Psychiatric status, somatisation, and health care utilization of frequent attenders at the emergency department A comparison with routine attenders

Seventy-seven frequent attenders at an emergency department (ED) in an inner-city hospital in the UK (defined as seven or more visits in the previous 12 months) were compared with 182 patients who were attending the same department on a routine basis. Patients completed the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) and the Short Form (SF)-36. Information was obtained on 64% of the frequent attenders and 45% underwent a detailed psychiatric assessment. Of the frequent attenders, 45% had psychiatric disorder and 49% had some form of an alcohol-related disorder. Compared with routine attenders, frequent attenders reported lower health status, had more psychiatric disorder (odds ratio: OR = 8.2, 95% confidence interval: CI = 3.8-18.1), had more general hospital admissions (OR = 19.9, 95% CI = 8.3-47.8), more psychiatric admissions (OR = 167.5, 95% CI = 9.5-2959.0), and more GP visits (95% CI for difference = - 10.2 to - 5.7). There was no evidence that frequent attenders had more somatisation than routine attenders. Specific treatment and management strategies need to be developed for this group of patients, although a substantial proportion may be difficult to engage in the treatment process. © 2001 Elsevier Science Inc. All rights reserved.