Frequent Attenders of the Emergency Department: Patients’ Perspectives and Impact of a Multidisciplinary Case Management Intervention in Reducing Attendance

Background

Recent literature shows that multidisciplinary case management (MDCM) is the most cost-effective intervention in reducing emergency department (ED) overutilization by frequent attenders (FAs). It is unclear whether we can extrapolate this finding to a Singapore-based practice in light of the differences between healthcare systems and social structures.

Objectives

Our objectives were understand from the FA's perspective the reasons behind frequent ED visits and determine the clinical effectiveness of MDCM intervention in reducing ED visits by FAs at a tertiary hospital in Singapore.

Methods

We conducted a two-stage pilot study that involved prospective recruitment of eligible patients for a qualitative study via face-to-face in-depth interviews and subsequent random assignment of these patients into a dual-arm randomized control trial with MDCM intervention.

Results

We recruited 40 patients (67.5% male, mean age = 58.25 years) between June 2014 and March 2015. Six main themes on why FAs chose to visit ED emerged: free/subsidized consultation, convenience, perceived better quality of care, perceived emergencies, third party's advice, and health services issues. Interim data analysis was conducted after 6 months’ follow-up. The median percentage reduction of ED visits between control arm (50%, IQR = –80.00 to –5.00) and MDCM intervention arm (50%, IQR = –76.70 to 30.00) showed no significant difference (95% CI, p = 0.461).

Conclusion

While we discovered six major themes on patient's perspective of reasons behind frequent ED visits, the ability of MDCM intervention to reduce ED visits by FAs was not seen in the initial 6-month interim analysis. Further research in FA subgroups is needed to develop more targeted interventions.

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