Official websites use. Share sensitive information only on official, secure websites. Open Access This article is distributed under the terms of the Creative Commons Attribution 4. This study aimed to characterize frequent ED users and to define risk factors of frequent ED use within a universal health care coverage system, applying a conceptual framework of vulnerability. A controlled, cross-sectional study comparing frequent ED users to a control group of non-frequent users was conducted at the Lausanne University Hospital, Switzerland. Frequent users were defined as patients with five or more visits to the ED in the previous 12 months. The two groups were compared using validated scales for each one of the five dimensions of an innovative conceptual framework: socio-demographic characteristics; somatic, mental, and risk-behavior indicators; and use of health care services. To examine the -related to vulnerability- risk factors for being a frequent ED user, univariate and multivariate logistic regression models were used. We compared frequent users and controls. Frequent users had more vulnerabilities in all five dimensions of the conceptual framework. The most significant frequent ED use risk factors were a history of more than three hospital admissions in the previous 12 months adj OR Frequent ED users within a universal health coverage system form a highly vulnerable population, when taking into account all five dimensions of a conceptual framework of vulnerability. The predictive factors identified could be useful in the early detection of future frequent users, in order to address their specific needs and decrease vulnerability, a key priority for health care policy makers. Application of the conceptual framework in future research is warranted. The online version of this article doi Keywords: Conceptual framework of vulnerability, Frequent emergency department users. A heterogeneous subgroup of patients uses the emergency department ED frequently and accounts for a substantial proportion of all ED visits in developed countries [ 1 ]. Our study is in response to the calls of several authors [ 3 — 5 ] to identify the needs of those at risk of future frequent ED use, by examining the predictive risk factors of frequent ED use and by applying a robust and innovative conceptual framework of vulnerability to characterize this population. Characterizing vulnerable persons or populations is challenging [ 6 ]. Recent studies evaluating the medical and social factors associated with frequent ED use have demonstrated the compounding effect of these variables taken together [ 29 ]. Based on these results, the Lausanne University Hospital created a clinical evaluation grid of vulnerability. This tool was used to assess the multiple dimensions of vulnerability among ED patients, with a particular focus on frequent users [ 10 ]. Frequent ED users, by definition, are patients who visit ED on multiple occasions. Therefore, they already meet one criterion of vulnerability from our conceptual framework—namely, health care consumption. Indeed, frequent ED users tend to have higher hospital admission rates [ 311 — 14 ], and vi menn novelle norsk sex date higher or lower triage scale levels, depending on the definition of frequent ED use [ 1516 ]. They also use non-ED based health care services, such as primary care physicians PCPssocial workers, and psychiatrists, more frequently than non-frequent users [ 412 ]. Frequent ED users have been described in several countries recently [ 141718 ] including Switzerland [ 29 ]. A picture of frequent ED users is emerging from the literature demonstrating the presence of many dimensions of vulnerability beyond high health care consumption. Compared to non-frequent ED users, they have higher rates of social isolation [ 4 ], lower socio-economic status [ 2 ], a higher burden of psychiatric and medical disease [ 19 ], and increased rates of substance abuse [ 220 ]. Yet, these findings have not been systematically investigated within a universal health care coverage system, taking vi menn novelle norsk sex date account all of the dimensions of vulnerability. ED use is partially determined by the characteristics of health care delivery and insurance. In Switzerland, mandatory health insurance is a central feature of the health care system and provides coverage for the full spectrum of health needs, from ambulatory to hospital care [ 21 ]. Insurance premiums are paid by individuals independently of earnings, except for subsidies provided to citizens with low incomes [ 2324 ]. Deductibles range from CHF to to 2, USD inwith a maximum of CHF USD in out-of-pocket expenditures charged after the deductible is reached. Cost for outpatient and ED visits are similar and determined by a standardized fee for service scale [ 25 ]. Two recent studies conducted in the French-speaking part of Switzerland report that between Given high out-of-pocket expenditures may be a barrier to accessing appropriate health care in Switzerland [ 28 ], avoiding preventive or elective health care for economic reasons could be one of the factors that motivate those who are less well-off and in poorer health to use the ED more frequently than less vulnerable patients. In this system, patients are free to choose any practitioner [ 29 ]. Both ED and PCP may be accessed relatively expediently. The aim of this study was to characterize frequent ED users and to define the risk factors of frequent ED use, within a universal health care coverage system, applying a robust conceptual framework of vulnerability. We used a controlled, cross-sectional design to compare frequent and non-frequent users of the ED at the Lausanne University Hospital, in Switzerland.
Our study shows the potential of health insurance claims data in identifying diseases when no diagnostic coding is available. Keywords: Conceptual framework of vulnerability, Frequent emergency department users. Finally, our findings are based on a study conducted at a single, urban ED at a large, public teaching hospital; the external validity for other types of ED settings in Switzerland has not been established. Share sensitive information only on official, secure websites. Therefore, they already meet one criterion of vulnerability from our conceptual framework—namely, health care consumption. Archived from the original on 29 July
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19,95 €. SEX-KOMMISSAR SCHWARZ: Ein Mann, ein Mord! Aktivistin. Für eine grüne und gerechte Zukunft. SEX-KOMMISSAR SCHWARZ hält, was er verspricht! Promovierte Meeresbiologin. Dr. Iris Menn. Bildung für Kinder bei FORWAC. Geschäftsleiterin Greenpeace Schweiz. Mädchen in Uniform ("Girls in Uniform") is a German romantic drama film based on the play Gestern und heute (Yesterday and Today) by Christa Winsloe. Diverse partner relationship constellations of gender dysphoric women and men with different sexual orientations are explored in a sample of.Schmidt, who convinces him to give up on Helga and his mother, and enjoy his freedom from them. The driver escapes over Gereon's balcony and down onto the street. The spending by disease depends substantially on the number of patients with the disease. First, patients presenting during the daytime with low severity scores were directed to an urgent care clinic after triage by ED nurses, and thus were not included. Charlotte becomes a deputy homicide detective. Side entrance of the Berlin City Hall , used as Police Headquarters. The film's producer, Bellman, informs the Armenian, who is his financier, of the incident. She and Gereon part ways after gathering up their respective files they had dropped. HRT has been associated with therapeutic benefits in improving patient outcomes in osteoporosis, cardiovascular disease, muscle mass, physical strength, and viral infections [ 8 ]. Archived from the original on 30 June Under the impression that it was his intention, the press and his fellow officers laud Gereon as a hero for arranging the deaths of Berlin's criminal element. Helga meets with Nyssen, who offers to let her use the suite, which belongs to his family, for as long as she wants. Of these, Read Edit View history. This information contributes to a better understanding of the effects of epidemiological and demographic trends on health care spending. Without it, they cannot inherit her fortune for ten years. Have you philosophers really no clue that you have been beaten with your own weapons? We also provide disease-specific spending estimates for Switzerland on a more granular level than in Wieser et al. The Rotes Rathaus Berlin City Hall was used for most closeup scenes involving the exterior of the police headquarters, because their red brick appearance and architectural style are very similar. The cloak is discovered to be Rot's costume for the film, and a seamstress admits that Krempin got her to steal a copy of it but confirms his alibi for Winter's murder. The Phantom's mask comes off, revealing Weintraub. Plot [ edit ]. The murderer of Betty Winter is now dubbed The Phantom by the Press. Table 1 in Additional file 2 provides the descriptive statistics of this comparison. Looking back on The Unique and Its Property , Stirner claims that "Stirner himself has described his book as, in part, a clumsy expression of what he wanted to say. And what is true is that before we can be active in any cause we must make it our own, egoistic cause—and that in this sense, quite aside from any material expectations, we are communists in virtue of our egoism, that out of egoism we want to be human beings and not merely individuals. It has been argued that historical materialism was Marx's method of reconciling communism with a Stirnerite rejection of morality. Additional file 1: In The Unique and Its Property , Stirner launches a radical anti-authoritarian and individualist critique of contemporary Prussian society and modern western society as such. External links [ edit ]. When others cry savagely "down with the kings" Stirner immediately supplements "down with the laws also. Nyssen forges a document to obtain power of attorney from his mother and enters into a three-month short futures contract with the bank. During the afterparty, the girls are served punch containing alcohol. Our estimated treated prevalence rates are mostly lower than the overall prevalence rates estimated in the GBD study for Switzerland and in other studies see Table 2.
