Qualitative exploration of why people repeatedly attend emergency departments for alcohol-related reasons

Background
Understanding why people repeatedly attend Emergency Departments (EDs) for alcohol-related reasons is an important prerequisite to identifying ways of reducing any unnecessary demands on hospital resources. We use Andersen’s Behavioural Model of Health Services Use to explore factors that contributed to repeat ED attendances.

Methods
Qualitative interviews were conducted with 30 people who repeatedly attended EDs for alcohol-related reasons (≥10 attendances in the past 12 months). We recruited participants from 6 EDs in London, United Kingdom. Data on socio-demographic characteristics, substance use, contact with specialist addiction and other health services, most recent ED attendance, and previous ED attendances were analysed.

Results
Participants reported long-standing health problems, almost all were unemployed, and many had limited education and unstable housing. Most held positive health beliefs about EDs, despite some negative experiences. They reported limited community resources: poor social support, inaccessible primary care services, dislike or lack of information about specialist addiction services, and difficulties travelling to services. In contrast, EDs offered immediate, sympathetic care and free transport by ambulance. Participants’ perceived need for care was high, with physical injury and pain being the main reasons for ED attendance.

Conclusions
Push’ and ‘pull’ factors contributed to repeated ED use. ‘Push’ factors included individual-level problems and wider community service failings. ‘Pull’ factors included positive experiences of, and beliefs about, ED care. Community services need to better engage and support people with complex drinking problems, whilst ED staff can be more effective in referring patients to community-based services.