Factors influencing low-acuity emergency department visits by older patients in Catalonia (Spain)

Abstract

Objectives. This study aims to identify the factors influencing low-acuity emergency department (ED) visits among older adults, focusing on chronic diseases, wealth, health care system access, and demographic characteristics. Methods. Using longitudinal data from the Catalan public health system (2014-2020), we analyzed a cohort of individuals older than 65 years to analyze associations among sociodemographic characteristics, health care system access, and low-acuity ED visits. Low-acuity visits were defined by specific ICD-10 diagnoses selected based on a literature review. Econometric models, including Poisson and Negative Binomial regressions were used to control for time-related factors (eg, holidays, weekends) and health care supply-side variables (eg, access to primary care). Results. Chronic diseases were not significantly associated with higher rates of low-acuity ED visits, suggesting that older adults with chronic conditions don't necessarily rely on EDs for their care. Individuals with higher incomes were less likely to use EDs. Nationality (which may reflect cultural factors, among others) also influenced the number of ED visits, as did hospital complexity. More complex hospitals recorded higher rates of low-acuity visits, leading to increased costs. Periods of peak influx for low-acuity visits were identified, suggesting that extended primary care hours could reduce pressure on EDs. Conclusions. The study highlights the role of health care access, income, and demographic factors in the use of low-acuity EDs among older adults. Strategies to optimize primary care access and redirect non-urgent cases to lower-cost centers could help reduce ED saturation and improve resource allocation, especially during periods of high demand.