Heavy users of an emergency department--a two year follow-up study

Persons who repeatedly turn to emergency departments (ED) for medical services often have an unfavourable social situation. Very little is known about how their situation and utilization of ED services change with time. In the present study, 232 persons who had made 4+ visits to an ED during the previous year were followed for two years. In the first year 31% and in the second 19% of the original group remained heavy users of the ED. Patients diagnosed as having bronchial asthma remained heavy ED users to a greater extent than others. The mortality in the whole group was high, the standardized mortality rate (SMR) was 590% for the men and 740% for the women during the first follow-up year and 380% respectively 350% during the second. A sub-sample of the patients was interviewed both in the beginning and at the end of the study period with regard to psycho-social factors. The follow-up analysis showed that number of previous visits, contact with psychiatric care, living alone and perceived loneliness were predictive factors for continued ED use. Twenty-two percent of the variation in ED use could be accounted for by changes in the social network over time. The present study supports the hypothesis that the quality of the social network is related to the use of medical services, here expressed in ED use. The findings raise the question of how to handle the variety of psycho-social problems found among these ED users.