These factors were associated with a higher number of visits to the emergency department. Additional factors included an inability to afford doctor visits or prescriptions, homelessness, and lack of health insurance.

Forty-two percent of patients indicated they had also visited emergency departments at other hospitals more than five times in the last 12 months.

Factors that were not associated with a higher number of emergency department visits included: dissatisfaction with their doctors, alcohol and illicit drug use, educational level, or annual income (more than 70 percent reported annual incomes of less than $10,000).

In addition to Dr. Brauer, the team studying social impact included Joseph Miller, M.D., and Stephanie Stokes-Buzzelli, M.D.

Although the demographics of frequent users and interventions to decrease emergency department use has been described, Dr. Martin's 10-year study is the first to document changes in frequent users over an extended period.

Variables analyzed in the 10-year study included number of visits, age, disposition and insurance status.

Researchers found an 83-percent increase in visits by frequent users over the decade of the study. This increase was dramatically greater than the 9 percent increase of overall Emergency Department visits during this time.

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