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Frequent Users (frequent + user)

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Medical Sciences100%

Selected Abstracts

Epidemiologic Analysis of an Urban, Public Emergency Department's Frequent Users

ACADEMIC EMERGENCY MEDICINE, Issue 6 2000
Joshua H. Mandelberg BA
Abstract. Objectives: To determine how the demographic, clinical, and utilization characteristics of emergency department (ED) frequent users differ from those of other ED patients. Methods: A cross-sectional and retrospective cohort study was performed using a database of all 348,858 visits to the San Francisco General Hospital ED during a five-year period (July 1, 1993, to June 30, 1998). A "frequent user" visited the ED five or more times in a 12-month period. Results: Frequent users constituted 3.9% of ED patients but accounted for 20.5% of ED visits. The relative risk (RR) of frequent use was high among patients who were homeless (RR = 4.5), African American (RR = 1.8), and Medi-Cal sponsored (RR = 2.1). Frequent users were more likely to be seen for alcohol withdrawal (RR = 4.4), alcohol dependence (RR = 3.4), and alcohol intoxication (RR = 2.4). Frequent users were also more likely to visit for exacerbations of chronic conditions, including sickle cell anemia (RR = 8.0), renal failure (RR = 3.6), and chronic obstructive pulmonary disease (RR = 3.3). They were less likely to visit for all forms of trauma (RR = 0.43). Survival analysis showed that only 38% of frequent users for one year remained frequent users the next year. However, 56% of frequent users for two consecutive years remained frequent users in the third year. Conclusions: Frequent use of the ED reflects the urban social problems of homelessness, poverty, alcohol abuse, and chronic illness. Frequent use of the ED shows a high rate of decline from one year to the next. This rate of decline slows after the first year and suggests the existence of a smaller group of chronic frequent users. [source]

Ketamine use, cognition and psychological wellbeing: a comparison of frequent, infrequent and ex-users with polydrug and non-using controls

ADDICTION, Issue 1 2009
Celia J. A. Morgan
ABSTRACT Introduction Preliminary research has indicated that recreational ketamine use may be associated with marked cognitive impairments and elevated psychopathological symptoms, although no study to date has determined how these are affected by differing frequencies of use or whether they are reversible on cessation of use. In this study we aimed to determine how variations in ketamine use and abstention from prior use affect neurocognitive function and psychological wellbeing. Method We assessed a total of 150 individuals: 30 frequent ketamine users, 30 infrequent ketamine users, 30 ex-ketamine users, 30 polydrug users and 30 controls who did not use illicit drugs. Cognitive tasks included spatial working memory, pattern recognition memory, the Stockings of Cambridge (a variant of the Tower of London task), simple vigilance and verbal and category fluency. Standardized questionnaires were used to assess psychological wellbeing. Hair analysis was used to verify group membership. Results Frequent ketamine users were impaired on spatial working memory, pattern recognition memory, Stockings of Cambridge and category fluency but exhibited preserved verbal fluency and prose recall. There were no differences in the performance of the infrequent ketamine users or ex-users compared to the other groups. Frequent users showed increased delusional, dissociative and schizotypal symptoms which were also evident to a lesser extent in infrequent and ex-users. Delusional symptoms correlated positively with the amount of ketamine used currently by the frequent users. Conclusions Frequent ketamine use is associated with impairments in working memory, episodic memory and aspects of executive function as well as reduced psychological wellbeing. ,Recreational' ketamine use does not appear to be associated with distinct cognitive impairments although increased levels of delusional and dissociative symptoms were observed. As no performance decrements were observed in the ex-ketamine users, it is possible that the cognitive impairments observed in the frequent ketamine group are reversible upon cessation of ketamine use, although delusional symptoms persist. [source]

Epidemiologic Analysis of an Urban, Public Emergency Department's Frequent Users

ACADEMIC EMERGENCY MEDICINE, Issue 6 2000
Joshua H. Mandelberg BA
Abstract. Objectives: To determine how the demographic, clinical, and utilization characteristics of emergency department (ED) frequent users differ from those of other ED patients. Methods: A cross-sectional and retrospective cohort study was performed using a database of all 348,858 visits to the San Francisco General Hospital ED during a five-year period (July 1, 1993, to June 30, 1998). A "frequent user" visited the ED five or more times in a 12-month period. Results: Frequent users constituted 3.9% of ED patients but accounted for 20.5% of ED visits. The relative risk (RR) of frequent use was high among patients who were homeless (RR = 4.5), African American (RR = 1.8), and Medi-Cal sponsored (RR = 2.1). Frequent users were more likely to be seen for alcohol withdrawal (RR = 4.4), alcohol dependence (RR = 3.4), and alcohol intoxication (RR = 2.4). Frequent users were also more likely to visit for exacerbations of chronic conditions, including sickle cell anemia (RR = 8.0), renal failure (RR = 3.6), and chronic obstructive pulmonary disease (RR = 3.3). They were less likely to visit for all forms of trauma (RR = 0.43). Survival analysis showed that only 38% of frequent users for one year remained frequent users the next year. However, 56% of frequent users for two consecutive years remained frequent users in the third year. Conclusions: Frequent use of the ED reflects the urban social problems of homelessness, poverty, alcohol abuse, and chronic illness. Frequent use of the ED shows a high rate of decline from one year to the next. This rate of decline slows after the first year and suggests the existence of a smaller group of chronic frequent users. [source]

Comparing Frequent and Average Users of Elementary School-Based Health Centers in the Bronx, New York City

JOURNAL OF SCHOOL HEALTH, Issue 4 2002
Raymundo S. Baquiran
ABSTRACT: This study analyzed health care utilization at three school-based health centers (SBHCs) in the Bronx, New York City, and compared characteristics of "frequent" and "average" service users. Encounter form data for visits by 2,795 students who received services at least once between September 7, 1998, and June 30, 1999, were reviewed. Demographic comparisons between clinic users and the total school population, and between "frequent" (five or more visits/year) and "average" (one to four visits/year) users were made. The two groups also were compared after primary diagnoses were classified into five general categories. Some 96% (3,469/3,614) of students were registered in the SBHCs, of whom 81% (2,795/3,469) used clinic services at least once during the school year. Clinic users did not differ from the general school population by gender, but were younger (p < 0.01). "Frequent" users were more likely than "average" users to be older (p < 0.01), but they did not differ by gender, race/ethnicity, or insurance status. "Frequent" users comprised 28% of the clinic-using population, but accounted for 72.5% of all visits. Similarly, "average" users comprised 72.4% of the clinic-using population, but accounted for 27.5% of all visits. "Frequent" users generated most visits for mental health and chronic medical conditions, while "average" users generated most visits for preventive care, acute medical care, and injuries/emergencies (p < 0.01 for all). Important challenges for elementary SBHCs include developing new approaches that meet children's needs while protecting clinic resources, like scheduling group interventions for those with on-going health care needs who require frequent use of school health services. [source]

Epidemiologic Analysis of an Urban, Public Emergency Department's Frequent Users

ACADEMIC EMERGENCY MEDICINE, Issue 6 2000
Joshua H. Mandelberg BA
Abstract. Objectives: To determine how the demographic, clinical, and utilization characteristics of emergency department (ED) frequent users differ from those of other ED patients. Methods: A cross-sectional and retrospective cohort study was performed using a database of all 348,858 visits to the San Francisco General Hospital ED during a five-year period (July 1, 1993, to June 30, 1998). A "frequent user" visited the ED five or more times in a 12-month period. Results: Frequent users constituted 3.9% of ED patients but accounted for 20.5% of ED visits. The relative risk (RR) of frequent use was high among patients who were homeless (RR = 4.5), African American (RR = 1.8), and Medi-Cal sponsored (RR = 2.1). Frequent users were more likely to be seen for alcohol withdrawal (RR = 4.4), alcohol dependence (RR = 3.4), and alcohol intoxication (RR = 2.4). Frequent users were also more likely to visit for exacerbations of chronic conditions, including sickle cell anemia (RR = 8.0), renal failure (RR = 3.6), and chronic obstructive pulmonary disease (RR = 3.3). They were less likely to visit for all forms of trauma (RR = 0.43). Survival analysis showed that only 38% of frequent users for one year remained frequent users the next year. However, 56% of frequent users for two consecutive years remained frequent users in the third year. Conclusions: Frequent use of the ED reflects the urban social problems of homelessness, poverty, alcohol abuse, and chronic illness. Frequent use of the ED shows a high rate of decline from one year to the next. This rate of decline slows after the first year and suggests the existence of a smaller group of chronic frequent users. [source]

Factors affecting participation in Sure Start programmes: a qualitative investigation of parents' views

HEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 3 2007
Mark Avis BA(Hons) MSc RN RNT Cert Ed
Abstract The objectives of the present study were to examine the factors that parents identify as promoting or hindering participation in Sure Start programmes, and to identify methods for enhancing parents' engagement with Sure Start. A qualitative, in-depth interview study was conducted with parents registered with two local Sure Start programmes based in the East Midlands, UK, and located in inner city areas with a range of health and social problems associated with social exclusion and disadvantage. Sixty parents, guardians or carers of children living in both Sure Start areas were recruited during autumn of 2004 on the basis of whether they were identified as a ,frequent user' or ,non-frequent user' of Sure Start services. The data were analysed using a thematic approach supported by NVivo computer software, and explanatory themes were subsequently tested for completeness and adequacy. The results of the study indicated that parents who used Sure Start services were positive about the benefits that they obtained for themselves and their children, in particular in overcoming a sense of isolation. Parents who were non-frequent users identified a number of practical reasons that prevented them using Sure Start services, although parents also recognised a loss of confidence and trust in the local communities summarised in the phrase ,keeping myself to myself'. Parents' awareness of the targeted nature of Sure Start can also lead to stigma and reluctance to use services. It is concluded that continued investment of time and effort in maintaining communication networks between Sure Start staff and local parents is vital if parents and children are to make the best use of Sure Start services. [source]

Cancer risk from diagnostic radiology in a deliberate self-harm patient

ACTA PSYCHIATRICA SCANDINAVICA, Issue 5 2010
L. J. Norelli
Norelli LJ, Coates AD, Kovasznay BM. Cancer risk from diagnostic radiology in a deliberate self-harm patient. Objective:, Patients who engage in recurrent deliberate self-harm (DSH) behaviours have increased morbidity and mortality and use emergency services more than others. Unrecognized iatrogenic injury may play a role. Specifically, we call attention to the potential danger of cumulative radiation exposure. Method:, Case presentation and discussion. Results:, A 29-year-old woman with multiple episodes of deliberate foreign body ingestion received over 400 diagnostic radiology examinations during a 12 year period. The patient's calculated total radiation dose reached an average of 20.5 mSv per year, a dose comparable to atomic bomb survivors and nuclear industry workers, populations in which there is a significant excess cancer risk. Conclusion:, Patients with recurrent self-injurious behaviours, frequent users of healthcare services who often undergo repeated medical assessment and treatment, are likely at higher risk for iatrogenic adverse events. Multiple diagnostic radiology examinations have recently come under scrutiny for causing increased lifetime risk of cancer. Healthcare providers, in particular psychiatrists and emergency department physicians, should consider the cumulative risks of radiological procedures when assessing and treating patients with DSH. [source]

Consequences of chronic ketamine self-administration upon neurocognitive function and psychological wellbeing: a 1-year longitudinal study

ADDICTION, Issue 1 2010
Celia J. A. Morgan
ABSTRACT Background ,Recreational' use of ketamine is spreading rapidly among young people. In healthy individuals an acute dose of the N-methyl D-aspartate (NMDA) receptor antagonist ketamine induces marked psychosis-like effects and cognitive impairments, but little is known about the long-term effects of the drug. Aims To evaluate the long-term neuropsychiatric or cognitive consequences. Methods A total of 150 individuals were assessed, 30 in each of five groups: frequent ketamine users, infrequent ketamine users, abstinent users, polydrug controls and non-users of illicit drugs. Twelve months later, 80% of these individuals were re-tested. Results Cognitive deficits were mainly observed only in frequent users. In this group, increasing ketamine use over the year was correlated with decreasing performance on spatial working memory and pattern recognition memory tasks. Assessments of psychological wellbeing showed greater dissociative symptoms in frequent users and a dose,response effect on delusional symptoms, with frequent users scoring higher than infrequent, abstinent users and non-users, respectively. Both frequent and abstinent using groups showed increased depression scores over the 12 months. Conclusions These findings imply that heavy use of ketamine is harmful to aspects of both cognitive function and psychological wellbeing. Health education campaigns need to raise awareness among young people and clinicians about these negative consequences of ketamine use. [source]

Ketamine use, cognition and psychological wellbeing: a comparison of frequent, infrequent and ex-users with polydrug and non-using controls

ADDICTION, Issue 1 2009
Celia J. A. Morgan
ABSTRACT Introduction Preliminary research has indicated that recreational ketamine use may be associated with marked cognitive impairments and elevated psychopathological symptoms, although no study to date has determined how these are affected by differing frequencies of use or whether they are reversible on cessation of use. In this study we aimed to determine how variations in ketamine use and abstention from prior use affect neurocognitive function and psychological wellbeing. Method We assessed a total of 150 individuals: 30 frequent ketamine users, 30 infrequent ketamine users, 30 ex-ketamine users, 30 polydrug users and 30 controls who did not use illicit drugs. Cognitive tasks included spatial working memory, pattern recognition memory, the Stockings of Cambridge (a variant of the Tower of London task), simple vigilance and verbal and category fluency. Standardized questionnaires were used to assess psychological wellbeing. Hair analysis was used to verify group membership. Results Frequent ketamine users were impaired on spatial working memory, pattern recognition memory, Stockings of Cambridge and category fluency but exhibited preserved verbal fluency and prose recall. There were no differences in the performance of the infrequent ketamine users or ex-users compared to the other groups. Frequent users showed increased delusional, dissociative and schizotypal symptoms which were also evident to a lesser extent in infrequent and ex-users. Delusional symptoms correlated positively with the amount of ketamine used currently by the frequent users. Conclusions Frequent ketamine use is associated with impairments in working memory, episodic memory and aspects of executive function as well as reduced psychological wellbeing. ,Recreational' ketamine use does not appear to be associated with distinct cognitive impairments although increased levels of delusional and dissociative symptoms were observed. As no performance decrements were observed in the ex-ketamine users, it is possible that the cognitive impairments observed in the frequent ketamine group are reversible upon cessation of ketamine use, although delusional symptoms persist. [source]

Epidemiologic Analysis of an Urban, Public Emergency Department's Frequent Users

ACADEMIC EMERGENCY MEDICINE, Issue 6 2000
Joshua H. Mandelberg BA
Abstract. Objectives: To determine how the demographic, clinical, and utilization characteristics of emergency department (ED) frequent users differ from those of other ED patients. Methods: A cross-sectional and retrospective cohort study was performed using a database of all 348,858 visits to the San Francisco General Hospital ED during a five-year period (July 1, 1993, to June 30, 1998). A "frequent user" visited the ED five or more times in a 12-month period. Results: Frequent users constituted 3.9% of ED patients but accounted for 20.5% of ED visits. The relative risk (RR) of frequent use was high among patients who were homeless (RR = 4.5), African American (RR = 1.8), and Medi-Cal sponsored (RR = 2.1). Frequent users were more likely to be seen for alcohol withdrawal (RR = 4.4), alcohol dependence (RR = 3.4), and alcohol intoxication (RR = 2.4). Frequent users were also more likely to visit for exacerbations of chronic conditions, including sickle cell anemia (RR = 8.0), renal failure (RR = 3.6), and chronic obstructive pulmonary disease (RR = 3.3). They were less likely to visit for all forms of trauma (RR = 0.43). Survival analysis showed that only 38% of frequent users for one year remained frequent users the next year. However, 56% of frequent users for two consecutive years remained frequent users in the third year. Conclusions: Frequent use of the ED reflects the urban social problems of homelessness, poverty, alcohol abuse, and chronic illness. Frequent use of the ED shows a high rate of decline from one year to the next. This rate of decline slows after the first year and suggests the existence of a smaller group of chronic frequent users. [source]

Hospital care of people living in residential care facilities: Profile, utilization patterns and factors impacting on quality and safety of care

GERIATRICS & GERONTOLOGY INTERNATIONAL, Issue 3 2007
Sanjay Jayasinghe
Background: Residents in residential care facilities (RCF) are frequent users of acute hospital services. However, the interface between the two sectors remains relatively unexplored. Our objective was to determine the patterns of utilization, characteristics and experiences of RCF residents accessing a tertiary referral center (TRC). Methods: An observational study of RCF residents presenting to the TRC emergency department (ED). The experiences of acute care services were explored for more than one-quarter of this group 2,3 days postdischarge. The carer within the RCF acted as the proxy respondent. Results: During the study period, RCF residents accounted for 2.3% of all ED presentations. These presentations involved 526 residents. The dimension "continuity of care" for the Picker Patient Experience questionnaire had the highest proportion (53.1%) reporting a problem. The likelihood of reporting a problem for "continuity of care" (odds ratio [OR], 3.58; confidence interval [CI], 1.72,7.45) and "information and education" (OR, 2.62; CI, 1.14,3.01) were higher if the resident was admitted to a ward compared to ED only. If the resident had a low level care status the likelihood of reporting a problem for "continuity of care" (OR, 2.8; CI, 1.02,7.72) also increased. The odds of RCF staff reporting a problem for "ambulance service" were significantly higher if the resident's presentation was related to a fall. (OR, 3.35; CI, 1.28,8.8). Conclusion: The utilization rates for acute hospital care in our study were similar to the two previous Australian studies. Factors at the patient and organizational level impacted significantly on problems relating to the quality and safety of care being reported. [source]

Survey findings on characteristics and health status of clients treated by the federally funded (US) Health Care for the Homeless Programs

HEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 1 2009
Cheryl Zlotnick RN DrPH
Abstract For almost two decades, the US Health Care for the Homeless (HCH) Program has funded clinics across the country for homeless populations. Between October and December 2003, for the first time ever, a nationally representative sample of the almost 200 HCH clinics with a response rate of approximately 71% (the HCH User Visit Survey) was created to examine the health status of its users (n = 1017). This study employed the HCH User Visit Survey's cross-sectional data set to evaluate health indicators of individuals using HCH Services with the US population, and compare individuals who reported they routinely used HCH clinics (,usual' HCH users) to those who did not (,non-usual' users). HCH users had poorer health status than the US population (44.0% versus 12.3%, respectively). Usual HCH users had similar healthcare status compared to non-usual users, but were more likely to be uninsured, non-English speakers, and walking or taking public transportation to their medical appointments. Usual versus non-usual HCH users were also more apt to have slept in cars, buses or on the streets in the week prior to the survey (14.8% versus 4.3%, respectively). This study shows that the HCH clinics are serving homeless individuals who have a variety of complex health and psychosocial needs, and its most frequent users are those who experience the most barriers accessing care. [source]