# Frequent emergency department users in Finnish public healthcare – a nationwide registry-based study

## TL;DR

This study identifies frequent emergency department users in Finland and finds that older, multimorbid patients with chronic conditions are most likely to use EDs repeatedly.

## Contribution

The study provides a nationwide characterization of frequent ED users in Finland and identifies key predictors and chronic conditions associated with frequent use.

## Key findings

- Frequent ED users accounted for 24.3% of all ED visits despite representing only 1.4% of users.
- Multimorbidity and prior ED use were the strongest predictors of frequent ED use.
- Chronic conditions like psychiatric disorders and hypertension were most associated with frequent ED visits.

## Abstract

Frequent users of emergency departments (ED) often have complex healthcare needs and chronic conditions, contributing markedly to the overall ED burden. This study aimed to characterise frequent ED users in Finnish public healthcare and study frequent ED use among patients with chronic diseases.

This was a nationwide registry-based cross-sectional analysis using national register data from the Finnish Care Register and Statistics Finland, we analysed all adults (≥ 18 years) who used public healthcare services in 2018 (N = 3.05 million). ED users were classified as frequent (≥ 4 visits/year) or infrequent. Logistic regression assessed associations between frequent ED use and variables including age, sex, region, multimorbidity, and prior healthcare use. Spearman correlation evaluated associations with 2017 service use.

In 2018, 1.4% (41,880 individuals) were frequent users, contributing 24.3% of all ED visits. Frequent users were older (mean age 65 vs. 55 years) and more often multimorbid (30.5% vs. 10.1%) than infrequent users. Prior ED use was the strongest predictor of future frequent use (Odds Ratio (OR) 22.43). Multimorbidity increased the odds of frequent ED use (OR 4.26; 95% CI: 4.15–4.38, p < 0.001). Psychiatric and behavioural disorders related to substance abuse (14.4%), chronic kidney disease (6.5%) were among the conditions with the most frequent ED use. The most common patients among all ED users were those with hypertensive diseases (21.9%), other diseases of the heart and pulmonary circulation (10.3%), and they also had a high prevalence of frequent ED use 2.9% and 5.6% respectively.

A subgroup analysis of frequent ED users, particularly those with multimorbidity and chronic cardiac, pulmonary, or psychiatric conditions, can inform policies for integrated care and resource allocation. Targeted interventions and improved coordination across primary, specialised, and social care could reduce ED use and overall system burden.

The online version contains supplementary material available at 10.1186/s12913-026-14049-5.