Examining emergency department utilisation in people with Crystal Arthropathies: a 10-year analysis of visits in a publicly funded universal healthcare system

Objectives: This study aims to describe emergency department (ED) use by persons with crystal arthropathies, to identify where improvements in ambulatory care accessibility could improve acute care health system efficiency. Methods: Linked population-based administrative datasets from a universal healthcare system in Canada were used to retrospectively assess all ED use by persons meeting the case definition for crystal arthropathies over a 10-year period (2007/2008-2017/2018). Frequency of use and characterisation of visits for any reason among people with crystal arthropathies including acuity (Canadian Triage and Acuity Scale [CTAS]), length of stay, most responsible diagnosis, and disposition were calculated and stratified by sex and geographic location of residence. Results: Six hundred forty-six thousand nine hundred twenty-six ED visits were made by 88,373 individuals with crystal arthropathies in Alberta. We observed a 69% increase in ED use over the study period by the cohort, with 32.5% and 32.2% of visits triaged as urgent (CTAS 3) and less urgent (CTAS 4) acuity, respectively. A final diagnosis was not determined in 33.1% of visits, and crystal arthropathies flares accounted for 5.7% of ED use in the cohort. Female patients more frequently required hospital admission (20.4% vs males 15.7%), and while urban residents had an increased frequency of visits, they were less likely to be admitted to hospital than rural residents (11.4% vs rural 20.0%). Conclusions: Acute care use by persons with crystal arthropathies has significantly increased, predominantly with lower acuity presentations. Enhanced ambulatory care services with collaboration between primary and specialty care are proposed to improve alignment in health service use.