Key result
Thirty days after an emergency department admission, 38% of medical patients experienced psychological distress, with unplanned general practitioner visits being the strongest predictor (aOR 4.75).
Cohort (n=1,575)
No
Odds Ratio: 4.75 (95% CI 2.57–8.8)
p-value: p=<0.001
A significant proportion (38%) of medical patients experience psychological distress 30 days after an ED admission, highlighting the need for post-discharge support.
May warrant post-ED psychological screening in medical patients; observational data leaves open whether targeting GP visits improves outcomes.
BACKGROUND: Psychological distress in medical patients admitted to the emergency department (ED) is not well studied. Our aim was to investigate the extent of psychological distress in a broad and unselected medical patient sample 30 days after ED admission and its association with socio-demographic and clinical variables. METHOD: We used data from a prospective observational cohort study including 1575 consecutive adult medical patients presenting to the ED with acute somatic conditions. Outcome variables were patient's psychological distress measured by the 4-item Patient Health Questionnaire (PHQ-4) and self-rated health assessed 30 days after ED admission using telephone interviews. Risk factors included socio-demographic variables (e.g. gender, marital status), clinical presentation (e.g. illness severity, main initial diagnosis) and course of illness (e.g. rehospitalisation, length of hospital stay). RESULTS: A total of 38 % of patients had evidence for psychological distress 30 days after ED admission. Multivariate analysis found female gender (adjusted odds ratio [aOR] 1.35, 95 % confidence interval [CI] 1.02 to 1.78), comorbid psychiatric disorder (aOR 1.63, 95 % CI 1.08 to 2.62), discharge to a post-acute care institution (aOR 1.47, 95 % CI 1.03 to 2.09), unplanned rehospitalisation (aOR 2.38, 95 % CI 1.47 to 3.86), and unplanned visit at general practitioner (aOR 4.75, 95 % CI 2.57 to 8.80) to be associated with distress at day 30 following ED admission. CONCLUSIONS: One month after ED admission a significant number of patients still show a moderate amount of psychophysical distress. Strongest related variables were course of illness, in particular unplanned general practitioner visits. Future interventional studies should assess possibilities to reduce distress in patients at increased risk. TRIAL REGISTRATION: NCT01768494 , January 9, 2013 (registration date), February 25, 2013 (enrolment of first participant).
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Faessler et al. (2016) conducted a cohort in Acute somatic conditions (n=1,575). Unplanned visit at general practitioner vs. No unplanned visit at general practitioner was evaluated on Psychological distress 30 days after ED admission (aOR 4.75, 95% CI 2.57 to 8.80, p=<0.001). Thirty days after an emergency department admission, 38% of medical patients experienced psychological distress, with unplanned general practitioner visits being the strongest predictor (aOR 4.75).
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