Emergency department utilization among frequent users with psychiatric visits.

Objectives The objective was to assess the incidence of psychiatric visits among frequent emergency department (ED) users and utilization among frequent psychiatric users. Methods This was a multicenter retrospective longitudinal study of 1.76 million adult ED visits from acute care hospitals serving the metropolitan San Diego region (2008 through 2010) using nonpublic data submitted to the Office of Statewide Health Planning and Development. Frequent users were defined as having at least four ED visits within 12 consecutive months and were further classified into three groups based on the number of primary psychiatric visits in the same period, as defined by the primary discharge diagnosis (zero, one to three, and four or more visits). Descriptive, univariate, and logistic regression analyses are reported. Results Patients with at least one primary psychiatric visit were 4.6 (95% confidence interval [CI] = 4.5 to 4.7) times more likely to be frequent ED users compared to patients with none. However, the majority of frequent ED users (80.1%) did not have any primary psychiatric visits; 16.6% of frequent ED users were classified as occasional psychiatric users, and only 3.3% were classified as frequent psychiatric users. Compared to frequent users without primary psychiatric visits, frequent psychiatric users were more likely to be male, non-Hispanic white, and without private insurance and visited the ED more frequently. Frequent psychiatric users also suffered from psychiatric, medical, and substance abuse comorbidity. Conclusions While patients with primary psychiatric visits were more likely to be frequent users of the ED, only a small percentage of frequent ED users were seen primarily and repeatedly for psychiatric care. However, this small group of frequent psychiatric users visited the ED at a much higher rate than other frequent users and was burdened with both chronic medical and psychiatric conditions. Resumen Objetivos Evaluar la incidencia de visitas psiquiatricas entre los hiperfrecuentadores del Servicio de Urgencias (SU) y la utilizacion entre los hiperfrecuentadores psiquiatricos. Metodologia Estudio longitudinal retrospectivo de 1,76 millones de visitas de adultos al SU de hospitales con atencion aguda que cubren la region metropolitana de San Diego (de 2008 a 2010) utilizando datos no publicos enviados a la Office of Statewide Health Planning and Development. Los hiperfrecuentadores se definieron como pacientes que tienen al menos cuatro visitas al SU en 12 meses consecutivos y se clasificaron posteriormente en tres grupos basandose en el numero de visitas principalmente psiquiatricas en el mismo periodo, definido por el diagnostico principal al alta (0, de 1 a 3, y 4 o mas visitas). Se realizaron analisis descriptivos, univariable y de regresion logistica. Resultados Los pacientes con al menos una visita principalmente psiquiatrica tuvieron una probabilidad 4,6 (IC 95% = 4,5 a 4.7) superior de ser un hiperfrecuentador del SU en comparacion con los pacientes con ninguna. Sin embargo, la mayoria de los hiperfrecuentadores del SU (80,1%) no tuvieron ninguna visita principalmente psiquiatrica. Un 16,6% de los hiperfrecuentadores del SU se clasificaron como frecuentadores ocasionales psiquiatricos y solo un 3,3% se clasificaron como hiperfrecuentadores psiquiatricos. En comparacion con los hiperfrecuentadores sin visitas principalmente psiquiatricas, los hiperfrecuentadores psiquiatricos son mas frecuentemente varones, blancos no hispanos, sin seguro privado y visitan el SU mas frecuentemente. Los hiperfrecuentadores psiquiatricos tambien sufrieron de comorbilidad psiquiatrica y medica y de abuso de sustancias. Conclusiones Mientras los pacientes con visitas principalmente psiquiatricas tienen mayor probabilidad de ser hiperfrecuentadores del SU, solo un pequeno porcentaje de hiperfrecuentadores del SU se vieron principal y repetidamente por la atencion psiquiatrica. Sin embargo, este pequeno grupo de hiperfrecuentadores psiquiatricos visitaron el SU en mucho mayor porcentaje que otros hiperfrecuentadores, tanto por patologia medica cronica como psiquiatrica.