Potentially Avoidable Emergency Department Utilization by Persons With Psoriatic Arthritis and Radiographic Axial Spondyloarthritis: A Population-Based Cohort Study

Objective Greater accessibility to ambulatory services may mitigate emergency department (ED) presentations for lower acuity issues. This study examined ED utilization patterns for individuals with psoriatic arthritis (PsA) and radiographic axial spondyloarthritis (r-axSpA) in a universal access healthcare setting.

Methods Linked population-based administrative datasets in Alberta, Canada (fiscal years 2007/2008-2017/2018) were assessed for yearly ED visit frequency, timing, triage acuity, most responsible diagnoses, and disposition for persons with PsA and r-axSpA.

Results A total of 4984 individuals with PsA and 14,690 with r-axSpA had 53,174 and 124,037 unique ED encounters, respectively. On average, 47.6% of persons with PsA and 35.7% with r-axSpA accessed the ED annually. Low acuity encounters (triaged as less urgent or nonurgent) were common, comprising 44.2% and 50.3% of visits for PsA and r-axSpA cohorts, respectively. Infection and injury were the most common responsible diagnoses. Presentations for inflammatory arthritis were infrequent (1.2% and 2% for PsA and r-axSpA cohorts, respectively), with no significant differences by sex or urbanicity. Rural patients had nearly twice the mean number of visits per year, had a higher frequency of less acute presentations, and were admitted less often in both disease cohorts. Sex differences included differential timing of presentation to EDs, and female patients with PsA had a lower frequency of admission relative to male patients with PsA.

Conclusion ED use for less urgent and nonurgent health concerns was frequent for persons with PsA and r-axSpA, particularly in rural settings. These data can inform tailored health service delivery including access solutions for persons residing in rural areas.