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Exploring factors associated with high frequency emergency department use by children and young people: a
Akshay Kumar1, Rebecca M Simpson2, Kerryn Husk3
1Division of Applied Health Research Methods, University of Leeds, Leeds, UK.
Insights
High frequency emergency department (ED) use by children is linked to younger age and deprivation, with ethnicity playing a role. Addressing social determinants is key to reducing frequent ED visits.
Area of Science:
- Pediatric Emergency Medicine
- Health Services Research
- Social Determinants of Health
Background:
- High frequency emergency department (ED) use among children and young people presents a significant challenge in healthcare systems.
- Understanding the specific drivers of frequent ED attendance is crucial for developing targeted interventions.
Purpose of the Study:
- To investigate the factors contributing to high-frequency ED use in children and young people.
- To identify characteristics of individuals with the most frequent ED attendances.
Main Methods:
- A population-based retrospective cohort study was conducted using linked healthcare data.
- The study analyzed ED attendances for 288,545 children and young people (aged 17 and under) in the Yorkshire and Humber region of the UK between April 2016 and March 2017.
Main Results:
- 9.6% of children were high-frequency ED attenders (3+ visits), accounting for 25% of all attendances.
- Younger age groups and higher levels of deprivation were associated with increased ED attendance rates, particularly among high-frequency users.
- Ethnic minorities in the most deprived categories showed lower attendance rates, indicating complex interactions between deprivation and ethnicity.
Conclusions:
- Reducing frequent ED use requires multifaceted strategies that consider age and condition specifics.
- Addressing social determinants of health, especially in deprived areas, is essential for mitigating high ED utilization by children and young people.
Objective:
To explore drivers of high frequency emergency department (ED) use by children and young people, particularly among those attending EDs most often.
Design:
A population-based retrospective cohort study using routinely collected linked healthcare data.
Setting:
EDs in the Yorkshire and Humber region of the UK.
Patients:
288 545 children and young people aged 17 and under making at least one ED attendance in the year period 1 April 2016 to 31 March 2017.
Main Outcome Measures:
ED attendances made by individuals in the year period.
Results:
Of the 288 545 distinct children and young people making at least one attendance to an ED, 27 560 (9.6%) were defined as high frequency ED attenders (making 3+attendances in the year) and accounted for 105 063 (25%) ED attendances in the study period. When considering factors associated with ED attendance rates, younger age groups and greater levels of deprivation were found to be associated with higher rates of attendance. This association was amplified in those attending the ED most often. Ethnicity was found to be associated with ED attendance rates, with those reported as mixed and other ethnicities displaying greater rates of attendance than those reported as white and those reported as black ethnicity displaying lower attendance rates in comparison to those reported as white. The interaction between an individual's deprivation and ethnic status generally displayed lower rates of attendance in ethnic minorities belonging to the most deprived category.
Conclusions:
When seeking to reduce frequent ED attendance by children and young people this study highlights the need for any approach to be multifaceted, nuanced to age or condition specifics and consider social determinants that drive ED use in more deprived areas.
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