Chronic Disease

Certain patients with lupus are more likely to end up in the emergency department three or more times a year

Patients with systemic lupus erythematosus (lupus), an inflammatory connective tissue disease, often suffer from fatigue, skin rashes, and joint pain, and may have more serious problems with their kidneys, heart, lungs, or other organs. Patients with lupus who are insured by Medicaid or have more active disease are more likely to end up in the emergency department (ED) three or more times a year, according to a new study. Frequent reliance on the ED for medical care may indicate that the person has poor access to primary care, inadequate coordination among their health care providers, or lax adherence to prescribed treatments, note the researchers.

Of the 807 persons with lupus studied, 61.7 percent were nonusers of the ED, 28.5 percent were occasional users (1-2 times annually), and 9.7 percent were frequent users (3 or more times a year). The frequent users accounted for the majority of all ED visits (58.1 percent), were younger (mean age of 44.5 years) than nonusers (47.6 years) and occasional users (49.0 years), and were more likely to rely on Medicaid as their primary health insurance (21.3 percent) than nonusers (3.0 percent) or occasional users (6.1 percent).

After adjusting for demographic factors, a Medicaid-insured patient was more than four times more likely to be a frequent ED user than someone with employer-based insurance. Patients with disease activity, as shown on the Systemic Lupus Activity Questionnaire, were slightly, but significantly, more likely to be frequent ED users. The patients were drawn from a large group of lupus patients in 41 States enrolled in an ongoing longitudinal study. Trained survey workers collected data on demographic information, disease and general health status, utilization of health care resources, and insurance coverage. The study was funded in part by the Agency for Healthcare Research and Quality (HS13893).

More details are in "Frequent use of the emergency department among persons with systemic lupus erythematosus," by Pantelis Panopalis, M.D., Joann Zell Gillis, M.D., Jinoos Yazdany, M.D., M.P.H., and others in the March 2010 Arthritis Care & Research 62(3), pp. 401-408.

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