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Loyal frequent users of hospital emergency departments: the FIDUR project



Loyal frequent users of hospital emergency departments: the FIDUR project



Emergencias 28(1): 16-20



To describe the characteristics of frequent users of hospital emergency departments and analyze whether characteristics varied in relation to how revisits were distributed over the course of the year studied. Retrospective study of patients over the age of 14 years who were treated in a hospital emergency department at least 10 times in 2013. Patients were identified in 17 public hospitals in the Spanish autonomous community of Madrid. Data related to the first and successive visits were gathered and analyzed by quarter year. We included 2340 patients with a mean (SD) age of 54 (21) years. A total of 1361 (58.%) were women, 1160 (50%) had no concomitant diseases, 1366 (58.2%) were substance abusers, and 25 (1.1%) were homeless. During the first visit, 2038 (87.1%) complained of a recent health problem, and 289 (12.4%) were admitted. Sixty (2.6%) patients concentrated their revisits in a single quarters 335 (14.3%) in 2 quarters, 914 (39.1%) in 3, and 1005 (42.9%) in 4. Patients whose revisits were distributed over more quarters were older (> 65 years), had more concomitant conditions, were on more medications (P < .001), showed cognitive impairment (P = .039), and were more functionally dependent (P = .007). They were also more likely to have been hospitalized on the first visit (P < .001). Patients whose revisits were concentrated in fewer quarters were more often women (P = .012) and more likely to have a specific diagnosis (P < .001) and revisit for a reason related to the initial visit (P = .012). Our study shows that the frequent user has specific characteristics and loyally comes to the same emergency department over the course of a year. Patients whose revisits are dispersed over a longer period have more complex problems and use more resources during their initial visit. Describir las características del paciente hiperfrecuentador (HF) en servicios de urgencias hospitalarios (SUH) y analizar si existen diferencias en función de la distribución de revisitas durante el periodo de estudio. Estudio de cohorte retrospectivo que seleccionó a pacientes mayores de 14 años que frecuentaron el SUH al menos en 10 ocasiones en 2013. Se reclutaron pacientes de 17 hospitales públicos de la Comunidad de Madrid (CM). Se recogieron variables relativas a la visita índice y visitas sucesivas. Se analizó la muestra en función del número de trimestres (TM) en el que se reparten las revisitas. Se incluyeron 2.340 pacientes con una edad media de 54 (DE 21) años, 1.361 (58,2%) fueron mujeres, 1.160 (50,0%) no presentaban comorbilidad, 1.366 (58,2%) consumían tóxicos y 25 (1,1%) vivían en la calle. En la visita índice, 2.038 (87,1%) acudieron por un problema de salud reciente, 289 (12,4%) fueron hospitalizados, 60 (2,6%) concentraron sus revisitas en un solo TM, 335 (14,3%) en 2 TM, 914 (39,1%) las repartieron en 3 TM y 1.005 (42,9%) en 4 TM. En el grupo de pacientes cuyas revisitas se reparten en mayor número de TM observamos que aumenta la edad (> 65 años), la comorbilidad y la polifarmacia (p < 0,001), el deterioro cognitivo (p = 0,039) y la dependencia (p = 0,007), así como la hospitalización en la visita índice (p < 0,001). A medida que las revisitas se concentran en un menor número de TM, aumenta la proporción de mujeres (p = 0,012), determinados diagnósticos (p < 0,001) y la coincidencia entre el motivo de las revisitas y la visita índice (p = 0,012). El paciente HF tiene unas características determinadas y acude a urgencias de una forma homogénea a lo largo del año (fidelizado). A medida que las revisitas se dispersan más, se objetivan pacientes con mayor complejidad y que consumen más recursos en la visita índice.

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Accession: 059932629

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PMID: 29094821


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