aVulnerable Population Unit, Department of Ambulatory Care and Community Medicine, University of Lausanne & Lausanne University Hospital (CHUV) bDepartment of Community Medicine and Public Health cEmergency Service dTechnology Assessment Unit (UET) eAlcohol Treatment Centre, Lausanne University Hospital (CHUV) fAddiction Switzerland gInstitute of Health Economics and Management (IEMS), University of Lausanne, Lausanne, Switzerland.
Eur J Emerg Med. 2013 Dec;20(6):413-9. doi: 10.1097/MEJ.0b013e32835e078e.
The aim of this study was to describe the demographic, social and medical characteristics, and healthcare use of highly frequent users of a university hospital emergency department (ED) in Switzerland.
A retrospective consecutive case series was performed. We included all highly frequent users, defined as patients attending the ED 12 times or more within a calendar year (1 January 2009 to 31 December 2009). We collected their characteristics and calculated a score of accumulation of risk factors of vulnerability.
Highly frequent users comprised 0.1% of ED patients, and they accounted for 0.8% of all ED attendances (23 patients, 425 attendances). Of all highly frequent users, 87% had a primary care practitioner, 82.6% were unemployed, 73.9% were socially isolated, and 60.9% had a mental health or substance use primary diagnosis. One-third had attempted suicide during study period, all of them being women. They were often admitted (24.0% of attendances), and only 8.7% were uninsured. On average, they cumulated 3.3 different risk factors of vulnerability (SD 1.4).
Highly frequent users of a Swiss academic ED are a highly vulnerable population. They are in poor health and accumulate several risk factors of being even in poorer health. The small number of patients and their high level of insurance coverage make it particularly feasible to design a specific intervention to approach their needs, in close collaboration with their primary care practitioner. Elaboration of the intervention should focus on social reinsertion and risk-reduction strategies with regard to substance use, hospital admissions and suicide.
本研究旨在描述瑞士一所大学附属医院急诊部（ED）高度频繁使用者的人口统计学、社会和医学特征以及医疗保健利用情况。
我们进行了回顾性连续病例系列研究。我们纳入了所有高度频繁使用者，定义为在一个日历年内（2009 年 1 月 1 日至 2009 年 12 月 31 日）到 ED 就诊 12 次或以上的患者。我们收集了他们的特征，并计算了脆弱性危险因素积累评分。
高度频繁使用者占 ED 患者的 0.1%，占所有 ED 就诊的 0.8%（23 例，425 次就诊）。在所有高度频繁使用者中，87%有初级保健医生，82.6%失业，73.9%社会孤立，60.9%有精神健康或药物使用原发性诊断。三分之一的人在研究期间曾试图自杀，且均为女性。他们经常住院（就诊的 24.0%），只有 8.7%没有保险。平均而言，他们累计有 3.3 种不同的脆弱性危险因素（标准差 1.4）。
瑞士学术 ED 的高度频繁使用者是一个高度脆弱的人群。他们健康状况不佳，且积累了多种使其健康状况更差的脆弱性危险因素。患者数量较少且保险程度较高，这使得与初级保健医生密切合作，设计专门的干预措施来满足他们的需求变得特别可行。干预措施的制定应侧重于社会重新融入和减少与药物使用、住院和自杀相关的风险策略。
