Hudon Catherine, Courteau Josiane, Krieg Cynthia, Vanasse Alain
Groupe de recherche PRIMUS, Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CRCHUS), 3001 12e avenue nord, Sherbrooke, QC, J1H 5N4, Canada.
Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, 3001 12e avenue nord, Sherbrooke, QC, J1H 5N4, Canada.
BMC Health Serv Res. 2017 Aug 4;17(1):525. doi: 10.1186/s12913-017-2453-3.
A small proportion of patients utilizes a disproportionately large amount of emergency department (ED) resources. Being able to properly identify chronic frequent ED users, i.e. frequent ED users over a multiple-year period, would allow healthcare professionals to intervene before it occurs and, if possible, redirect these patients to more appropriate health services. The objective of this study was to explore the factors associated with chronic frequent ED utilization in a population with diabetes.
A population-based retrospective cohort study using administrative data was conducted on 62,316 patients with diabetes living in metropolitan areas of Quebec (Canada), having visited an ED during 2006, and still alive in 31 December 2009. The dependant variable was being a chronic frequent ED user, defined as having at least 3 ED visits per year during three consecutive years (2007-2009). Independent variables, measured during 2006, included age, sex, neighbourhood deprivation, affiliation to a general practitioner, and number of physical and mental health comorbidities. Logistic regression and tree-based method were used to identify factors associated with chronic frequent ED use.
A total of 2.6% of the cohort (patients with diabetes and at least one ED visit in 2006) was identified as chronic frequent ED users. These patients accounted for 16% of all ED visits made by the cohort during follow-up. The cumulative effect of a high illness burden combined with mental health disorders was associated with an increased risk of chronic frequent ED use.
Interventions must target the population at higher risk of becoming chronic frequent ED users and should be designed to manage the complex interaction between high illness burden and mental health.
一小部分患者使用了不成比例的大量急诊科（ED）资源。能够正确识别慢性频繁急诊科使用者，即在多年期间频繁使用急诊科的患者，将使医疗保健专业人员能够在其发生之前进行干预，并在可能的情况下将这些患者引导至更合适的医疗服务。本研究的目的是探讨糖尿病患者中与慢性频繁使用急诊科相关的因素。
使用行政数据对居住在加拿大魁北克市大都市区、在2006年曾就诊于急诊科且在2009年12月31日仍存活的62316例糖尿病患者进行了一项基于人群的回顾性队列研究。因变量是成为慢性频繁急诊科使用者，定义为在连续三年（2007 - 2009年）中每年至少有3次急诊科就诊。在2006年测量的自变量包括年龄、性别、邻里贫困程度、与全科医生的关系以及身体和心理健康合并症的数量。使用逻辑回归和基于树的方法来识别与慢性频繁使用急诊科相关的因素。
该队列中共有2.6%（2006年患有糖尿病且至少有一次急诊科就诊的患者）被确定为慢性频繁急诊科使用者。这些患者占该队列在随访期间所有急诊科就诊次数的16%。高疾病负担与精神健康障碍的累积效应与慢性频繁使用急诊科的风险增加相关。
干预措施必须针对成为慢性频繁急诊科使用者风险较高的人群，并且应设计用于管理高疾病负担与精神健康之间的复杂相互作用。
