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Medical Emergency Department Utilization Patterns Among Uninsured Patients With Psychiatric Disorders

Dr. Baillargeon is affiliated with Preventive Medicine and Community Health, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555 (e-mail: jbaillar{at}utmb.edu). Dr. Thomas and Dr. Sharma are with the Department of Psychiatry, University of Texas Medical Branch. Dr. Williams is with the Department of Internal Medicine, University of California, San Francisco. Dr. Begley is with the School of Public Health, University of Texas Health Science Center, Houston, and Dr. Pollock is with the Department of Epidemiology, University of Texas Health Science Center, San Antonio. Dr. Murray, Mr. Pulvino, and Dr. Raimer are with Community Health Services, University of Texas Medical Branch, Galveston.

OBJECTIVE: This study examined medical emergency department utilization for patterns among uninsured patients with psychiatric disorders. METHODS: Billing records of 15,672 uninsured adult patients treated in the emergency department of an academic medical center in southeast Texas over a 12-month period were analyzed for information on demographic characteristics, diagnosis, number of emergency department visits, and hospitalization. RESULTS: Overall, 11.8% of the population was diagnosed as having at least one psychiatric disorder during an emergency department visit. Patients with psychiatric disorders had an increased risk of having multiple emergency department visits and hospitalization compared with patients without psychiatric disorders. The risk of multiple emergency department visits was particularly high for patients with either bipolar disorder or psychotic disorders. CONCLUSIONS: Uninsured patients with psychiatric disorders appear to be heavy users of medical emergency department services. These findings may be helpful in developing more efficient strategies to serve the mental health needs of the uninsured.

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