A patient is considered a super-frequent user if they visit the ER at least 10 times a year, explained Jennifer Peltzer-Jones, R.N., Psy.D., a clinical psychologist at Detroit’s Henry Ford Hospital’s Department of Emergency Medicine and the study’s lead author.
She notes that emergency room doctors have long theorized that patients who frequent the ER are addicts, but few studies have measured the rate of addiction in these patients.
What she found:
- 77 percent of patients had a substance abuse addiction;
- 47 percent were addicted to pain-relief narcotics such as Vicodin and Dilaudid;
- 44 percent were addicted to illegal drugs, such as cocaine or marijuana, and;
- 35 percent were addicted to alcohol.
The researchers also found it was more common for women to be super-frequent users seeking pain-relief narcotics at the ER.
“Emergency Departments cannot address the super-frequent users problem without addressing the underlying reason they’re here — their substance abuse problem,” said Peltzer-Jones.
“Boosting federal and state funding for substance abuse programs could help alleviate some of the frequent use of Emergency Departments as sources of addiction care.”
According to the federal Drug Abuse Warning Network, an estimated 2.5 million ER visits involved drug misuse or abuse in 2011. ER visits involving drug misuse or abuse jumped 19 percent from 2009-11, researchers noted.
For their study, Peltzer-Jones and her team of researchers sought to examine the level of addiction of 255 super-frequent users who sought care at Henry Ford’s Emergency Department from 2004-2013. They also wanted to determine whether imposing prescribing guidelines for narcotics affected the number of patients seeking those medications.
In 2004, the hospital created the Community Resources for Emergency Department Overuse (CREDO) to manage the increased frequent users in the ER with individual care plans.
After reviewing data from each of the patients’ electronic medical record, researchers found that CREDO had a significant impact. Before CREDO was initiated, the super-frequent users sought care in the ER 32.4 times a year.
Since it was initiated, the number of visits to the ER of super-frequent users who sought pain-relief narcotics dropped to 13.8 visits. For other super-frequent users, visits dropped to 11.6 visits a year from 33, according to the researchers.
“Emergency Departments that implement case management initiatives can make meaningful progress in addressing their frequent-user patient population,” Peltzer-Jones says. “As our study showed, the number of frequent users visiting the ED for narcotics is alarming.
“A successful remedy to curtailing that problem is implementing case management strategies such as ours. However, if Emergency Departments don’t have the resources to create a program, instituting narcotic prescribing guidelines may lead to decreased visits by frequent users.”
The study, funded by Henry Ford Hospital, was presented at the Society for Academic Emergency Medicine (SAEM) annual meeting in Dallas.
Source: Henry Ford Health System