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Characterizing the vulnerability of frequent emergency department users by applying a conceptual framework: a controlled, cross-sectional study

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Title: Characterizing the vulnerability of frequent emergency department users by applying a conceptual framework: a controlled, cross-sectional study
Authors: Bodenmann, P., Baggio, S., Iglesias, K., Althaus, F., Velonaki, V.S., Stucki, S., Ansermet, C., Paroz, S., Trueb, L., Hugli, O., Griffin, J.L., Daeppen, J.B.
Source: International Journal For Equity In Health, vol. 14, no. 1, pp. 146
Publication Year: 2015
Collection: Université de Lausanne (UNIL): Serval - Serveur académique lausannois
Subject Terms: Adult, Aged, Cross-Sectional Studies, Emergency Service, Hospital/utilization, Female, Health Services/utilization, Humans, Logistic Models, Male, Middle Aged, Retrospective Studies, Risk Factors, Socioeconomic Factors, Surveys and Questionnaires, Switzerland, Universal Coverage/utilization, Vulnerable Populations/statistics & numerical data
Description: BACKGROUND: Frequent emergency department (ED) users meet several of the criteria of vulnerability, but this needs to be further examined taking into consideration all vulnerability's different dimensions. This study aimed to characterize frequent ED users and to define risk factors of frequent ED use within a universal health care coverage system, applying a conceptual framework of vulnerability. METHODS: A controlled, cross-sectional study comparing frequent ED users to a control group of non-frequent users was conducted at the Lausanne University Hospital, Switzerland. Frequent users were defined as patients with five or more visits to the ED in the previous 12 months. The two groups were compared using validated scales for each one of the five dimensions of an innovative conceptual framework: socio-demographic characteristics; somatic, mental, and risk-behavior indicators; and use of health care services. Independent t-tests, Wilcoxon rank-sum tests, Pearson's Chi-squared test and Fisher's exact test were used for the comparison. To examine the -related to vulnerability- risk factors for being a frequent ED user, univariate and multivariate logistic regression models were used. RESULTS: We compared 226 frequent users and 173 controls. Frequent users had more vulnerabilities in all five dimensions of the conceptual framework. They were younger, and more often immigrants from low/middle-income countries or unemployed, had more somatic and psychiatric comorbidities, were more often tobacco users, and had more primary care physician (PCP) visits. The most significant frequent ED use risk factors were a history of more than three hospital admissions in the previous 12 months (adj OR:23.2, 95%CI = 9.1-59.2), the absence of a PCP (adj OR:8.4, 95%CI = 2.1-32.7), living less than 5 km from an ED (adj OR:4.4, 95%CI = 2.1-9.0), and household income lower than USD 2,800/month (adj OR:4.3, 95%CI = 2.0-9.2). CONCLUSIONS: Frequent ED users within a universal health coverage system form a highly vulnerable population, when ...
Document Type: article in journal/newspaper
File Description: application/pdf
Language: English
Relation: info:eu-repo/semantics/altIdentifier/pmid/26645272; info:eu-repo/semantics/altIdentifier/eissn/1475-9276; info:eu-repo/semantics/altIdentifier/urn/urn:nbn:ch:serval-BIB_377FBBB4F30B6; https://serval.unil.ch/notice/serval:BIB_377FBBB4F30B; https://serval.unil.ch/resource/serval:BIB_377FBBB4F30B.P001/REF.pdf
DOI: 10.1186/s12939-015-0277-5
Availability: https://serval.unil.ch/notice/serval:BIB_377FBBB4F30B
https://doi.org/10.1186/s12939-015-0277-5
https://serval.unil.ch/resource/serval:BIB_377FBBB4F30B.P001/REF.pdf
http://nbn-resolving.org/urn/resolver.pl?urn=urn:nbn:ch:serval-BIB_377FBBB4F30B6
Rights: info:eu-repo/semantics/openAccess ; Copying allowed only for non-profit organizations ; https://serval.unil.ch/disclaimer
Accession Number: edsbas.B51BD713
Database: BASE
Description
Abstract:BACKGROUND: Frequent emergency department (ED) users meet several of the criteria of vulnerability, but this needs to be further examined taking into consideration all vulnerability's different dimensions. This study aimed to characterize frequent ED users and to define risk factors of frequent ED use within a universal health care coverage system, applying a conceptual framework of vulnerability. METHODS: A controlled, cross-sectional study comparing frequent ED users to a control group of non-frequent users was conducted at the Lausanne University Hospital, Switzerland. Frequent users were defined as patients with five or more visits to the ED in the previous 12 months. The two groups were compared using validated scales for each one of the five dimensions of an innovative conceptual framework: socio-demographic characteristics; somatic, mental, and risk-behavior indicators; and use of health care services. Independent t-tests, Wilcoxon rank-sum tests, Pearson's Chi-squared test and Fisher's exact test were used for the comparison. To examine the -related to vulnerability- risk factors for being a frequent ED user, univariate and multivariate logistic regression models were used. RESULTS: We compared 226 frequent users and 173 controls. Frequent users had more vulnerabilities in all five dimensions of the conceptual framework. They were younger, and more often immigrants from low/middle-income countries or unemployed, had more somatic and psychiatric comorbidities, were more often tobacco users, and had more primary care physician (PCP) visits. The most significant frequent ED use risk factors were a history of more than three hospital admissions in the previous 12 months (adj OR:23.2, 95%CI = 9.1-59.2), the absence of a PCP (adj OR:8.4, 95%CI = 2.1-32.7), living less than 5 km from an ED (adj OR:4.4, 95%CI = 2.1-9.0), and household income lower than USD 2,800/month (adj OR:4.3, 95%CI = 2.0-9.2). CONCLUSIONS: Frequent ED users within a universal health coverage system form a highly vulnerable population, when ...
DOI:10.1186/s12939-015-0277-5