Table 1.
Summary of selected studies (n=14)
| Author (Year) | Journal | Country | Tipe of Study | Number of Edaccess | Frequent Users Characteristics | Follow Up | Case Management Team | Interventions | Main Findings | Casp Quality Score |
| Bodenmann et al. (2017) | Gen Intern Med | Switzerland | RCT | ≥ 5 in a year | 125 patients, male 57.2 %, mean age 48.5 years. Chronic condition, medical co-morbidity or psychiatric illness. |
1 year | 4 nurse practitioners and 1 chief resident. | ICP, providing intervention in an ambulatory care, hospital or home setting. Telephone contact with case management team. | Reduction of ED access: -19% (P=.048). | 10\11 |
| Chiang et al. (2014) | Hong Kong J Emerg Med | Cina | Prospective observational | ≥3 visits in 3 days | 14 patients, male 78.6%, mean age 44.3 years. Cases were divided into the pain management or chronic disease group according to their chief complaint. |
6 months | Physicians, primary care physicians, psychiatrists, social workers and pharmacologists. | ICP dynamically whith internal ED information system. | Reduction of ED access: -58.5% (P=.004). | 9\11 |
| Crane et al. (2012) | Am Board Fam Mec | USA | Prospective observational | ≥ 6 in a year | 36 patients, male 55.6%, mean age 34 years. Chronic pain 75%, substance abuse 47%, COPD/asthma 17%, homeless 19%. |
1 year | 1 family physician, 1 nurse case manager and 2 behavioral health providers. | ICP, group appointment, direct telephone access and sessions with the care manager. | Reduction of ED access per month: -35% (P<.001). Reduction of costs (ED and inpatient) per patient per month: -80% (P<.001). |
10\11 |
| Edgren et al. (2016) | EurJ Emerg Med | Sweden | RCT | ≥ 3 in 6 month | 4273 patients, male 43.6%, mean age 62.5 years. Generalized or unspecific pain diagnosis, hypertension, ischemic heart disease, atrial fibrillation. |
2 years | Nurse case manager. | Telephone-based intervention, facilitated contacts with healthcare providers, coached patients’ disease selfmanagement and supported interactions with social services. | Reduction of ED access: -14% (P=.007). Reduction of costs per patient per year: -16% (P=.004). |
10\11 |
| Grover et al. (2016) | Emerg Med | USA | Prospective observational | 12 in a year 6 in 3 months 4 in a month |
533 patients, male 32.2%, mean age 42.6 years. Chronic conditions 71.4%, chemical dependency evaluation/drug abuse treatment 30.7%, pain management 25.6%. |
From 1 month to 8 years | ED nurse and nurse case manager. | ICP based on chronic medical problems and reasons for repeat ED usage. Patients were “flagged” in the ED information system for immediately identify. | Reduction of ED access per month: -56.5%(P<.001). | 10\11 |
| Groveretal. (2018) | West J Emerg Med | USA | Retrospective observational | ≥10 in a year 6 in 6 months 4 in a month |
158 patients, male 44.9%, mean age 42.4 years. Substance use 63.5%, pain management 60.4%. | 19 months | Registered nurse, emergency physicians, social workers, ED nurses, chemical dependency providers, behavioral health registered nurse, case managers and representatives from local insurance providers. | ICP. | Reduction of ED access: -49% (P<.05). Reduction of costs: -41% (P<.05). | 11\11 |
| Moschetti et al. (2018) | Plos One | Switzerland | RCT | ≥ 5 in a year | 125 patients, male 56%, mean age 46 years. Social difficulty 74,4%, somatic problem 72%, mental health problem 49,6%, risky behavior 30,4%, not having a primary care physician 16%. |
1 year | 4 nurses and 1 general practitioner. | ICP, providing intervention in an ambulatory care, hospital or home setting and telephone contact with case management team. | No reduction of ED costs: -19% (P=.29). | 10\11 |
| Peddie et al. (2011) | N Z Med J | Australia | Prospective observational | ≥ 10 in a year | 87 patients, male 40%, mean age 35 years. Desease: medical 45%, psychiatric 29%, substance/alcohol abuse 26%. |
4 years | Nurse, ED consultant, medical specialists, psychiatric services and social workers. | ICP. | The interventions and the control are infussicient to prove the utility. | 10\11 |
| Reinius et al. (2013) | EurJ Emerg Med | Sweden | RCT | ≥ 3 in 6 months | 211 patients, male 40.3% mean age 62.6 years. Hypertension 26%, ischaemic heart disease 19%, chronic obstructive pulmonary disorders 9%, heart failure 15%, anxiety disorders 9%, generalized or unspecified pain 41%, atrial fibrillation 18%. |
1 year | Case management nurses. | Telephone calls: motivational conversations (13%), support for patient self-care (17%), education on basic medical issues (18%), providing contact with counsellors (3%) or social services (5%), providing contacts with primary care physicians (14%) primary care nurses (5%) and help to establish contacts or appointments at other healthcare facilities (15%). | Reduction of ED access: - 20% (P not avaiable). Reduction of costs: -45% (P=.004). |
11\11 |
| Sadowski et al. (2009) | Jama | USA | RCT | Not define | 201 patients, male 74%, mean age 47 years. Homeless adults with chronic medical illnesses median duration of homelessness of 30 months. |
18 months | Social worker whith post-graduate specialization. | Provision of transitional housing and subsequent placement in stable housing. | Reduction of ED access: -24% (P=,03). | 10\11 |
| Shah et al. (2011) | Med Care | USA | Retrospective observational | ≥ 6 in a year | 98 patients, male 59.2%, mean age 46.6 years. Deseases of pancreas 15.56%, asthma 6.67%, Charlson comorbidity index mean 1.4. |
2 years | Not identified the professional profiles. | ICP, schedule appointments, arranging for support services, discharge plans and communication with providers. | Reduction of ED access: -32% (P<.001). Reduction of costs per patient per year: -26% (P<.001). | 9\11 |
| Shumwayetal.(2008) | Am J Emerg Med | USA | RCT | ≥5 inayear | 167 patients, male 75%, mean age 43 years. Mental disorders (22%), injury (16%), diseases of the skin (8%), endocrine disorders (5%), digestive system disorders (5%), respiratory illnesses (5%). |
2 years | Nurse practitioner, a primary care physician and a psychiatrist. | ICP, assessment, crisis intervention, individual and group supportive therapy, linkage to medical care providers, referral to services when needed, assistance in obtaining stable housing and income entitlements. | Reduction of ED access: (P=.01) no single number or percentage avaiable. Reduction of costs per patient: (P=,01) no single number or percentage avaiable. | 11\11 |
| Stergiopoulos et al. (2017) | Plos One | Canada | RCT | ≥ 5 in a year | 83 patients, male 47%, mean age 42.7 years. Anxiety disorders 61.5%, mood disorders 63.9%, psychotic disorders 25.6%, substance misuse disorder 53%, personality disorder 25%, |
1 year | Not identified the professional profiles. | Home visits, crisis intervention, supportive therapy, practical needs assistance and care coordination, aiming to integrate hospital, community and social care and improve continuity of care. | No reduction of ED access -14% (P=.31). | 10\11 |
| Stokes-Buzzelli et al. (2010) | West J Emerg Med | USA | Retrospective observational | Not define | 45 patients, male 75%, mean age 48 years. Substance abuse problems 89%, mental illness 72%, various medical co-morbidity as asthma/COPD 44%, hypertension 64%. |
2 years | ED attending physician, ED medical socia worker, ED mental health social worker, ED psychologist, ED resident, ED clinical nurse specialists and a student healthcare volunteer. | ICP, use of health information technologies and electronic medical record systems for immediately identify. | Reduction of ED access: -25% (P=.046). Reduction of costs per patient per 2 years: -25% (P=.049). | 9\11 |
Legend: COPD chronic obstructive pulmonary disease, ED Emergency Department, ICP individual care plan, RCT randomized controlled trial