Richard-Lepouriel Hélène, Weber Kerstin, Baertschi Marc, DiGiorgio Sergio, Sarasin François, Canuto Alessandra
Except for Prof. Sarasin, the authors are with the Department of Mental Health and Psychiatry, Division of Liaison Psychiatry and Crisis Intervention, University of Geneva, Geneva, Switzerland. Prof. Sarasin is with the Department of Community, Primary Care, and Emergency Medicine, Division of Emergency Medicine, at the university. Send correspondence to Mr. Baertschi (e-mail:
Psychiatr Serv. 2015 May 1;66(5):521-6. doi: 10.1176/appi.ps.201400097. Epub 2015 Feb 2.
Many patients visit psychiatric emergency services several times per year, which raises questions about the limits of this treatment setting. Previous studies have focused on recurrent visits over one year of follow-up. This study examined sociodemographic and diagnostic predictors of recurrent visits (three or more visits a year) to a psychiatric emergency service over three consecutive years.
This three-year retrospective cohort study used data from computerized administrative and medical records of 4,322 patients who visited the psychiatric emergency service of the University Hospitals of Geneva, Switzerland, at least once in 2008.
A total of 210 (5%) of the 4,322 patients had three or more visits in 2008. Of these, 22% also had recurrent use (three or more visits per year) in 2009, 2010, or 2011, and 78% did not. Recurrent visits were not predicted by sociodemographic characteristics, such as age, gender, marital status, professional activity, and citizenship. Two variables were significant predictors of recurrent visits: a diagnosis of a personality disorder and recurrent use of the emergency service in the 18 months before study entry in 2008.
Patients with personality disorders and past recurrent use of emergency services appeared to rely more on psychiatric emergency services for continuous psychiatric care than patients without past recurrent use of emergency services and patients with mood, substance use, anxiety, or psychotic disorders. Creation of a follow-up treatment program for this clinical population within the psychiatric emergency setting itself may provide better access to care for these patients.
许多患者每年多次前往精神科急诊服务部门就诊，这引发了对这种治疗环境局限性的质疑。以往研究主要关注一年随访期内的反复就诊情况。本研究调查了连续三年每年三次或更多次前往精神科急诊服务部门反复就诊的社会人口学和诊断预测因素。
这项为期三年的回顾性队列研究使用了来自瑞士日内瓦大学医院精神科急诊服务部门4322名患者的计算机化行政和医疗记录数据，这些患者在2008年至少就诊过一次。
4322名患者中共有210名（5%）在2008年有三次或更多次就诊。其中，22%在2009年、2010年或2011年也有反复就诊（每年三次或更多次），78%没有。反复就诊并非由年龄、性别、婚姻状况、职业活动和国籍等社会人口学特征所预测。有两个变量是反复就诊的显著预测因素：人格障碍诊断以及在2008年研究入组前18个月内反复使用急诊服务。
与无既往急诊服务反复使用史的患者以及患有情绪、物质使用、焦虑或精神障碍的患者相比，患有人格障碍且既往有急诊服务反复使用史的患者似乎更依赖精神科急诊服务来获得持续的精神科护理。在精神科急诊环境中为这一临床群体创建后续治疗项目可能会为这些患者提供更好的护理途径。
