Hyperusers and emergency.

Abstract

The emergency service is the source of medical assistance for users in need of other medical care. The hyperusers make substantial part of the emergency services and their impact on the health system is unknown.To know the pattern of the emergency unit (UU) of Espinho's Hospital used by frequent visitors and compare them with infrequent visitors.In a retrospective study of cases and controls in the year 2006, were evaluated episodes of the emergency unit, defining hyperusers who attended UU in four or more occasions. The UU works twenty four hours a day, with a staff of two general physicians and in front of it functions the centre of primary care, twelve hours a day in five days a week. The variables analyzed were: sex, age, cause of admission administrative, time of admission and discharge, destination and procedures.The number of attendances was 36715 made by 19525 patients. The hyperusers represented 9.7% of all patients and accounted for 33.2% of visits to the unit. Infrequent UU users were younger (36,7 vs. 45,2 years p < 0.001) than frequent users to urgent care and search more times for traumatic disease (23,5% vs. 12,1% p < 0.001).The determinants associated with the hyperusers were hospitalization (OR = 3.38, CI = 2.89 to 3.95), the old age group (OR = 2.44, CI = 2.32 to 2.57) and medical disease (OR = 2.23, CI = 2.09 to 2.30).The profile of hyperuser of UU is the elderly in need of hospitalization because of medical illness. It's important to these patients an effective communication and coordination of care between UU and primary care settings, that can improve the continuity of care.