These data are consistent with observations from studies undertak

These data are consistent with observations from studies undertaken overseas [1,7,12,13]. In particular, we observed that one-quarter of FPs presented with either a psychiatric or respiratory complaint, suggesting that these two diagnosis groups may be the focus of particular interventions to reduce re-attendance. In addition to these diagnostic patient groups the study identified psychosocial Inhibitors,research,lifescience,medical factors that should be

addressed in any approach for this vulnerable population. There are many negative associations with FPs who are often labelled as ‘frequent flyers’. The complexities of their health care needs may be overlooked due to various misconceptions. Frequent Presenters may be perceived as time consuming, illegitimate users of the ED, leading to the development of staff indifference towards Inhibitors,research,lifescience,medical these patients [10]. There may be a tendency to divert frequent ED presenters to general practice to address their complex health care needs. However, previous epidemiologic studies suggest that these patients are not general practice patients, and that simple diversion to primary health care is not the answer in many cases [15,17]. In fact, frequent ED presenters may be better cared for when they attend an ED that is supported by a multidisciplinary

team providing medical, nursing, allied health and mental health Inhibitors,research,lifescience,medical assessment in a collaborative and timely way. This includes liaison with GPs, ambulance services, case managers, family members and other community care providers. Frequent presenters not only have a significant impact on the use of ED resources but also may have an impact on the utilisation of pre-hospital resources. This is evidenced by the large percentage Inhibitors,research,lifescience,medical of FPs that arrived via ambulance in our study. Interestingly, Ambulance Inhibitors,research,lifescience,medical Victoria has developed a referral service for patients who are frequent callers for transport to hospital in an attempt to reduce unnecessary utilisation of acute care ambulances for patient transport (Ambulance Victoria, Referral Service). Emergency department case management of FPs has been reported to increase MEK inhibitor attendances in some studies

[15]. However, these studies excluded large FP populations who already received case management support. They demonstrated that multidisciplinary case management has been shown to Thymidine kinase have a positive effect on psychosocial factors for FPs. Similarly, individual care plans for specific patient groups reduce hospital admissions and decrease the number of investigations carried out in selected patients [19]. In addition to ED care plans, targeted interventions may also be effective in reducing FPs [9,10,13,20,21]. Development of care plans to address gaps in service delivery may be warranted. These particularly include understanding the complex psychosocial needs of chronic psychiatric and respiratory frequent presenters that are frequently neglected despite multiple ED visits.

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