PSYCHOSOCIAL DIFFICULTIES AND EMERGENCY DEPARTMENT USE

Objective: To determine whether psychosocial difficulties are more pre valent among ambulatory patients using the ED for nonemergent complain ts as compared with ambulatory patients having emergent complaints. Me thods: A survey of noncritical ED patients was performed using anonymo us questionnaires addressing psychosocial difficulties: psychiatric il lness, educational level, homelessness, alcohol and/or drug dependency (CAGE and DAST surveys), and depression (DSM-III criteria), Three ind ependent physicians ranked each patient's chief complaint as either em ergent or appropriate for primary care. The majority ranking was used to determine whether the complaint was emergent. Groups with and witho ut specific psychosocial difficulties were compared for their proporti on of emergent vs primary care complaints. Results: Of 700 patients, 3 67 (52%) met criteria for greater than or equal to 1 psychosocial diff iculty [acute psychosis-36 (5%), illiteracy-139 (20%), homelessness-45 (6%), alcohol dependency-111 (16%), drug dependency-66 (9%), and depr ession-130 (19%)]. There were 379 (54%) ED visits considered emergent. Patient groups with vs without greater than or equal to 1 psychosocia l difficulty had similar rates of emergent visits (58% vs 50%, p = 0.0 4), Emergent visit rates also were similar for subgroups with vs witho ut specific psychosocial difficulties: psychosis (56% vs 54%, p = 1.00 ), illiteracy (58% vs 53%, p = 0.89), homelessness (62% vs 54%, p = 0. 33), alcohol dependency (62% vs 53%, p = 0.08), drug dependency (59% v s 54%, p = 0.47), or depression (58% vs 53%, p = 0.42). Conclusion: Ps ychosocial difficulties are common among ED patients; however, emergen t complaints are just as common in these patients as they are in those without psychosocial difficulties.