Emergency department overuse amongst urban and rural areas: a retrospective decriptive analysis in Southern Tuscany [Differenze di ricorso al pronto soccorso tra aree urbane e rurali: analisi retrospettiva nella Toscana meridionale]

Background. The phenomenon of repeated accesses to the emergency department (ED) by users, the so-called frequent users, is frequent and documented. The totality of the EDs often have to deal with patients who come several times in short periods of time. In this study we try to analyze the characteristics of these users and the differences between the emergency department in rural, zonal or urban areas. Methods. A retrospective observational multicentre analysis was conducted using the access data in 2018 in the EDs of Southern Tuscany. The EDs have been classified into three different categories based on the urbanization of the considered areas. The data were processed using Microsoft Excel and R Project software. A statistical analysis was carried out by calculating the Chi square (χ2). Results. The results show that frequent users have a higher average age, longer stay times in the emergency rooms, an increase in higher priority access codes (yellow and red) and a higher percentage of hospitalizations and transfers; there are not significant differences with respect to the dropout rates. Among the diagnoses, pregnancy and fever are among the most frequent found among frequent users under-65, while among the over-65 there is a significant presence of diagnoses of congestive heart failure. The characterization of frequent users provided basic information on their peculiarities and on the most frequent problems. Conclusions. In order to reduce this phenomenon it is important to study the reasons for access and re-access in the EDs so as to optimally plan the territorial Health Services, develop proper interventions and follow the chronical illness.