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

## TL;DR

This study examines frequent users of emergency departments in Rome, identifying their characteristics and how general practitioners influence their behavior.

## Contribution

The study quantifies the role of GPs and LHDs in determining frequent ED use for the first time in this context.

## Key findings

- Mental illness was more common in frequent users compared to non-frequent users.
- Higher clinical complexity was associated with a greater likelihood of being a frequent user.
- General Practitioners significantly influenced frequent ED use, but Local Health Districts did not.

## Abstract

Background/Objectives: Frequent users (FUs) are patients who repeatedly attend Emergency Departments (EDs). 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 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 status, GP, LHD and chronic diseases. Different FU thresholds (attendances ≥4, 5, 7 or 10) were used for descriptive analyses. Univariate logistic analysis and a multilevel logistic model were performed for inferential analyses. Results: A total of 89,036 individuals attended at least one of the 13 EDs included in the study. Mental illness was present in 2.6% of non-FUs compared with 7.6% of FUs with ≥4 attendances. The OR of being FU increased with higher clinical complexity. GP appeared to play an important role in determining FU behavior, while no significant effect was found on the LHD level. Conclusions: This study identified potential risk factors predictive of disproportionate ED use and may help policymakers address the FU phenomenon.