Sociodemographic and health behaviour of frequent, avoidable emergency department users in Ontario, Canada: a population-based descriptive study

Introduction — Frequent users are a small but important group of patients in the emergency department (ED). This group is often the target of interventions that redirect visits to other areas of the healthcare system under the premise that some of these visits could be best managed elsewhere. Most existing interventions do not consider sociodemographic factors when targeting specific populations, while larger scale policy initiatives often do not reach those who would most benefit from alternative points of healthcare access. In this study we use population-level survey data linked to health administrative data to describe frequent ED users and those whose visits are potentially avoidable and could benefit from additional points of healthcare access.

Methods — This was a population-based cohort study of responses from 18-74 year-old Ontario residents to the Canadian Community Health Survey from 2001–2014, which we linked to administrative health data for one-year following survey completion. We categorized participants according to the frequency of their ED use in the year following survey date and whether any of their visits were potentially avoidable. Associations between category of ED use and various sociodemographic, health, and behavioural factors were examined with multinomial logistic regression.

Results — A total of 181,369 eligible respondents were included in this study. Of these, 1,460 (0.8%) were frequent users (four or more visits) with one or more potentially avoidable visits in the year following survey date. Compared to non-ED users, frequent users with avoidable visits were associated with the lowest quintile of household income (aOR: 1.91, 95% CI: 1.37, 2.65), rural-dwelling (aOR: 1.44, 95% CI: 1.18, 1.77), and the highest quintile of material resource deprived neighbourhoods (aOR: 2.23, 95% CI: 1.47, 3.36). They were more likely to have poor self-reported physical (17.2% vs 9.0%) and mental health (4.1% vs 2.7%) compared to total cohort, and more likely to have comorbidities (63.3% vs 48.7%), but less likely to access a usual provider of care for their healthcare needs (33.3% vs 28.2% without a usual provider of care).

Conclusion — This study provides a novel description of frequent ED users for whom some of their visits were potentially avoidable. As efforts are made to redesign access to primary and community care, and with increasing emphasis on virtual care and other initiatives to reduce avoidable ED use, the healthcare system should ensure that these interventions are responsive to the needs of the people at higher likelihood of needing them.