Les grands utilisateurs de services d'urgence avec conditions chroniques propices aux soins ambulatoires : bien identifier la clientèle complexe à risque pour mieux intervenir


Catherine Hudon

Université de Sherbrooke


Domaine : Services de santé

Programme : Recherches sur l'urgence et le continuum des soins - Volet 1

Concours 2016-2017

Frequent users of emergency services (FU) represent a low proportion of patients who account for a large number of emergency room visits. Several of these FU have chronic conditions which should be adequately managed in ambulatory primary care, but also have psychological and/or social problems, creating a complexity which interferes with usual care and can cause an inappropriate use of emergency services. Case management (CM) is recognized as an appropriate intervention to improve the quality of life and reduce costs associated with FU. However, the challenge of clearly identifying the complex clientele at risk of becoming a major user of emergency services remains a critical issue.

The objectives of this research project are, in an adult population with chronic conditions, to: 1) Describe the FU of emergency services clientele and identify personal, organizational and contextual determinants predicting a frequent use of emergency services following a first visit to the emergency department; 2) Develop and validate a clinical tool to identify complex patients at risk of becoming FU. Regression analysis models will be used to identify factors predicting the likelihood of being a FU. These factors will then be used to develop a clinical tool that will be evaluated among 623 adult patients with chronic diseases in the 15 emergency departments in the Centres intégrés universitaires de santé et de services sociaux of Estrie and Saguenay-Lac-St-Jean regions.

The new evidence will inform decision-makers on how to better identify patients requiring particular monitoring and follow-up in primary care, such as a case management intervention.