March 2003 Frequent attenders to Irish Emergency Departments: they will always be with us

The problems of Irish Emergency Departments have received much publicity recently. An often-suggested solution is for frequent Emergency Department attenders to be encouraged to attend their general practitioner and other community based services. A paper just published by Irish researchers in the prestigious American Annals of Emergency Medicine shows this to be simplistic, as such patients are already frequent attenders to their general practitioner and other community services.

In addition, the study confirms that these patients are a psychosocially vulnerable group with multiple needs. This is the first study in Ireland to have followed such patients from the Emergency department (ED) to the community. The report found that frequent attenders to Emergency Departments:

• Made heavy use of other health services. They had visited their general practitioner more frequently and were more likely to have used public health nursing services, community welfare services, social work services, addiction counselling, and psychiatric services in the previous year compared to non-frequent ED attenders.
• Made more other hospital visits and had spent more nights in the hospital than non-frequent attenders.
• Had poorer psychological well-being, as measured by the General Health Questionnaire – 12 (QHQ 12), than non-frequent ED attenders.
• Reported lower levels of perceived social support.
• Were more likely to have presented with psychological problems
• Alcohol and drug use were much more frequently reported in the medical charts of ED frequent attenders compared to non-frequent ED attenders.

The study was carried out in the ED of St James's Hospital Dublin, comparing a group of 100 frequent attenders to the ED with a group of 100 non-frequent attenders in terms of their general health service use and their clinical, psychological and social profiles. Patients were interviewed as they attended the ED, and patients' general practitioners were contacted to validate attendance data. Patients' medical charts were searched for evidence of psychological problems and alcohol or drug abuse.

Ms Molly Byrne of NUI Galway said that 'this is further evidence that ED frequent attenders complement, rather than substitute, such heavy use of ED with heavy use of both primary and hospital services'. Mr Patrick K Plunkett, St. James's Hospital, noted that 'these patients are a psychosocially vulnerable group. It is important that service providers and policy makers take this vulnerable patient profile into account, as they endeavour to meet the service needs of these patients, as well as deal with resource problems in the country's Emergency Departments'.

The study was carried out by Ms Molly Byrne and Prof Andrew Murphy of the Department of General Practice, NUI, Galway; Drs Patrick Plunkett and Alistair Murray, of the Department of Emergency Medicine, St James's Hospital, Dublin; Prof Hannah Mc Gee, of the Health Services Research Centre, Department of Psychology, Royal College of Surgeons in Ireland and Prof Gerry Bury, of the Department of General Practice, UCD.

This study is published in the March issue of Annals of Emergency Medicine and is available on the Annals Web site (www.mosby.com/AnnEmergMed).

For further information please contact: Máire Mhic Uidhir, Press Officer, NUI Galway. Tel. 091-750418; 087-2986592
Ms Molly Byrne, Department of General Practice, NUI Galway. Tel. 091-512