In 1975, the medical staff at Glasgow's Western Infirmary suggested a study of patients making frequent and inappropriate use of the hospital IS acute receiving area. The staff claimed that these patients seldom had acute medical problems; they wasted the doctors I time; and consumed a substantial amount of hospital resources. The staff wondered what prompted the behaviour of these patients and whether they could be better managed in the future. In order to identify the frequent and inappropriate users of the acute receiving area, we reviewed the past acute attendances of the 3,284 patients in our patient sample. As we had no objective measures of inappropriate patient behaviour, we used the frequency of presentation as our sole selection criterion. knowinq that any frequent and inappropriate users would thereby be included. After samplinq the patient records. we defined frequent attendance as six or more acute attendances between 1st January 1970 - 31st July 1975, a 5 year 7 month study period. We found 150 (5%) of the 3,284 patients studied had been frequent attenders. We looked for ways to identify the frequent attenders at presentation but found no significant difference in age. sex. or presenting complaint between the frequent attenders and the 3.284 patients sampled. We then used these characteristics (age. sex, and presenting complaint) to select matched controls from the patient sample for each of the 120 frequent attenders who proved available for interview. We found inappropriate use of the acute receiving area mentioned in all but two of the 120 frequent attender records and 68% of the frequent attenders' acute presentations were attributed to inappropriate patient behaviour. While few (12%) frequent attenders were diagnosed as having greater medical problems than their matched controls, psychological problems were diagnosed in 77% of the frequent attenders in contrast to only 22% of the controls. The patients· answers at interview showed frequent attendance strongly associated with a number of background variables, with no single variable proving pathognomonic of frequent attenders. We found that, on average, the frequent attenders had greater health, housing, and employment problems, greater difficulties in relating to others, and were more accident-prone than their matched controls. We found most of the acute receiving area costs to be fixed costs and thought little would have been saved had the frequent attenders not presented. We thought the amount of hospital resources consumed by the frequent attenders was too small to. adversely affect other patients. Our study showed that a small number of frequent and inappropriate users of the acute receiving area indeed existed at the Western Infirmary. However, we thought that little could be done either to alter the social and psychological factors we found associated with frequent attendance or to prevent future acute attendances by these patients. At a hospital level, we thought the costs and risks involved in excluding the frequent attenders were outweighed by the benefits of simply treating these patients. At a community level, we thought that seeing the frequent attenders on demand in the acute receiving area was an efficient and relatively inexpensive way of supporting and maintaining these patients in the community.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:352635 |
| Date | January 1983 |
| Creators | McArdle, Christine Grizel |
| Publisher | University of Glasgow |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
| Source | http://theses.gla.ac.uk/4073/ |
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