PMID- 26284824
OWN - NLM
STAT- MEDLINE
DCOM- 20160427
LR  - 20181202
IS  - 1553-2712 (Electronic)
IS  - 1069-6563 (Linking)
VI  - 22
IP  - 9
DP  - 2015 Sep
TI  - Factors Contributing to Inappropriate Visits of Frequent Attenders and Their 
      Economic Effects at an Emergency Department in Singapore.
PG  - 1025-33
LID - 10.1111/acem.12738 [doi]
AB  - OBJECTIVES: This study aimed to determine which factors contribute to frequent 
      visits at the emergency department (ED) and what proportion were inappropriate in 
      comparison with nonfrequent visits. METHODS: This study was a retrospective, 
      case-control study comparing a random sample of frequent attenders and 
      nonfrequent attenders, with details of their ED visits recorded over a 12-month 
      duration. Frequent attenders were defined as patients with four or more visits 
      during the study period. RESULTS: In comparison with nonfrequent attenders 
      (median age = 45.0 years, interquartile range [IQR] = 28.0 to 61.0 years), 
      frequent attenders were older (median = 57.5 years, IQR = 34.0 to 74.8 years; p = 
      0.0003). They were also found to have more comorbidities, where 53.3% of frequent 
      attenders had three or more chronic illnesses compared to 14% of nonfrequent 
      attenders (p < 0.0001), and were often triaged to higher priority (more severe) 
      classes (frequent 52.2% vs. nonfrequent 37.6%, p = 0.0004). Social issues such as 
      bad debts (12.7%), heavy drinking (3.3%), and substance abuse (2.7%) were very 
      low in frequent attenders compared to Western studies. Frequent attenders had a 
      similar rate of appropriate visits to the ED as nonfrequent attenders (55.2% vs. 
      48.1%, p = 0.0892), but were more often triaged to P1 priority triage class (6.7% 
      vs. 3.2%, p = 0.0014) and were more often admitted for further management 
      compared to nonfrequent attenders (47.5% vs. 29.6%, p < 0.001). The majority of 
      frequent attender visits were appropriate (55.2%), and of these, 81.1% resulted 
      in admission. For the same number of patients, total visits made by frequent 
      attenders ($174,247.60) cost four times as much as for nonfrequent attenders 
      ($40,912.40). This represents a significant economic burden on the health care 
      system. CONCLUSIONS: ED frequent attenders in Singapore were associated with 
      higher age and presence of multiple comorbidities rather than with social causes 
      of ED use. Even in integrated health systems, repeat ED visits are frequent and 
      expensive, despite minimal social causes of acute care. EDs in aging populations 
      must anticipate the influx of vulnerable, elderly patients and have in place 
      interventional programs to care for them.
CI  - (c) 2015 by the Society for Academic Emergency Medicine.
FAU - Boh, Connie
AU  - Boh C
AD  - Duke-NUS Graduate Medical School Singapore, Singapore.
FAU - Li, Huihua
AU  - Li H
AD  - Health Services Research and Biostatistics Unit, Division of Research, Singapore 
      General Hospital, Singapore.
FAU - Finkelstein, Eric
AU  - Finkelstein E
AD  - Health Services & Systems Research Program, Duke-NUS Graduate Medical School 
      Singapore, Singapore.
FAU - Haaland, Benjamin
AU  - Haaland B
AD  - Office of Clinical Sciences, Duke-NUS Graduate Medical School Singapore, 
      Singapore.
FAU - Xin, Xiaohui
AU  - Xin X
AD  - Division of Medicine, Singapore General Hospital, Singapore.
FAU - Yap, Susan
AU  - Yap S
AD  - Department of Emergency Medicine, Singapore General Hospital, Singapore.
FAU - Pasupathi, Yogeswary
AU  - Pasupathi Y
AD  - Department of Emergency Medicine, Singapore General Hospital, Singapore.
FAU - Ong, Marcus Eh
AU  - Ong ME
AD  - Department of Emergency Medicine, Singapore General Hospital, Singapore.
AD  - Office of Clinical Sciences, Duke-NUS Graduate Medical School Singapore, 
      Singapore.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20150818
PL  - United States
TA  - Acad Emerg Med
JT  - Academic emergency medicine : official journal of the Society for Academic 
      Emergency Medicine
JID - 9418450
SB  - IM
MH  - Adult
MH  - Aged
MH  - Case-Control Studies
MH  - Chronic Disease/epidemiology
MH  - Comorbidity
MH  - Emergency Service, Hospital/*economics/*statistics & numerical data
MH  - Female
MH  - Health Behavior
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Retrospective Studies
MH  - Singapore/epidemiology
MH  - Socioeconomic Factors
MH  - Substance-Related Disorders/epidemiology
MH  - Triage
EDAT- 2015/08/19 06:00
MHDA- 2016/04/28 06:00
CRDT- 2015/08/19 06:00
PHST- 2014/11/28 00:00 [received]
PHST- 2015/01/20 00:00 [revised]
PHST- 2015/02/17 00:00 [revised]
PHST- 2015/05/01 00:00 [accepted]
PHST- 2015/08/19 06:00 [entrez]
PHST- 2015/08/19 06:00 [pubmed]
PHST- 2016/04/28 06:00 [medline]
AID - 10.1111/acem.12738 [doi]
PST - ppublish
SO  - Acad Emerg Med. 2015 Sep;22(9):1025-33. doi: 10.1111/acem.12738. Epub 2015 Aug 
      18.