Background: Frequent users (FUs) are patients who repeatedly and inappropriately visit the emergency department (ED) for low-grade symptoms that could be treated outside the hospital setting. This study aimed to investigate the phenomenon of the FU in Rome by profiling such users and analyzing ED attendance by FUs.Methods: The analysis was carried out for attendance in 2021 at 15 EDs in the Local Health Authority Roma 1 geographical area. A digital app collected data, including information on the following variables: number of attendance, demographic characteristics, emergency medical service (EMS) usage, triage code, and appropriateness of attendance. COVID-19 diagnosis was also studied to analyze any possible influence on ED attendance. Differences between FUs and non-FUs were investigated statistically by t-test and chi-square test. Univariate analysis and multivariable logistic regression were performed to analyze the associated factors.Results: A total of 122,762 ED attendance and 89,036 users were registered. The FU category represented 2.9% of all users, comprising 11.9% of total ED attendance. There was a three times higher frequency of non-urgent codes in attendance of FU patients (FU: 9.7%; non-FU: 3.2%). FUs were slightly more likely to have used the EMS (13.6% vs. 11.4%) and had a lower frequency of appropriate ED attendance (23.8% vs. 27.0%). Multivariate logistic analysis confirmed a significant effect of triage code, gender, age, EMS usage, and COVID-19 diagnosis for the appropriateness of attendance. The results were statistically significant (p < 0.001).Conclusion: The FU profile describes mostly non-urgent and inappropriate attendance at the ED, including during the COVID-19 pandemic. This study represents an important tool for strengthening preventive policies outside the hospital setting. The Italian National Recovery and Resilience Plan represents an excellent opportunity for the development of new strategies to mitigate the phenomenon of FUs.

Background/Objectives: Frequent users (FUs) are patients who repeatedly attend Emergency Departments (EDs). This study aims to identify the clinical and social characteristics of FUs in a Local Health Authority in Rome and to quantify and compare the variation in the probability of being FU attributable to General Practitioners (GPs) and Local Health Districts (LHDs). Methods: The Healthcare Emergency Information System and an automated database of Lazio Region residents were used for the collection of data on the patients’ socioeconomic status, GP, LHD and chronic diseases. Different FU thresholds (attendances ≥4, 5, 7 or 10) were used for descriptive analyses. Univariate logistic analysis and a multilevel logistic model were performed for inferential analyses. Results: A total of 89,036 individuals attended at least one of the 13 EDs included in the study. Mental illness was present in 2.6% of non-FUs compared with 7.6% of FUs with ≥4 attendances. The OR of being FU increased with higher clinical complexity. GP appeared to play an important role in determining FU behavior, while no significant effect was found on the LHD level. Conclusions: This study identified potential risk factors predictive of disproportionate ED use and may help policymakers address the FU phenomenon.

Background/Objectives: Frequent users (FUs) are defined as patients who repeatedly attend the Emergency Department (ED). This study aims to identify the clinical and social characteristics of FUs in a Local Health Authority in Rome and to quantify and compare the amount of variation in the probability of being FU attributable to General Practitioners (GPs) and Local Health Districts (LHDs). Methods The Healthcare Emergency Information System and an automated database of Lazio region residents were used for the collection of data on the patients' socioeconomic level, GPs, LHD and information about any chronic diseases. Different FU classes (visits ≥4, 5, 7 or 10) were considered in the descriptive analysis. Univariate logistic analysis and a logistic multilevel model were performed for inferential analyses. Results: A total of 89,036 individuals visited at least one of the 13 EDs included in the study. A total of 2.6% of the no FU group had mental illnesses, compared to 7.6% in the FU≥4 group. The OR for becoming an FU increased with the patient's clinical complexity. GP can play an important role in determining FU behavior, while no significant effect was found on the LHD level. Conclusions: This study allows the identification of potential predictive risk factors for disproportionate use of the ED and helps policymakers face the FU phenomenon.

Background: To identify the perception and the reason of defensive medicine among Italian physicians, and identify the socio-demographic and work-related determinants of the increased practice of defensive medicine. Methods: This study is a cross sectional web survey. A questionnaire was sent by e-mail to all the physicians registered to the Order of Physicians and Dentists of the Province of Rome. The collection period was from mar 2024 to may 2024. Descriptive analysis and multivariable linear regression models were conducted to describe differences between groups and to estimate the relationships between variables. Results: A total of 291 physicians completed the survey and were included in this analysis. Almost 60% of respondents feel under pressure due to the possibility of legal disputes. 73,8% adopted defensive medicine behaviours during the last year. More than 80% are aware that defensive medicine represents a limitation for their profession and a unfavourable factor for patients. Who answered that they practice defensive medicine think that it is a factor limiting their professional activity (OR: 2.3) and an unfavourable factor for the patient’s health (OR: 1.1). Conclusions: Defensive medicine is an important factor in health care costs without increasing the benefits to the patient. The study contributes to a deeper understanding of the perception of defensive medicine among physicians. Defensive medicine practice is common among physicians with concerns about increasing pattern in the future. Key messages: • Our study highlights physicians’ awareness of adopting defensive medicine behaviors in their clinical practice. • The study contributes to a deeper understanding of the perception of defensive medicine among physicians.