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Conclusions
In conclusion, our results suggest that frequent and super-frequent ED users in the US are a vulnerable group of individuals with Medicaid insurance, of lower socioeconomic status and with significant chronic medical and mental health conditions. In an attempt to reduce healthcare costs, several interventions have been designed and implemented to divert frequent users from the ED to primary care services. In our study, we were unable to evaluate whether or not the ED visits made by these groups of patients were appropriate or inappropriate, although our data suggest that these patients have an established primary care provider (as illustrated by the high number of outpatient visits) and health insurance. Given previous studies suggesting patients with Medicaid face significant barriers in accessing primary care services in a timely fashion, we believe that interventions aimed at improving overall individual health and increasing access to primary care services, including same day appointments during acute illnesses, may prove more effective in reducing the frequency of ED visits in the USA. Future interventions, such as patient navigation, that account for individual level factors may be more effective at reducing frequent ED utilisation.
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