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Examining the need profiles of patients with multiple emergency department visits for mental health reasons: a cross-sectional study

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Abstract

Objectives

Study objectives were to: (1) provide an estimate of the prevalence of repeat emergency department (ED) use for mental health reasons among individuals enrolled in intensive case management programs; and (2) to identify socio-demographic, diagnostic, and service need characteristics associated with repeat ED visits among this service population.

Methods

The study utilized administrative health data from community mental health organizations in Toronto, Canada on a sample of 2274 individuals enrolled in intensive case management programs. Patients with 2+ ED visits for mental health reasons within the prior 6 months were compared with individuals who had no ED visits or one visit on the basis of demographic, diagnostic and service need characteristics.

Results

Approximately 6 % of intensive case management clients had two or more ED visits over a 6-month period. Membership in the repeat ED user group was associated with younger age (OR 0.98), a mood disorder (OR 1.58), being in service less than 1 year (OR 1.94) and unmet needs related to psychotic symptoms (OR 2.19), substance use (OR 2.27), and safety to self/others (OR 3.42).

Conclusions

The repeat ED user group within case management may have distinct need profiles that require different treatment responses. Moreover, clinical needs rather than psychosocial needs have the greatest relationship with repeat psychiatric ED utilization. These unmet needs suggest areas for future interventions aimed at reducing the use of ED services for mental health reasons and improving care for patients who repeatedly present at the ED.

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References

  1. Sun BC, Burstin HR, Brennan TA (2003) Predictors and outcomes of frequent emergency department users. Acad Emerg Med 10(4):320–328. doi:10.1111/j.1553-2712.2003.tb01344.x

    Article  PubMed  Google Scholar 

  2. Wooden MD, Air TM, Schrader GD, Wieland B, Goldney RD (2009) Frequent attenders with mental disorders at a general hospital emergency department. Emerg Med Aust 21(3):191–195. doi:10.1111/j.1742-6723.2009.01181.x

    Article  Google Scholar 

  3. Chaput YV, Lebel MJ (2007) Demographic and clinical profiles of patients who make multiple visits to psychiatric emergency services. Psychiatr Serv 58(3):335–341. doi:10.1176/ps.2007.58.3.335

    Article  PubMed  Google Scholar 

  4. LaCalle E, Rabin E (2010) Frequent users of emergency departments: the myths, the data and the policy implications. Ann Emerg Med 56(1):42–48. doi:10.1016/j.annemergmed.2010.01.032

    Article  PubMed  Google Scholar 

  5. Blanks FS, Li H, Hennenman PL, Smithline HA, Santoro JS, Provost D, Maynard AM (2005) A descriptive study of heavy emergency department users at an academic emergency department reveals heavy ED users have better access to care than average users. J Emerg Nurs 31(2):139–144. doi:10.1016/j.jen.2005.02.008

    Article  Google Scholar 

  6. Riggs JE, Davis SM, Hobbs GR, Paulson DJ, Chinnis AS, Heilman PL (2003) Association between early returns and frequent ED visits at a rural academic medical center. Am J Emerg Med 21(1):30–31. doi:10.1053/ajem.2003.50017

    Article  PubMed  Google Scholar 

  7. Cook LJ, Knight S, Junkins EP Jr, Mann NC, Dean JM, Olson LM (2004) Repeat patients to the emergency department in a statewide database. Acad Emerg Med 11(3):256–263. doi:10.1111/j.1553-2712.2004.tb02206.x

    Article  PubMed  Google Scholar 

  8. Hunt KA, Weber EJ, Showstack JA, Colby DC, Callaham ML (2006) Characteristics of frequent users of emergency departments. Ann Emerg Med 48(1):1–8. doi:10.1016/j.annemergmed.2005.12.030

    Article  PubMed  Google Scholar 

  9. Vandyk AD, Harrison MB, VanDenLerkhof EG, Graham ID, Ross-White A (2013) Frequent emergency department use by individuals seeking mental healthcare: a systematic search and review. Arch Psychiatr Nurs 27(4):171–178. doi:10.1016/j.apnu.2013.03.001

    Article  PubMed  Google Scholar 

  10. Mehl-Madrona LE (2008) Prevalence of psychiatric diagnoses among frequent users of rural emergency medical services. Can J Rural Med 13(4):22–30

    PubMed  Google Scholar 

  11. Williams ER, Guthrie E, Mackway-Jones K, James M, Tomenson B, Eastham J, McNally D (2001) Psychiatric status, somatisation, and health care utilization of frequent attenders at the emergency department: a comparison with routine attenders. J Psychosom Res 50(3):161–167. doi:10.1016/S0022-3999(00)00228-2

    Article  CAS  PubMed  Google Scholar 

  12. Curran GM, Sullivan G, Williams K, Hans X, Collins K, Key J, Kotria KJ (2003) Emergency department use of persons with comorbid psychiatric and substance abuse disorders. Ann Emerg Med 41(5):659–667. doi:10.1067/mem.2003.154

    Article  PubMed  Google Scholar 

  13. Oven HJ, Chan BT (2001) Heavy users of emergency services: a population-based review. Can Med Assoc J 165(8):1049–1050

    Google Scholar 

  14. Markham D, Graudin A (2011) Characteristics of frequent emergency department presenters to an Australian emergency medicine network. BMC Emerg Med 11:21–26. doi:10.1186/1471-227X-11-21

    Article  PubMed  PubMed Central  Google Scholar 

  15. Mandelberg JH, Kuhn RE, Kohn MA (2000) Epidemiologic analysis of an urban, public emergency department’s frequent users. Acad Emerg Med 7(6):637–646. doi:10.1111/j.1553-2712.2000.tb02037.x

    Article  CAS  PubMed  Google Scholar 

  16. Aagaard J, Aagaard A, Buus N (2014) Predictors of frequent visits to a psychiatric emergency room: a large-scale register study combined with a small-scale interview study. Int J Nurs Stud 51(7):1003–1013. doi:10.1016/j.ijnurstu.2013.11.002

    Article  PubMed  Google Scholar 

  17. Ledoux Y, Minner P (2006) Occasional and frequent repeaters in a psychiatric emergency room. Soc Psychiatry Psychiatric Epidemiol 41(2):115–121. doi:10.1007/s00127-005-0010-6

    Article  Google Scholar 

  18. Chaput YJ, Lebel MJ (2007) An examination of the temporal and geographical patterns of psychiatric emergency service use by multiple visit patients as a means for their early detection. BMC Psychiatry 7:60. doi:10.1186/1471-244X-7-60

    Article  PubMed  PubMed Central  Google Scholar 

  19. Bruffaerts R, Sabbe M, Demyttenaere K (2006) Who visits the psychiatric emergency room for the first time? Soc Psychiatry Psychiatr Epidemiol 41(7):580–586. doi:10.1007/s00127-006-0062-2

    Article  PubMed  Google Scholar 

  20. Dhossche DM, Ghani SO (1998) A study on recidivism in the psychiatric emergency room. Ann Clin Psychiatry 10(2):59–67. doi:10.3109/10401239809147744

    Article  CAS  PubMed  Google Scholar 

  21. Arfken CL, Zeman LL, Yeager L, White A, Mischel E, Amirsadri A (2004) Case-control study of frequent visitors to an urban psychiatric emergency service. Psychiatr Serv 55(3):295–301. doi:10.1176/appi.ps.55.3.295

    Article  PubMed  Google Scholar 

  22. Pasic J, Russo J, Roy-Byrne P (2005) High utilizers of psychiatric emergency services. Psychiatr Serv 56(6):678–684. doi:10.1176/appi.ps.56.6.678

    Article  PubMed  Google Scholar 

  23. Saarento O, Hakko H, Joukamaa M (1998) Repeated use of psychiatric emergency out-patient services among new patients: a 3-year follow-up study. Acta Psychiatr Scand 98(4):276–282. doi:10.1111/j.1600-0447.1998.tb10084.x

    Article  CAS  PubMed  Google Scholar 

  24. Perez E, Minoletti A, Blouin J, Blouin A (1986) Repeated users of a psychiatric emergency service in a Canadian general hospital. Psychiatr Q 58(3):189–201. doi:10.1007/BF01064733

    Article  PubMed  Google Scholar 

  25. Ellison JM, Blum N, Barsky AJ (1989) Frequent repeaters in a psychiatric emergency service. Hosp Comm Psychiatry 44(4):372–375. doi:10.1176/ps.40.9.958

    Google Scholar 

  26. Althaus F, Paroz S, Hugll O, Ghall WA, Daeppen JB, Peytremann-Bridevaux I, Bodenmann P (2011) Effectiveness of interventions targeting frequent users of emergency departments: a systematic review. Ann Emerg Med 58(1):41–52. doi:10.1016/j.annemergmed.2011.03.007

    Article  PubMed  Google Scholar 

  27. Curtis J, Millman E, Struening E, D’Ercore A (1992) Effects of case management on rehospitalization and utilization of ambulatory care services. Hosp Community Psychiatr 43(9):895–908

    CAS  Google Scholar 

  28. Craig TJ, Bracken J (1995) A case-control study of rapid readmission in a state hospital population. Ann Clin Psychiatry 7(2):79–85. doi:10.3109/10401239509149031

    Article  CAS  PubMed  Google Scholar 

  29. Phillips GA, Brphy DS, Weiland TJ, Chenhall AJ, Dent AW (2006) The effect of multidisciplinary case management on selected outcomes for frequent attenders at an emergency department. Med J Aust 184(12):602–606

    PubMed  Google Scholar 

  30. Ontario Ministry of Health and Long-Term Care (2005) Intensive case management services standards for mental health services and supports. Queen’s Printer for Ontario. http://health.gov.on.ca/en/common/ministry/publications/reports/mentalhealth/intens_cm.pdf. Accessed 25 May 2015

  31. Ontario Ministry of Health and Long-Term Care (2004) Community Mental Health—Common Data Set—Mental Health (CDS-MH) Version 2. Toronto: Information Management Unit, Finance and Information Management Branch, Ministry of Health and Long-Term Care

  32. Community Care Information Management (2010) Ontario common assessment of need (OCAN): OCAN user guide 2.0. https://www.ccim.on.ca/CMHA/OCAN/Private/Document/Education%20and%20Training%20v2.0/OCAN%202%20Day%20Training%20Materials/OCAN%202%20Day%20Training%20-%20User%20Binder/Tab%201%20-%20OCAN%20User%20Guide.pdf. Accessed 25 May 2015

  33. IBM Corp. (2013) IBM SPSS Statistics for Windows, Version 22.0. IBM Corp, Armonk

  34. Wennström E, Wiesel FA (2006) The Camberwell assessment of need as an outcome measure in routine mental health care. Soc Psychiatry Psychiatr Epidemiol 41(9):728–733. doi:10.1007/s00127-006-0084-9

    Article  PubMed  Google Scholar 

  35. Community Care Information Management and Ontario Common Assessment of Need (OCAN): Community mental health common assessment project: Full OCAN 2.0 Revision 2.0.5. https://www.ccim.on.ca/CMHA/OCAN/Private/Document/Assessment%20Tool%20v2.0/OCAN_2.0/OCAN_2.0_FULL_v2.0.5i.pdf. Accessed 25 May 2015

  36. Doupe MB, Palatnick W, Day S, Chateau D, Soodeen RA, Burchill C, Derksen S (2012) Frequent users of emergency departments: developing standard definitions and defining prominent risk factors. Ann Emerg Med 60(1):24–32. doi:10.1016/j.annemergmed.2011.11.036

    Article  PubMed  Google Scholar 

  37. National Collaborating Centre for Mental Health (2014) Psychosis and schizophrenia in adults: treatment and management. National Institute for Health and Care Excellence, London. http://www.guideline.gov/content.aspx?id=47863. Accessed 25 May 2015

  38. Malik N, Kingdon D, Pelton J, Mehta R, Turkington D (2009) Effectiveness of brief cognitive-behavioral therapy for schizophrenia delivered by mental health nurses: relapse and recovery at 24 months. J Clin Psychiatry 70(2):201–207. doi:10.4088/JCP.07m03990

    Article  PubMed  Google Scholar 

  39. Rathod S, Turkington D (2005) Cognitive-behaviour therapy for schizophrenia: a review. Curr Opin Psychiatry 18(2):159–163. doi:10.1097/00001504-200503000-00009

    Article  PubMed  Google Scholar 

  40. Turkington D, Munetz M, Pelton J, Monesano V, Sivec HJ, Nausheen B, Kingdon D (2014) High-yield cognitive behavioral techniques for psychosis delivered by case managers to their clients with persistent psychotic symptoms: an exploratory trial. J Nerv Ment Dis 202(1):30–34. doi:10.1097/NMD.0000000000000070

    Article  PubMed  Google Scholar 

  41. Jung XT, Newton R (2009) Cochrane reviews of non-medication-based psychotherapeutic and other interventions for schizophrenia, psychosis, and bipolar disorder: a systematic literature review. Int J Ment Health Nurs 18(4):239–249. doi:10.1111/j.1447-0349.2009.00613.x

    Article  PubMed  Google Scholar 

  42. Burns T, Catty J, Dash M, Roberts C, Lockwood A, Marshall M (2007) Use of intensive case management to reduce time in hospital in people with severe mental illness: systematic review and meta-regression. BMJ 335(7615):336–340. doi:10.1136/bmj.39251.599259.55

    Article  PubMed  PubMed Central  Google Scholar 

  43. Drukker M, Maarschalkerweerd M, Bak M, Driessen G, a Campo J, de Bie A, Poddighe G, van Os J, Delespaul P (2008) A real-life observational study of the effectiveness of FACT in a Dutch mental health region. BMC Psychiatry 8:93. doi:10.1186/1471-244X-8-93

    Article  PubMed  PubMed Central  Google Scholar 

  44. Horsfall J, Cleary M, Hunt GE, Walter G (2009) Psychosocial treatments for people with co-occuring severe mental illnesses and substance user disorders (dual diagnosis): a review of empirical evidence. Harv Rev Psychiatry 17(1):24–34. doi:10.1080/10673220902724599

    Article  PubMed  Google Scholar 

  45. Sinclair JH, Gray A, Rivero-Arias O, Saunders KE, Hoawton K (2011) Healthcare and social services resource use and costs of self-harm patients. Soc Psychiatry Psychiatr Epidemiol 46(4):263–271. doi:10.1007/s00127-010-0183-5

    Article  PubMed  Google Scholar 

  46. Larkin C, Blasi Z, Arensman E (2014) Risk factors for repetition of self-harm: a systematic review of prospective hospital-based studies. PLoS One 9(1):e84282. doi:10.1371/journal.pone.0084282

    Article  PubMed  PubMed Central  Google Scholar 

  47. Kliem S, Kröger C, Kosfelder J (2010) Dialectical behavior therapy for borderline personality disorder: a meta-analysis using mixed effects modelling. J Consult Clin Psychol 78(6):936–951. doi:10.1037/a0021015

    Article  PubMed  Google Scholar 

  48. Stoffers JM, Vollm BA, Rucker G, Timmer A, Husband N, Lieb K (2012) Psychological therapies for people with borderline personality disorder. Cochrane Database Syst Rev 8:CD005652

    PubMed  Google Scholar 

  49. Linehan MM, Korslund KE, Harned MS, Gallop RJ, Lungu A, Neacsiu AD, McDavid J, Comtois KA, Murray-Gregory AM (2015) Dialectical behavior therapy for high suicide risk in individuals with borderline personality disorder: a randomized clinical trial and component analysis. JAMA Psychiatry 72(5):475–482. doi:10.1001/jamapsychiatry.2014.3039

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors would like to thank the managers and data support staff of the organizations participating in this study for their time and assistance in pulling data for this study. This research was made possible by funding from the Toronto Central Local Health Integration Network (TC LHIN) which is gratefully acknowledged. The views expressed in this report do not necessarily reflect those of the TC LHIN or the Ontario Ministry of Health and Long-Term Care.

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Correspondence to Frank Sirotich.

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Sirotich, F., Durbin, A. & Durbin, J. Examining the need profiles of patients with multiple emergency department visits for mental health reasons: a cross-sectional study. Soc Psychiatry Psychiatr Epidemiol 51, 777–786 (2016). https://doi.org/10.1007/s00127-016-1188-5

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