International Journal for Equity in Health
Volume 14, Issue 1, 2015

Characterizing the vulnerability of frequent emergency department users by applying a conceptual framework: A controlled, cross-sectional study (Article) (Open Access)

Bodenmann P.* , Baggio S. , Iglesias K. , Althaus F. , Velonaki V.-S. , Stucki S. , Ansermet C. , Paroz S. , Trueb L. , Hugli O. , Griffin J.L. , Daeppen J.-B.
  • a Vulnerable Populations Center, Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne University Hospital, Lausanne, CH-1015, Switzerland
  • b Life Course and Inequality Research Center, Faculty of Social and Political Sciences, University of Lausanne, Lausanne, CH-1015, Switzerland
  • c Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, CH-1011, Switzerland
  • d Vulnerable Populations Center, Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne University Hospital, Lausanne, CH-1015, Switzerland
  • e Institute of Higher Education and Research in Healthcare, Lausanne University Hospital, Lausanne, CH-1010, Switzerland
  • f Addiction Switzerland, Research Institute, Lausanne, CH-1001, Switzerland
  • g Department of Community Medicine and Public Health, Lausanne University Hospital, Lausanne, CH-1011, Switzerland
  • h Department of Community Medicine and Public Health, Lausanne University Hospital, Lausanne, CH-1011, Switzerland
  • i Emergency Department, Lausanne University Hospital, Lausanne, CH-1011, Switzerland
  • j Emergency Department, Lausanne University Hospital, Lausanne, CH-1011, Switzerland
  • k Vulnerable Populations Center, Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne University Hospital, Lausanne, CH-1015, Switzerland
  • l Alcohol Treatment Service, Lausanne University Hospital, Lausanne, CH-1011, Switzerland

Abstract

Background: Frequent emergency department (ED) users meet several of the criteria of vulnerability, but this needs to be further examined taking into consideration all vulnerability's different dimensions. This study aimed to characterize frequent ED users and to define risk factors of frequent ED use within a universal health care coverage system, applying a conceptual framework of vulnerability. Methods: A controlled, cross-sectional study comparing frequent ED users to a control group of non-frequent users was conducted at the Lausanne University Hospital, Switzerland. Frequent users were defined as patients with five or more visits to the ED in the previous 12 months. The two groups were compared using validated scales for each one of the five dimensions of an innovative conceptual framework: socio-demographic characteristics; somatic, mental, and risk-behavior indicators; and use of health care services. Independent t-tests, Wilcoxon rank-sum tests, Pearson's Chi-squared test and Fisher's exact test were used for the comparison. To examine the -related to vulnerability- risk factors for being a frequent ED user, univariate and multivariate logistic regression models were used. Results: We compared 226 frequent users and 173 controls. Frequent users had more vulnerabilities in all five dimensions of the conceptual framework. They were younger, and more often immigrants from low/middle-income countries or unemployed, had more somatic and psychiatric comorbidities, were more often tobacco users, and had more primary care physician (PCP) visits. The most significant frequent ED use risk factors were a history of more than three hospital admissions in the previous 12 months (adj OR:23.2, 95%CI = 9.1-59.2), the absence of a PCP (adj OR:8.4, 95%CI = 2.1-32.7), living less than 5 km from an ED (adj OR:4.4, 95%CI = 2.1-9.0), and household income lower than USD 2,800/month (adj OR:4.3, 95%CI = 2.0-9.2). Conclusions: Frequent ED users within a universal health coverage system form a highly vulnerable population, when taking into account all five dimensions of a conceptual framework of vulnerability. The predictive factors identified could be useful in the early detection of future frequent users, in order to address their specific needs and decrease vulnerability, a key priority for health care policy makers. Application of the conceptual framework in future research is warranted. © 2015 Bodenmann et al.

Author Keywords

Conceptual framework of vulnerability Frequent emergency department users

Index Keywords

Vulnerable Populations vulnerable population hospital admission educational status immigrant alcohol consumption insurance demography predictive value human wellbeing comorbidity middle aged injury statistics and numerical data health service controlled study priority journal Aged general practitioner Logistic Models emergency ward chronic disease Cross-Sectional Studies marriage Surveys and Questionnaires income cross-sectional study Humans conceptual framework smoking male female Socioeconomic Factors risk factor Risk Factors socioeconomics questionnaire health services vulnerability Article health care Retrospective Studies health care utilization Charlson Comorbidity Index major clinical study household income adult age drug use utilization outcome assessment hospital emergency service Emergency Service, Hospital statistical model retrospective study Universal Coverage Switzerland Nicotiana tabacum
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-84949548483&doi=10.1186%2fs12939-015-0277-5&partnerID=40&md5=150d9d3d468e0ce5846af9458d0d32fc
DOI: 10.1186/s12939-015-0277-5
ISSN: 14759276
Cited by: 12
Original Language: English