Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, 524 Edmonton Clinic Health Academy, Edmonton, AB, T6G 1C9, Canada.
Department of Obstetrics and Gynecology, University of Alberta, Edmonton, AB, Canada.
CJEM. 2021 Mar;23(2):206-213. doi: 10.1007/s43678-020-00013-7. Epub 2021 Jan 4.
Frequent users to emergency departments (EDs) are a diverse group of patients accounting for a disproportionate number of ED presentations. This study examined sociodemographic and ED visit characteristics of adult high-system users in two Canadian provinces.
Cohorts of high-system users were created for Alberta and Ontario including patients with the top 10% of presentations in the National Ambulatory Care Reporting System (April 2015-March 2016). Controls were random samples of non-high-system user patients. Sociodemographic and ED visits data were used to predict high-system user group membership in a multivariable logistic regression model.
There were 579,674 high-system users and 2,115,960 controls. High-system users were more likely to be female [odds ratio (OR) = 1.1, 95% confidence interval (CI) 1.1,1.1], older (OR 1.02 per 5 years, 95% CI 1.02,1.02), from the lowest-income quintile (OR 1.8, 95% CI 1.7,1.8), and more rural (OR 1.6, 95% CI 1.6,1.6) than controls. High-system users had a higher proportion of presentations by ambulance (OR 1.1 per 0.25 increase, 95% CI 1.1,1.1) and disposition was admission/transfer (OR 1.1 per 0.25 increase, 95% CI 1.1,1.1), left without being seen (OR 1.1, 95% CI 1.1,1.1), or left against medical advice (OR 1.1, 95% CI 1.1,1.1) more often than controls.
High-system users were more likely to be female, older, live in rural areas and within the lowest-income quintile compared to controls. Their heterogeneity in acuity, comorbid chronic diseases, and limited access to primary care suggests that interventions referring high-system users to primary care may be fruitful in reducing ED utilization by high-system users.
频繁到急诊科（ED）就诊的患者是一个多样化的群体，他们在急诊科就诊次数中占了相当大的比例。本研究调查了加拿大两个省份成年高频使用者的社会人口学和 ED 就诊特征。
为艾伯塔省和安大略省创建了高频使用者队列，包括国家门诊护理报告系统（2015 年 4 月至 2016 年 3 月）中就诊次数最多的前 10%的患者。对照组为非高频使用者患者的随机样本。使用社会人口学和 ED 就诊数据，在多变量逻辑回归模型中预测高频使用者组的成员。
共纳入 579674 例高频使用者和 2115960 例对照组。高频使用者更可能为女性[比值比（OR）=1.1，95%置信区间（CI）1.1，1.1]，年龄更大（每增加 5 岁，OR 1.02，95% CI 1.02，1.02），收入最低五分位数（OR 1.8，95% CI 1.7，1.8），更可能居住在农村地区（OR 1.6，95% CI 1.6，1.6）。与对照组相比，高频使用者通过救护车就诊的比例更高（OR 每增加 0.25，1.1，1.1），出院或转院的比例更高（OR 每增加 0.25，1.1，1.1），未得到诊治的比例更高（OR 1.1，95% CI 1.1，1.1），或未经医嘱离开的比例更高（OR 1.1，95% CI 1.1，1.1）。
与对照组相比，高频使用者更可能为女性、年龄更大、居住在农村地区和收入最低五分位数。他们在疾病严重程度、合并慢性疾病和初级保健机会方面的异质性表明，将高频使用者转介到初级保健机构的干预措施可能有助于减少高频使用者对 ED 的使用。
