Psychosocial factors associated with frequent emergency department utilization across co-occurring medical conditions

Background:

Frequent emergency department (ED) utilization burdens the health care system.  Many patients present with medical and psychiatric comorbidities, but examination of underlying psychosocial challenges is lacking.

Objectives:

We examined the prevalence of co-occurring medical conditions and psychosocial factors associated with ED utilization in an academic, urban hospital.

Methods:

We conducted a retrospective chart review of ED patients treated between October 2013 and October 2014.  Patients had four or more ED visits annually and had been evaluated by an ED social worker using validated medical, psychiatric and psychosocial instruments.

Results:

Average age was 45 (SD=14.9) years, and 58% of patients were female.  84% were African American and 10% were Hispanic. Common medical conditions were hypertension (HTN) (66%), sickle cell disease (SCD) (20%), diabetes (26%), and asthma (16%).  Many patients had multiple conditions.  SCD patients had the greatest prevalence of low medication adherence (66%), compared to asthma (55%), HTN (50%), and diabetes (43%).  Asthma patients exhibited much higher levels of depression (62%) and anxiety (56%) than other conditions.  Prevalence of low social support was also highest amongst asthma patients (19%), compared to HTN (13%), SCD (10%), and diabetes (9%).

Conclusions:

Multiple psychosocial factors that are not typically addressed during an ED visit were found in this population. These results suggest a high prevalence of medical and psychiatric comorbidity with psychosocial complexities, especially amongst asthma and SCD patients.  There is a need for more comprehensive medical and behavioral intake assessments with an integrated care coordination intervention to facilitate person-centered pathways to care.