Frequent Users of Emergency Departments: Analysis of the Characteristics and Geographical Distribution in a Local Health Authority in Rome, Italy

Background/Objectives: Frequent users (FUs) are defined as patients who repeatedly attend the Emergency Department (ED). This study aims to identify the clinical and social characteristics of FUs in a Local Health Authority in Rome and to quantify and compare the amount of variation in the probability of being FU attributable to General Practitioners (GPs) and Local Health Districts (LHDs). Methods The Healthcare Emergency Information System and an automated database of Lazio region residents were used for the collection of data on the patients' socioeconomic level, GPs, LHD and information about any chronic diseases. Different FU classes (visits ≥4, 5, 7 or 10) were considered in the descriptive analysis. Univariate logistic analysis and a logistic multilevel model were performed for inferential analyses. Results: A total of 89,036 individuals visited at least one of the 13 EDs included in the study. A total of 2.6% of the no FU group had mental illnesses, compared to 7.6% in the FU≥4 group. The OR for becoming an FU increased with the patient's clinical complexity. GP can play an important role in determining FU behavior, while no significant effect was found on the LHD level. Conclusions: This study allows the identification of potential predictive risk factors for disproportionate use of the ED and helps policymakers face the FU phenomenon.