• Fabrice Althaus, Stephanie Stucki, Sophie Guyot, Lionel Trueb, Karine Moschetti, Jean-Bernard Daeppen, and Patrick Bodenmann.
• aVulnerable Population Unit, Department of Ambulatory Care and Community Medicine, University of Lausanne & Lausanne University Hospital (CHUV) bDepartment of Community Medicine and Public Health cEmergency Service dTechnology Assessment Unit (UET) eAlcohol Treatment Centre, Lausanne University Hospital (CHUV) fAddiction Switzerland gInstitute of Health Economics and Management (IEMS), University of Lausanne, Lausanne, Switzerland.
• Eur J Emerg Med. 2013 Dec 1;20(6):413-9.

ObjectivesThe aim of this study was to describe the demographic, social and medical characteristics, and healthcare use of highly frequent users of a university hospital emergency department (ED) in Switzerland.MethodsA retrospective consecutive case series was performed. We included all highly frequent users, defined as patients attending the ED 12 times or more within a calendar year (1 January 2009 to 31 December 2009). We collected their characteristics and calculated a score of accumulation of risk factors of vulnerability.ResultsHighly frequent users comprised 0.1% of ED patients, and they accounted for 0.8% of all ED attendances (23 patients, 425 attendances). Of all highly frequent users, 87% had a primary care practitioner, 82.6% were unemployed, 73.9% were socially isolated, and 60.9% had a mental health or substance use primary diagnosis. One-third had attempted suicide during study period, all of them being women. They were often admitted (24.0% of attendances), and only 8.7% were uninsured. On average, they cumulated 3.3 different risk factors of vulnerability (SD 1.4).ConclusionHighly frequent users of a Swiss academic ED are a highly vulnerable population. They are in poor health and accumulate several risk factors of being even in poorer health. The small number of patients and their high level of insurance coverage make it particularly feasible to design a specific intervention to approach their needs, in close collaboration with their primary care practitioner. Elaboration of the intervention should focus on social reinsertion and risk-reduction strategies with regard to substance use, hospital admissions and suicide.

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