In our recently published paper, titled Sociodemographic and health behaviour of frequent, avoidable emergency department users in Ontario, Canada: A population-based descriptive study, we describe the multifactorial nature of frequent, avoidable ED utilization. We linked data from over 180,000 Ontario adult respondents (18-74 years of age) from the Canadian Community Health Survey (CCHS) to ED utilization data from the National Ambulatory Care Reporting System (NACRS) database to describe the sociodemographic and health behaviour characteristics of frequent emergency department (ED) users. Avoidable visits were identified using previously-used definitions which indicate ED visits that may be better suited to other points of healthcare access or entirely preventable through better upstream management of chronic conditions, while frequent use was determined using the commonly-used benchmark of four visits within one year.
Among the characteristics associated with frequent, potentially-avoidable ED use were lower household income, lower education, rural-dwelling, poor self-reported physical and mental health, and residing in a neighbourhood with higher material resource deprivation. Interestingly, future frequent, avoidable ED use was also strongly associated with past frequent ED use, indicating that this behaviour often represents ongoing healthcare need that may be indicative of access barriers.
Lead author, Cam Thompson, says this study provides important population health context on individuals who rely heavily on emergency departments for their healthcare access, particularly those for whom some visits may be amenable to other areas of the healthcare system. It highlights the need to address ED utilization through both upstream public health intervention, and in-ED interventions which consider the social determinants of frequent, avoidable ED use.
This study was published in the Western Journal of Emergency Medicine. Read the full article here.