Phd in ADVANCES IN INFECTIOUS DISEASES, MICROBIOLOGY, LEGAL
MEDICINE AND PUBLIC HEALTH SCIENCES

Thesis title: Frequent User in Pronto Soccorso: analisi del profilo e potenziali strategie preventive sul territorio attraverso le nuove piattaforme digitali e le COT distrettuali

Introduction: In recent decades, the progressive aging of the population and the higher levels of urbanisation and pollution are increasing the number of patients suffering from chronic diseases, which has a significant impact on the use of health care services, in particular emergency departments. Frequent users (FUs) are patients who repeatedly and inappropriately attend the Emergency Department (ED) with low-grade symptoms that could be treated outside the hospital setting. This study, preceded by an extensive literature review, aims to identify the clinical and social characteristics of adult and paediatric FUs in a Roman Local Health Authority (LHA), quantify and compare the variation in the probability of being an adult FU attributable to General Practitioners (GPs) and LHA Districts, generate a geographic map of the amount of adult FUs in the LHA Roma 1 area, and describe a pilot study of targeted interventions that an LHA can implement through new chronic disease management models. An additional sub-project was developed to study the association with the phenomenon of bed blockers in two pilot wards of a hospital in the ASL Roma 1. The whole project was authorized by the LHA’s DPO and the “Lazio 1” Ethics Committee. Methods: The Emergency Health Information System and an automated database of residents in the Lazio Region were used for data collection. Record linkage with other platforms was performed using anonymous and automatically de-identified identifiers. A conversion table was generated and then discarded, providing researchers access only to fully anonymized data. Data on patients' socioeconomic status and characteristics of their visits, their clinical conditions, and their geographical distribution were encrypted, using the “Zone Urbanistiche” classification. Different FU thresholds (≥4, 5, 7, or 10 visits/year) were used for descriptive analyses. A univariate logistic analysis and a multilevel logistic model were performed for inferential analyses. Results: A total of 89,036 individuals visited at least one of the 13 EDs included in the study. Mental illness was present in 2.6% of non-FUs compared to 7.6% of FUs with ≥4 visits. The most significant effect was related to the presence of multiple chronic conditions. The greater the patient's clinical complexity, the higher the OR for being a FU. GPs did not appear to play a significant role in determining the behaviour of FUs (MOR 1.18, Wald p = 0.061), and no significant effect was found for LHA Districts either (MOR 1.05, Wald p = 0.127). Regarding the pilot project, 62 patients agreed to participate in the project, and during 2024, 51 patients (82.2% of the sample) had fewer than four visits, qualifying as non-FUs by definition. However, these results cannot be extended to the overall population given the small sample size. Conclusions: This study can be considered a first step towards developing specific public health strategies aimed at improving the appropriate use of healthcare for specific populations and communities. Quantifying and characterizing delayed discharges to inpatient wards and FU attendances in EDs can help policy makers decide on the most optimal way to allocate resources during healthcare planning in health systems, in the continuous search for providing each patient with the right care context, anticipating the needs of specific groups or categories of patients.