Introduction and objective: In response to the consequences of the recent epidemiological transition, Italy is experiencing the implementation of “Health Homes” as a way to reform and strengthen its Primary Health Care (PHC) system. Since Health Homes are still lacking of their own proper informative systems, many authors suggested that Emergency Department (ED) use can be considered as a proxy evaluation of the effectiveness of PHC services. Aim of our study was to investigate frequent users’ ED utilization in an italian hospital and to identify critical factors in Primary Care Health service delivery.
Methods: Data on frequent-users access to the Emergency Department of Ferrara University Hospital were collected. Frequent-users were defined as individuals making ≥ 5 accesses in a 15 months period. Demographic, clinical and logistic informations were extracted and analysed using a mixed methods approach.
Results: From January 2016 to March 2017 a total of 11.842 accesses were made by 1776 frequent-users patients. Mean number of access per patient was 6.7±4.1. Most part of the accesses was due to non-urgent conditions and carried out during day time in weekdays. Data available from ED reports were mainly focused on pathologies rather than persons and an in depth qualitative analysis was necessary in order to rebuild fragmented informations about long period history of patients. Handling data from a people-centered point of view was useful in order to find critical issues that should be addressed in the PHC context. We used several theoretical models, such as  the social determinants of health framework and the primary care sensitive conditions (PCSC) framework in order to get informations about complexity, vulnerability and appropriateness of use characterizing our study population.
Conclusions: Data from ED frequent users showed unmet health needs that PHC should be able to take care of. More research is needed to develop useful tools to collect data and use them as mean of empowerment for health professionals working in PHC and specifically in Health Homes.