency departments: A systematic review. Annals of Emergency Medicine, 58(1), 41–52.e42. doi: 10.1016/j.annemergmed.2011.03.007
Althaus, F., Stucki, S., Guyot, S., Trueb, L., Moschetti, K., Daeppen, J., & Bodenmann, P. (2013). Characteristics of highly frequent users of a Swiss academic emergency department: A retrospective consecutive case series. European Journal of Emergency Medicine, 20(6), 413–419. doi: 10.1097/MEJ.0b013e32835e078e
Andrews, S. (2014). Evaluation of the Health & Wellbeing Connection pilot; May 2012–October 2013. Christchurch, New Zealand: Richmond Services.
Backman, A., Blomqvist, P., Lagerlund, M., Carlsson-Holm, E., & Adami, J. (2008). Characteristics of non-urgent patients: Cross-sectional study of emergency department and primary care patients. Scandinavian Journal of Primary Health Care, 26(3), 181–187. doi: 10.1080/02813430802095838
Bieler, G., Paroz, S., Faouzi, M., Trueb, L., Vaucher, P., Althaus, F., . . . Bodenmann, P. (2012). Social and medical vulnerability factors of emergency department frequent users in a universal health insurance system. Academic Emergency Medicine, 19(1), 63–68. doi: 10.1111/j.1553-2712.2011.01246.x
Byrne, M., Murphy, A. W., Plunkett, P. K., McGee, H. M., Murray, A., & Bury, G. (2003). Frequent attenders to an emergency department: A study of primary health care use, medical profile, and psychosocial characteristics. Annals of Emergency Medicine, 41(3), 309–318. doi: 10.1067/mem.2003.68
The Code of Health and Disability Services Consumers’ Rights. (1994). Part 2 of the Health and Disability Commissioner Act, No. 88 (1994).
Dent, A. W., Phillips, G. A., Chenhall, A. J., & McGregor, L. R. (2003). The heaviest repeat users of an inner city emergency department are not general practice patients. Emergency Medicine, 15(4), 322–329. doi: 10.1046/j.1442-2026.2003.00470.x
Fuda, K. K., & Immekus, R. (2006). Frequent users of Massachusetts emergency departments: A statewide analysis. Annals of Emergency Medicine, 48(1), 9–16.
George, Jane., Cole, Martin., and Andrews, Sarah. (2013). The Health & Wellbeing Connection : An Integrated Assessment, Co-ordination & Navigation Pilot Service within a Primary Health Setting. Christchurch, New Zealand: Richmond New Zealand Ltd
Gili, M., Luciano, J. V., Serrano, M. J., Jimenez, R., Bauza, N., & Roca, M. (2011). Mental disorders among frequent attenders in primary care: A comparison with routine attenders. Journal of Nervous and Mental Disease, 199(10), 744–749. doi: 10.1097/NMD.0b013e31822fcd4d
Health Information Privacy Code. (1994). Part 6 of the Privacy Act, No. 28 (1993).
Helliwell, P., Hider, P., & Ardagh, M. (2001). Frequent attenders at Christchurch Hospital's Emergency Department. New Zealand Medical Journal, 114(1129), 160–161.
Hunt, K., Weber, E., Showstack, J., Colby, D. C., & Callaham, M. (2006). Characteristics of frequent users of emergency departments. Annals of Emergency Medicine, 48(1), 1–8. doi: 10.1016/j.annemergmed.2005.12.030
Jones, P. G., & Thornton, V. (2013). Does cost drive primary care patients to New Zealand’s emergency departments? A systematic review. New Zealand Medical Journal, 126(1387), 15.
Kennedy, D., & Ardagh, M. (2004). Frequent attenders at Christchurch Hospital’s Emergency Department: A 4-year study of attendance patterns. New Zealand Medical Journal, 117(1193).
Kirby, S. E., Dennis, S. M., Jayasinghe, U. W., & Harris, M. F. (2011). Frequent emergency attenders: Is there a better way? Australian Health Review, 35(4), 462–467. doi: 10.1071/AH10964
LaCalle, E., & Rabin, E. (2010). Frequent users of emergency departments: The myths, the data, and the policy implications. Annals of Emergency Medicine, 56(1), 42–48. doi: 10.1016/j.annemergmed.2010.01.032
Locker, T., Baston, S., Mason, S. M., & Nicholl, J. (2007). Defining frequent use of an urban emergency department. Emergency Medicine Journal, 24(6), 398–401. doi: 10.1136/emj.2006.043844
Mandelberg, J. H., Kuhn, R. E., & Kohn, M. A. (2000). Epidemiologic analysis of an urban, public emergency department's frequent users. Academic Emergency Medicine, 7(6), 637–646. doi: 10.1111/j.1553-2712.2000.tb02037.x
Markham, D., & Graudins, A. (2011). Characteristics of frequent emergency department presenters to an Australian emergency medicine network. BMC Emergency Medicine, 11, 21. doi: 10.1186/1471-227X-11-21
McHale, P. W., Wood, S., Hughes, K., Bellis, M. A., Demnitz, U., & Wyke, S. (2013). Who uses emergency departments inappropriately and when. BMC Medicine, 11 (2013), 258.
Michelen, W. M., Martinez, J., Lee, A., & Wheeler, D. P. (2006). Reducing frequent flyer emergency department visits. Journal of Health Care for the Poor and Undeserved, 17, 59–69.
Morriss, R., Kai, J., Atha, C., Avery, A., Bayes, S., Franklin, M., . . . Yang, Min. (2012). Persistent frequent attenders in primary care: Costs, reasons for attendance, organisation of care and potential for cognitive behavioural therapeutic intervention. BMC Family Practice, 13(39). doi: 10.1186/1471-2296-13-39
Nelson, K., Connor, M., Wensley, C., Moss, C., Pack, M., & Hussey, T. (2011). People who present on multiple occasions to emergency departments [Review article]. Emergency Medicine Australasia, 23, 532–540).
Phillips, G., Brophy, D., Weiland, T., Chenhall, A., & Dent, A. (2006). The effect of multidisciplinary case management on selected outcomes for frequent attenders at an emergency department. Medical Journal of Australia, 184(12), 602–606.Privacy Act, No. 28 (1993). Retrieved March 29, 2015, from http://www.legislation.govt.nz/act/public/1993/0028/latest/DLM296639.html
Rea, H., Kenealy, T., Horwood, F., Sheridan, N., Parsons, M., Wemekamp, B., . . . Degelong, P. (2010). Integrated systems to improve care for very high intensity users of hospital emergency department and for long-term conditions in the community. New Zealand Medical Journal, 123(1320).
Richardson, S. K. (2011). Defining appropriateness of emergency department attendance: A NZ perspective (Unpublished doctoral thesis). University of Otago, Dunedin, New Zealand.
Shippee, N., Shippee, T. P., Hess, E. P., & Beebe, T. J. (2014). An observational study of emergency department utilization among enrollees of Minnesota Health Care Programs: Financial and non-financial barriers have different associations. BMC Health Services Research, 14. doi: 10.1186/1472-6963-14-62
Shumway, M., Boccellari, A., Brien, K., & Okin, R. (2008). Cost-effectiveness of clinical case management for ED frequent users: Results of a randomized trial. American Journal of Emergency Medicine, 26(2), 155–164. doi: 10.1016/j.ajem.2007.04.021
Skinner, J., Carter, L., & Haxton, C. (2009). Case management of patients who frequently present to a Scottish emergency department. Emergency Medicine Journal, 26(2), 103–105. doi: 10.1136/emj.2008.063081
Thornton, V., Fogarty, A., Jones, P., Ragaban, N., & Simpson, C. (2014). Why do patients self-present to Middlemore Hospital Emergency Department? New Zealand Medical Journal, 127(1394), 19–30.
Weber, E. J., Showstack, J. A., Hunt, K. A., Colby, D. C., & Callaham, M. L. (2005). Does lack of a usual source of care or health insurance increase the likelihood of an emergency department visit? Results of a national population-based study. Annals of Emergency Medicine, 45(1), 4–12. doi: 10.1016/j.annemergmed.2004.06.023
Wooden, M. D., Air, T. M., Schrader, G. D., Wieland, B., & Goldney, R. D. (2009). Frequent attenders with mental disorders at a general hospital emergency department. Emergency Medicine Australasia, 21(3), 191–195. doi: 10.1111/j.1742-6723.2009.01181.x
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