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Acute Health Care Utilization Among Schizophrenia or Related Conditions and Bipolar Disorder Before, During, and
Luis A Ornelas1, Gary M Vilke1, Jesse J Brennan1
1Department of Emergency Medicine, University of California, San Diego Medical Center, San Diego, California.
Background:
Emergency departments (EDs) often care for patients with acute mental health issues, especially patients with severe mental illness (SMI). This study assessed trends in ED utilization for patients with schizophrenia and bipolar disorder over a 4-year period in California, including during the COVID-19 pandemic.
Objective:
This study aimed to assess changes in ED visit rates, demographic characteristics, and admission proportions for SMI-related visits before, during, and after COVID-19 pandemic.
Methods:
A multicenter retrospective analysis of ED utilization among patients 18 years or older with SMI was conducted from 2018 to 2021, using California's Department of Health Care Access and Information ED and inpatient discharged databases. SMI-related visits were identified using International Classification of Diseases, 10th Revision codes. Demographic variables included age, sex, race and ethnicity, expected payer, and geographic region.
Results:
Total ED visits increased from 2018 to 2019, then decreased in 2020 and 2021. SMI-related ED visits per 100,000 visits increased from 2019 to 2020 and remained elevated in 2021. Patients aged 25-44 years, non-Hispanic Black individuals, and Medicaid beneficiaries demonstrated the highest SMI-related ED utilization rates. Los Angeles County consistently had the highest rates among geographic regions.
Conclusions:
Despite an overall reduction in ED visits during the COVID-19 pandemic, SMI-related visits increased, demonstrating the need for mental health resources in EDs, specifically for vulnerable populations, such as non-Hispanic Black individuals and those with lower socioeconomic status.
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