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Brown JL, Gause NK, Braun R, Punches B, Spatholt D, Twitty TD, Sprunger JG, Lyons MS. Substance Use and Mental Health Screening Within an Emergency Department-Based HIV Screening Program: Outcomes From 1 Year of Implementation. Health Promot Pract 2023:15248399231193005. [PMID: 37650616 DOI: 10.1177/15248399231193005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
INTRODUCTION The emergency department (ED) may be an optimal setting to screen for substance use disorders (SUDs) and co-occurring psychiatric disorders (CODs). We report on the frequency of problematic substance use and comorbid elevated mental health symptoms detected during a 1-year implementation period of an ED-based SUD/COD screening approach within an established ED HIV screening program. METHODS Patients (N = 1,924) were approached by dedicated HIV screening staff in an urban, Midwestern ED. Patients first completed measures assessing problematic alcohol (Alcohol Use Disorder Identification Test-Concise [AUDIT-C]) and substance use across 10 categories of substances (National Institute on Drug Abuse-Modified Alcohol, Smoking, and Substance Involvement Screening Test [NIDA-Modified ASSIST]). Patients with positive alcohol and/or substance use screens completed measures assessing symptoms of depression (Patient Health Questionnaire-9 [PHQ-9]), anxiety (Generalized Anxiety Disorder-7 [GAD-7]), and post-traumatic stress disorder (PTSD) (PTSD Checklist-Civilian [PCL-C]). RESULTS Patients were predominantly male (60.3%) with a mean age of 38.1 years (SD = 13.0); most identified as White (50.8%) or Black (44.8%). A majority (58.5%) had a positive screen for problematic alcohol and/or other substance use. Of those with a positive substance use screen (n = 1,126), 47.0% had a positive screen on one or more of the mental health measures with 32.1% endorsing elevated depressive symptoms, 29.6% endorsing elevated PTSD-related symptoms, and 28.5% endorsing elevated anxiety symptoms. CONCLUSIONS Among those receiving ED HIV screening, a majority endorsed problematic alcohol and/or other substance use and co-occurring elevated mental health symptoms. Substance use and mental health screening programs that can be integrated within other ED preventive services may enhance the identification of individuals in need of further assessment, referral, or linkage to substance use treatment services.
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Affiliation(s)
| | - Nicole K Gause
- Duquesne University Counseling Services, Pittsburgh, PA, USA
| | - Robert Braun
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Brittany Punches
- The Ohio State University, Columbus, OH, USA
- The Ohio State University Wexner Medical Center, Columbus, OH USA
| | - David Spatholt
- The Ohio State University Wexner Medical Center, Columbus, OH USA
| | | | - Joel G Sprunger
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Michael S Lyons
- The Ohio State University Wexner Medical Center, Columbus, OH USA
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2
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Salvalaggio G, Dong KA, Hyshka E, McCabe C, Nixon L, Rosychuk RJ, Dmitrienko K, Krajnak J, Mrklas K, Wild TC. Impact of an addiction medicine consult team intervention in a Canadian inner city hospital on acute care utilization: a pragmatic quasi-experimental study. Subst Abuse Treat Prev Policy 2022; 17:20. [PMID: 35279178 PMCID: PMC8917626 DOI: 10.1186/s13011-022-00445-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2022] [Indexed: 11/15/2022] Open
Abstract
Background Inner city patients have a higher illness burden and need for care, but experience more unmet care needs. Hospital Addiction Medicine Consult Teams (AMCTs) are a promising emerging intervention. The objective of this study was to assess the impact of a Canadian AMCT-like intervention for inner city patients on reduction in high emergency department (ED) use, hospital admission, and inpatient length of stay. Methods Using a community-engaged, two-arm, pre-post, longitudinal quasi-experimental study design, 572 patients reporting active substance use, unstable housing, unstable income, or a combination thereof (302 at intervention site, 270 at control sites) were enrolled. Survey and administrative health service data were collected at baseline, six months post-enrolment, and 12 months post-enrolment. Multivariable regression models tested the intervention effect, adjusting for clinically important covariables (inpatient status at enrolment, medical complexity, age, gender, Indigenous identity, shelter use, opioid use). Results Initial bivariable analyses demonstrated an intervention effect on reduction in admissions and length of stay, however, this effect was no longer significant after adjusting for covariables. There was no evidence of reduction in high ED use on either bivariable or subsequent multivariable analysis. Conclusions After adjusting for covariables, no AMCT intervention effect was detected for reduction in high ED use, inpatient admission, or hospital length of stay. Further research is recommended to assess other patient-oriented intervention outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s13011-022-00445-7.
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Suen LW, Makam AN, Snyder HR, Repplinger D, Kushel MB, Martin M, Nguyen OK. National Prevalence of Alcohol and Other Substance Use Disorders Among Emergency Department Visits and Hospitalizations: NHAMCS 2014-2018. J Gen Intern Med 2022; 37:2420-2428. [PMID: 34518978 PMCID: PMC8436853 DOI: 10.1007/s11606-021-07069-w] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 07/21/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Acute healthcare utilization attributed to alcohol use disorders (AUD) and other substance use disorders (SUD) is rising. OBJECTIVE To describe the prevalence and characteristics of emergency department (ED) visits and hospitalizations made by adults with AUD or SUD. DESIGN, SETTING, AND PARTICIPANTS Observational study with retrospective analysis of the National Hospital Ambulatory Medical Care Survey (2014 to 2018), a nationally representative survey of acute care visits with information on the presence of AUD or SUD abstracted from the medical chart. MAIN MEASURES Outcome measured as the presence of AUD or SUD. KEY RESULTS From 2014 to 2018, the annual average prevalence of AUD or SUD was 9.4% of ED visits (9.3 million visits) and 11.9% hospitalizations (1.4 million hospitalizations). Both estimates increased over time (30% and 57% relative increase for ED visits and hospitalizations, respectively, from 2014 to 2018). ED visits and hospitalizations from individuals with AUD or SUD, compared to individuals with neither AUD nor SUD, had higher percentages of Medicaid insurance (ED visits: AUD: 33.1%, SUD: 35.0%, neither: 24.4%; hospitalizations: AUD: 30.7%, SUD: 36.3%, neither: 14.8%); homelessness (ED visits: AUD: 6.2%, SUD 4.4%, neither 0.4%; hospitalizations: AUD: 5.9%, SUD 7.3%, neither: 0.4%); coexisting depression (ED visits: AUD: 26.3%, SUD 24.7%, neither 10.5%; hospitalizations: AUD: 33.5%, SUD 35.3%, neither: 13.9%); and injury/trauma (ED visits: AUD: 51.3%, SUD 36.3%, neither: 26.4%; hospitalizations: AUD: 31.8%, SUD: 23.8%, neither: 15.0%). CONCLUSIONS In this nationally representative study, 1 in 11 ED visits and 1 in 9 hospitalizations were made by adults with AUD or SUD, and both increased over time. These estimates are higher or similar than previous national estimates using claims data. This highlights the importance of identifying opportunities to address AUD and SUD in acute care settings in tandem with other medical concerns, particularly among visits presenting with injury, trauma, or coexisting depression.
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Affiliation(s)
- Leslie W Suen
- National Clinician Scholars Program, Philip R. Lee Institute of Health Policy Studies, University of California, San Francisco, San Francisco, CA, USA. .,San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA.
| | - Anil N Makam
- Division of Hospital Medicine, Department of Medicine, San Francisco General Hospital, University of California, San Francisco, San Francisco, CA, USA.,University of California, San Francisco Center for Vulnerable Populations, San Francisco, CA, USA.,Philip R. Lee Institute of Health Policy Studies, University of California, San Francisco, San Francisco, CA, USA
| | - Hannah R Snyder
- Department of Family and Community Medicine, San Francisco General Hospital, University of California, San Francisco, San Francisco, CA, USA
| | - Daniel Repplinger
- Department of Emergency Medicine, San Francisco General Hospital, University of California, San Francisco, San Francisco, CA, USA
| | - Margot B Kushel
- University of California, San Francisco Center for Vulnerable Populations, San Francisco, CA, USA
| | - Marlene Martin
- Division of Hospital Medicine, Department of Medicine, San Francisco General Hospital, University of California, San Francisco, San Francisco, CA, USA
| | - Oanh Kieu Nguyen
- Division of Hospital Medicine, Department of Medicine, San Francisco General Hospital, University of California, San Francisco, San Francisco, CA, USA.,University of California, San Francisco Center for Vulnerable Populations, San Francisco, CA, USA
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Predictors of Frequent Emergency Department Use and Hospitalization among Patients with Substance-Related Disorders Recruited in Addiction Treatment Centers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116607. [PMID: 35682194 PMCID: PMC9180458 DOI: 10.3390/ijerph19116607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/24/2022] [Accepted: 05/27/2022] [Indexed: 12/10/2022]
Abstract
Few studies have assessed the overall impact of outpatient service use on acute care use, comparing patients with different types of substance-related disorders (SRD) and multimorbidity. This study aimed to identify sociodemographic and clinical characteristics and outpatient service use that predicted both frequent ED use (3+ visits/year) and hospitalization among patients with SRD. Data emanated from 14 Quebec (Canada) addiction treatment centers. Quebec administrative health databases were analyzed for a cohort of 17,819 patients over a 7-year period. Multivariable logistic regression models were produced. Patients with polysubstance-related disorders, co-occurring SRD-mental disorders, severe chronic physical illnesses, and suicidal behaviors were at highest risk of both frequent ED use and hospitalization. Having a history of homelessness, residing in rural areas, and using more outpatient services also increased the risk of acute care use, whereas high continuity of physician care protected against acute care use. Serious health problems were the main predictor for increased risk of both frequent ED use and hospitalization among patients with SRD, whereas high continuity of care was a protective factor. Improved quality of care, motivational, outreach and crisis interventions, and more integrated and collaborative care are suggested for reducing acute care use.
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Fleury MJ, Grenier G, Cao Z, Huỳnh C. Predictors of no, low and frequent emergency department use for any medical reason among patients with cannabis-related disorders attending Quebec (Canada) addiction treatment centres. Drug Alcohol Rev 2022; 41:1136-1151. [PMID: 35266240 DOI: 10.1111/dar.13451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 01/30/2022] [Accepted: 01/30/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Patients with substance-related disorders and mental disorders (MD) contribute substantially to emergency department (ED) overcrowding. Few studies have identified predictors of ED use integrating service use correlates, particularly among patients with cannabis-related disorders (CRD). This study compared predictors of low (1-2 visits/year) or frequent (3+ visits/year) ED use with no ED use for a cohort of 9836 patients with CRD registered at Quebec (Canada) addiction treatment centres in 2012-2013. METHODS This longitudinal study used multinomial logistic regression to evaluate clinical, sociodemographic and service use variables from various databases as predictors of the frequency of ED use for any medical reason in 2015-2016 among patients with CRD. RESULTS Compared to non-ED users with CRD, frequent ED users included more women, rural residents, patients with serious MD and chronic CRD, dropouts from programs in addiction treatment centres and with less continuity of physician care. Compared with non-users, low ED users had more common MD and there more workers than students. DISCUSSION AND CONCLUSIONS Multimorbidity, including MD, chronic physical illnesses and other substance-related disorders than CRD, predicted more ED use and explained frequent use of outpatient services and prior specialised acute care, as did being 12-29 years, after controlling for all other covariates. Better continuity of physician care and reinforcement of programs like assertive community or integrated treatment, and chronic primary care models may protect against frequent ED use. Strategies like screening, brief intervention and treatment referral, including motivational therapy for preventing treatment dropout may also be expanded to decrease ED use.
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Affiliation(s)
- Marie-Josée Fleury
- Department of Psychiatry, McGill University, Montreal, Canada.,Douglas Hospital Research Centre, Douglas Mental Health University Institute, Montreal, Canada
| | - Guy Grenier
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, Montreal, Canada
| | - Zhirong Cao
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, Montreal, Canada
| | - Christophe Huỳnh
- Institut Universitaire sur les Dépendances, Centre Intégré Universitaire de Santé et des Services Sociaux du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada
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6
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Fleury MJ, Grenier G, Cao Z, Huỳnh C. Profiles of individuals with cannabis-related disorders. Subst Abus 2022; 43:855-864. [PMID: 35179451 DOI: 10.1080/08897077.2021.2007515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Background: Profiles of individuals with cannabis-related disorders (CRD) in specialized addiction treatment centers serving high-need patients have not been identified. This longitudinal study developed a typology for 9,836 individuals with CRD attending Quebec (Canada) addiction treatment centers in 2012-2013. Methods: Data on sociodemographic, clinical and service use variables were extracted from several databases for the years 1996-1997 to 2014-2015. Individual profiles were produced using Latent Class Analysis and compared predicting health outcomes on emergency department (ED) use, hospitalizations and suicidal behaviors for 2015-2016. Results: Six profiles were identified: 1-Older individuals, many living in couples and working, with moderate health problems, receiving intensive general practitioner (GP) care and high continuity of physician care; 2-Older individuals with chronic CRD, multiple social and health problems, and low health service use (chronic CRD referred to experiencing CRD for several years; social problems related to homelessness, unemployment, having criminal records or living alone); 3-Students with few social and health problems, and low health service use; 4-Young adults, many working, with few health problems, least health service use and continuity of physician care; 5-Youth, many working but some criminal offenders, with 1 or 2 years of CRD, few health problems and high addiction treatment center use; and 6-Older individuals with chronic CRD and multiple social and health problems, high health service use and continuity of physician care. Profiles 6 and 2 had the worst health outcomes. Conclusions: For Profiles 2 to 5, outreach and motivational services should be prioritized, integrated health and criminal justice services for profile 5 and, for Profiles 2 and 6, assertive community treatments. Screening, brief intervention and referrals to addiction treatment centers may also be encouraged for individuals with CRD, particularly those in Profile 2. This cohort had high social and health needs relative to services received, suggesting continued need for care.
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Affiliation(s)
- Marie-Josée Fleury
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, Montreal, Canada.,Department of Psychiatry, McGill University, Montreal, Canada
| | - Guy Grenier
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, Montreal, Canada
| | - Zhirong Cao
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, Montreal, Canada
| | - Christophe Huỳnh
- Institut universitaire sur les dépendances, Centre intégré universitaire de santé et des services sociaux du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada
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Huỳnh C, Kisely S, Rochette L, Pelletier É, Morrison KB, Li S, Hopkin G, Smith M, Burchill C, Lin E, Asbridge M, Jutras-Aswad D, Lesage A. Measuring Substance-Related Disorders Using Canadian Administrative Health Databanks: Interprovincial Comparisons of Recorded Diagnostic Rates, Incidence Proportions and Mortality Rate Ratios. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2022; 67:117-129. [PMID: 34569874 PMCID: PMC8978214 DOI: 10.1177/07067437211043446] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
CONTEXT Assessing temporal changes in the recorded diagnostic rates, incidence proportions, and health outcomes of substance-related disorders (SRD) can inform public health policymakers in reducing harms associated with alcohol and other drugs. OBJECTIVE To report the annual and cumulative recorded diagnostic rates and incidence proportions of SRD, as well as mortality rate ratios (MRRs) by cause of death among this group in Canada, according to their province of residence. METHODS Analyses were performed on linked administrative health databases (AHD; physician claims, hospitalizations, and vital statistics) in five Canadian provinces (Alberta, Manitoba, Ontario, Québec, and Nova Scotia). Canadians 12 years and older and registered for their provincial healthcare coverage were included. The International Classification of Diseases (ICD-9 or ICD-10 codes) was used for case identification of SRD from April 2001 to March 2018. RESULTS During the study period, the annual recorded SRD diagnostic rates increased in Alberta (2001-2002: 8.0‰; 2017-2018: 12.8‰), Ontario (2001-2002: 11.5‰; 2017-2018: 14.4‰), and Nova Scotia (2001-2002: 6.4‰; 2017-2018: 12.7‰), but remained stable in Manitoba (2001-2002: 5.5‰; 2017-2018: 5.4‰) and Québec (2001-2002 and 2017-2018: 7.5‰). Cumulative recorded SRD diagnostic rates increased steadily for all provinces. Recorded incidence proportions increased significantly in Alberta (2001-2002: 4.5‰; 2017-2018: 5.0‰) and Nova Scotia (2001-2002: 3.3‰; 2017-2018: 3.8‰), but significantly decreased in Ontario (2001-2002: 6.2‰; 2017-2018: 4.7‰), Québec (2001-2002: 4.1‰; 2017-2018: 3.2‰) and Manitoba (2001-2002: 2.7‰; 2017-2018: 2.0‰). For almost all causes of death, a higher MRR was found among individuals with recorded SRD than in the general population. The causes of death in 2015-2016 with the highest MRR for SRD individuals were SRD, suicide, and non-suicide trauma in Alberta, Ontario, Manitoba, and Québec. DISCUSSION Linked AHD covering almost the entire population can be useful to monitor the medical service trends of SRD and, therefore, guide health services planning in Canadian provinces.
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Affiliation(s)
- Christophe Huỳnh
- University Institute on Addictions, 49987CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, Québec, Québec.,Department of Psychiatry and Addiction, University of Montréal, Montréal, Québec, Canada.,School of Psychoeducation, University of Montréal, Montréal, Québec, Canada.,Recherche et Intervention sur les Substances Psychoactives - Québec, Trois-Rivières, Québec, Canada.,54470Institut National de Santé Publique du Québec, Québec, Canada
| | - Steve Kisely
- Department of Community Health and Epidemiology, 12361Dalhousie University, Halifax, Nova Scotia, Canada.,School of Medicine, University of Queensland, Queensland, Australia
| | - Louis Rochette
- 54470Institut National de Santé Publique du Québec, Québec, Canada
| | - Éric Pelletier
- 54470Institut National de Santé Publique du Québec, Québec, Canada
| | | | - Shelley Li
- 151965Alberta Health, Edmonton, Alberta, Canada
| | - Gareth Hopkin
- Institute of Health Economics & University of Alberta, Edmonton, Alberta, Canada.,Health Technology Wales, 1029NHS Wales/GIG Cymru, Cardiff, Wales, UK
| | - Mark Smith
- Manitoba Centre for Health Policy, Rady Faculty of Health Sciences, 50023University of Manitoba, Winnipeg, Manitoba, Canada
| | - Charles Burchill
- Manitoba Centre for Health Policy, Rady Faculty of Health Sciences, 50023University of Manitoba, Winnipeg, Manitoba, Canada
| | - Elizabeth Lin
- 7978Centre for Addiction & Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | - Mark Asbridge
- Department of Community Health and Epidemiology, 12361Dalhousie University, Halifax, Nova Scotia, Canada
| | - Didier Jutras-Aswad
- University Institute on Addictions, 49987CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, Québec, Québec.,Department of Psychiatry and Addiction, University of Montréal, Montréal, Québec, Canada.,Research Centre, 5622Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Alain Lesage
- University Institute on Addictions, 49987CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, Québec, Québec.,Department of Psychiatry and Addiction, University of Montréal, Montréal, Québec, Canada.,54470Institut National de Santé Publique du Québec, Québec, Canada.,25443Research Centre of the Montréal Mental Health University Institute, Montréal, Québec, Canada
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8
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Brathwaite D, Waller AE, Gaynes BN, Stemerman R, Deselm TM, Bischof JJ, Tintinalli J, Brice JH, Bush M. A 7 Year Summary of Emergency Department Visits by Patients With Mental Health Disorders. Front Psychiatry 2022; 13:831843. [PMID: 35222127 PMCID: PMC8863870 DOI: 10.3389/fpsyt.2022.831843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 01/18/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Emergency departments (EDs) have been increasingly utilized over time for psychiatric care. While multiple studies have assessed these trends in nationally representative data, few have evaluated these trends in state-level data. This investigation seeks to understand the mental health-related ED burden in North Carolina (NC) by describing trends in ED visits associated with a mental health diagnosis (MHD) over time. METHODS Using data from NC DETECT, this investigation describes trends in NC ED visits from January 1, 2008 through December 31, 2014 by presence of a MHD code. A visit was classified by the first listed MHD ICD-9-CM code in the surveillance record and MHD codes were grouped into related categories for analysis. Visits were summarized by MHD status and by MHD category. RESULTS Over 32 million ED visits were recorded from 2008 to 2014, of which 3,030,746 (9.4%) were MHD-related visits. The average age at presentation for MHD-related visits was 50 years (SD 23.5) and 63.9% of visits were from female patients. The proportion of ED visits with a MHD increased from 8.3 to 10.2% from 2008 to 2014. Annually and overall, the largest diagnostic category was stress/anxiety/depression. Hospital admissions resulting from MHD-related visits declined from 32.2 to 18.5% from 2008 to 2014 but remained consistently higher than the rate of admissions among non-MHD visits. CONCLUSION Similar to national trends, the proportion of ED visits associated with a MHD in NC has increased over time. This indicates a need for continued surveillance, both stateside and nationally, in order to inform future efforts to mitigate the growing ED burden.
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Affiliation(s)
- Danielle Brathwaite
- Department of Health Policy and Management, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, United States
| | - Anna E Waller
- Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, United States.,Carolina Center for Health Informatics, University of North Carolina, Chapel Hill, NC, United States
| | - Bradley N Gaynes
- Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC, United States.,Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, United States
| | - Rachel Stemerman
- Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Tracy M Deselm
- Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Jason J Bischof
- Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, United States.,Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Judith Tintinalli
- Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Jane H Brice
- Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Montika Bush
- Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, United States
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9
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Armoon B, Grenier G, Cao Z, Huỳnh C, Fleury MJ. Frequencies of emergency department use and hospitalization comparing patients with different types of substance or polysubstance-related disorders. Subst Abuse Treat Prev Policy 2021; 16:89. [PMID: 34922562 PMCID: PMC8684146 DOI: 10.1186/s13011-021-00421-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2021] [Indexed: 01/20/2023] Open
Abstract
Background This study measured emergency department (ED) use and hospitalization for medical reasons among patients with substance-related disorders (SRD), comparing four subgroups: cannabis-related disorders, drug-related disorders other than cannabis, alcohol-related disorders and polysubstance-related disorders, controlling for various clinical, sociodemographic and service use variables. Methods Clinical administrative data for a cohort of 22,484 patients registered in Quebec (Canada) addiction treatment centers in 2012-13 were extracted for the years 2009-10 to 2015-16. Using negative binomial models, risks of frequent ED use and hospitalization were calculated for a 12-month period (2015-16). Results Patients with polysubstance-related disorders used ED more frequently than other groups with SRD. They were hospitalized more frequently than patients with cannabis or other drug-related disorders, but less frequently than those with alcohol-related disorders. Patients with alcohol-related disorders used ED more frequently than those with cannabis-related disorders and underwent more hospitalizations than both patients with cannabis-related and other drug-related disorders. Co-occurring SRD-mental disorders or SRD-chronic physical illnesses, more years with SRD, being women, living in rural territories, more frequent consultations with usual general practitioner or outpatient psychiatrist, and receiving more interventions in community healthcare centers increased frequency of ED use and hospitalization, whereas both adverse outcomes decreased with high continuity of physician care. Behavioral addiction, age less than 45 years, living in more materially deprived areas, and receiving 1-3 interventions in addiction treatment centers increased risk of frequent ED use, whereas living in semi-urban areas decreased ED use. Patients 25-44 years old receiving 4+ interventions in addiction treatment centers experienced less frequent hospitalization. Conclusion Findings showed higher risk of ED use among patients with polysubstance-related disorders, and higher hospitalization risk among patients with alcohol-related disorders, compared with patients affected by cannabis and other drug-related disorders. However, other variables contributed substantially more to the frequency of ED use and hospitalization, particularly clinical variables regarding complexity and severity of health conditions, followed by service use variables. Another important finding was that high continuity of physician care helped decrease the use of acute care services. Strategies like integrated care and outreach interventions may enhance SRD services. Supplementary Information The online version contains supplementary material available at 10.1186/s13011-021-00421-7.
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Affiliation(s)
- Bahram Armoon
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada
| | - Guy Grenier
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada
| | - Zhirong Cao
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada
| | - Christophe Huỳnh
- Institut universitaire sur les dépendances du Centre intégré universitaire de santé et des services sociaux du Centre-Sud-de-l'Île-de-Montréal, 950 Louvain Est, Montréal, Québec, H2M 2E8, Canada
| | - Marie-Josée Fleury
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada. .,Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC, H3A 1A1, Canada.
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10
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Kaltsidis G, Bamvita JM, Grenier G, Fleury MJ. Predictors of Frequent Emergency Department Utilization for Mental Health Reasons. J Behav Health Serv Res 2021; 48:259-273. [PMID: 32185614 DOI: 10.1007/s11414-020-09695-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Overcrowding in emergency departments (ED) jeopardizes quality and access to health care, which represents a major issue for service delivery. This study determined predictors of frequent ED utilization among 320 patients recruited from six hospital ED in Quebec (Canada). Data collection included patient interviews and administrative databanks. A hierarchical linear regression analysis was performed using the Andersen Behavioral Model as a framework, with variables organized into predisposing, enabling, and needs factors. Results showed that needs factors were most strongly associated with ED utilization, particularly schizophrenia and personality disorders. Predisposing and enabling factors each contributed one variable to the model: past hospitalization for Mental Health (MH) reasons, and having regular care from an outpatient psychiatrist over the 12 months prior to interview at the ED, respectively. Increasing integration of MH services in networks may reduce unnecessary ED utilization and overcrowding, while providing better accessibility and care continuity for patients who visit ED for MH reasons.
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Affiliation(s)
- Gesthika Kaltsidis
- Department of Psychiatry, McGill University, Montreal, QC, Canada.,Douglas Mental Health University Institute Research Centre, Montreal, QC, Canada
| | - Jean-Marie Bamvita
- Douglas Mental Health University Institute Research Centre, Montreal, QC, Canada
| | - Guy Grenier
- Douglas Mental Health University Institute Research Centre, Montreal, QC, Canada
| | - Marie-Josée Fleury
- Department of Psychiatry, McGill University, Montreal, QC, Canada. .,Douglas Mental Health University Institute Research Centre, Montreal, QC, Canada.
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11
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Causey ST, Towe SL, Hartsock J, Xu Y, Meade CS. Perceived Healthcare Access among Persons with and without HIV Who Use Illicit Stimulants: The Role of Cumulative Risk. Subst Use Misuse 2021; 56:1387-1396. [PMID: 34034631 PMCID: PMC8370044 DOI: 10.1080/10826084.2021.1928211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: Persons who use stimulant drugs have greater morbidity and mortality relative to non-users. HIV infection has the potential to contribute to even great disparity in health outcomes among persons who use stimulants. These health disparities likely result in part due to poorer access to healthcare. Our study used a cumulative risk model to examine the impact of multiple risk factors on healthcare access in a sample of persons with and without HIV who use stimulants. Method: Our sample included 453 persons who reported recent use of illicit stimulants (102 HIV+, 351 HIV-). Participants completed clinical interviews, questionnaires, and a rapid oral HIV test. We constructed an 8-item cumulative risk index that included factors related to socioeconomic status, homelessness, legal history, and substance use. Results: Participants with HIV (PHW) were older than participants without HIV and more likely to have health insurance. Participants with and without HIV reported similar prior treatment utilization, but PWH reported better healthcare access and lower cumulative risk scores. Regression analyses showed cumulative risk was a significant predictor of healthcare access (β = -0.20, p < 0.001) even after controlling for age, HIV status, and health insurance status. We did not observe an interaction of HIV status by cumulative risk. Conclusions: Access to care among persons who use stimulants, both with and without HIV, is negatively impacted by the accumulation of risk factors from a number of different domains. Understanding the cumulative effects of these factors is critical for developing interventions to facilitate access to care, thus reducing health disparities and improving health outcomes.
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Affiliation(s)
- Shakiera T Causey
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Sheri L Towe
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jeremiah Hartsock
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Yunan Xu
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Christina S Meade
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
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12
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Huỳnh C, Kisely S, Rochette L, Pelletier É, Jutras-Aswad D, Larocque A, Fleury MJ, Lesage A. Using administrative health data to estimate prevalence and mortality rates of alcohol and other substance-related disorders for surveillance purposes. Drug Alcohol Rev 2021; 40:662-672. [PMID: 33432695 DOI: 10.1111/dar.13235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 11/16/2020] [Accepted: 11/22/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Administrative health databases (AHD) are critical to guide health service management and can inform the whole spectrum of substance-related disorders (SRD). This study estimates prevalence and mortality rates of SRD in administrative health databases. METHODS The Quebec Integrated Chronic Disease Surveillance System consists of linked AHD. Analyses were performed on data of all Quebec residents aged 12 and over and eligible for health-care coverage using the International Classification of Diseases (ninth or tenth revision) for case identification. Mortality rate ratios stratified by causes of death were obtained to calculate an excess of mortality. RESULTS Since 2001-2002, the annual age-adjusted prevalence rate of diagnosed overall SRD remained stable (8.6 per 1000 in 2017-2018). In any given year, the annual prevalence rate was significantly higher in males; adolescents had the lowest rate, while adults 65 years and older the highest. The annual 2017-2018 rate was 2.1 per 1000 for alcohol-induced disorder, 1.9 for other drug-induced disorder, 0.7 for alcohol intoxication and 0.6 for other drug intoxications. Cumulative rate of any diagnosis related to alcohol was 32 per 1000 females and 53 per 1000 males (2001-2018), and 33 per 1000 females and 49 per 1000 males for any diagnosis related to other drugs. There was an excess of all-cause mortality among individuals with SRD compared to the general population. DISCUSSION AND CONCLUSIONS AHD can complement epidemiological surveys in monitoring SRD jurisdiction-wide. Surveillance of services utilisation and interventions, coupled with health outcomes like mortality, could be useful in guiding health services planning.
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Affiliation(s)
- Christophe Huỳnh
- University Institute on Addictions, CIUSSS du Centre-Sud-de-l'Île-de-Montréal (Integrated University Centre of Health and Social Services of the Centre-South-of-the-Island-of-Montréal), Montreal, Canada.,Department of Psychiatry and Addiction, University of Montréal, Montreal, Canada.,School of Psychoeducation, University of Montreal, Montreal, Canada.,Bureau d'information et d'études en santé des populations (Bureau of Information and Studies on the Health of Populations), Institut National de Santé Publique du Québec (National Institute of Public Health of Quebec), Quebec City, Canada
| | - Steve Kisely
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Canada.,School of Medicine, University of Queensland, Brisbane, Australia
| | - Louis Rochette
- Bureau d'information et d'études en santé des populations (Bureau of Information and Studies on the Health of Populations), Institut National de Santé Publique du Québec (National Institute of Public Health of Quebec), Quebec City, Canada
| | - Éric Pelletier
- Bureau d'information et d'études en santé des populations (Bureau of Information and Studies on the Health of Populations), Institut National de Santé Publique du Québec (National Institute of Public Health of Quebec), Quebec City, Canada
| | - Didier Jutras-Aswad
- University Institute on Addictions, CIUSSS du Centre-Sud-de-l'Île-de-Montréal (Integrated University Centre of Health and Social Services of the Centre-South-of-the-Island-of-Montréal), Montreal, Canada.,Department of Psychiatry and Addiction, University of Montréal, Montreal, Canada.,Research Centre, Centre Hospitalier de l'Université de Montréal (University of Montreal Health Centre), Montreal, Canada
| | - Alexandre Larocque
- Department of Emergency Medicine, Centre Hospitalier de l'Université de Montréal (University of Montreal Health Centre), Montreal, Canada.,Quebec Poison Control Center, Québec City, Canada
| | | | - Alain Lesage
- Department of Psychiatry and Addiction, University of Montréal, Montreal, Canada.,Bureau d'information et d'études en santé des populations (Bureau of Information and Studies on the Health of Populations), Institut National de Santé Publique du Québec (National Institute of Public Health of Quebec), Quebec City, Canada.,Research Centre of the Montreal Mental Health University Institute, Montreal, Canada
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13
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Economic and Social Factors That Predict Readmission for Mental Health and Drug Abuse Patients. SUSTAINABILITY 2021. [DOI: 10.3390/su13020531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
According to the United Nations, curtailing the rise of mental illness and drug abuse has been an important goal for sustainable development of member states. In the United States, reducing readmission rates for mental health and drug abuse patients is critical, given the rising health care costs and a strained health care system. This study aims to examine economic and social factors that predict readmission likelihood for mental health and drug abuse patients in the state of New York. Patient admission data of 25,846 mental health patients and 32,702 drug abuse patients with multiple visits in New York hospitals in 2015 were examined. Findings show that economic factors like income level and payment type impact readmission rates differently: The poorest patients were less likely to get readmitted while patients with higher incomes were likely to experience drug relapse. Regarding social factors, mental health patients who lived in neighborhoods with high social capital were less likely to be readmitted, but drug abuse patients in similar areas were more likely to be readmitted. The findings show that policy-makers and hospital administrators need to approach readmission rates differently for each group of patients.
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14
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Gentil L, Grenier G, Meng X, Fleury MJ. Impact of Co-occurring Mental Disorders and Chronic Physical Illnesses on Frequency of Emergency Department Use and Hospitalization for Mental Health Reasons. Front Psychiatry 2021; 12:735005. [PMID: 34880788 PMCID: PMC8645581 DOI: 10.3389/fpsyt.2021.735005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 11/01/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Patients with mental disorders (MD) are at high risk for a wide range of chronic physical illnesses (CPI), often resulting in greater use of acute care services. This study estimated risk of emergency department (ED) use and hospitalization for mental health (MH) reasons among 678 patients with MD and CPI compared to 1,999 patients with MD only. Methods: Patients visiting one of six Quebec (Canada) ED for MH reasons and at onset of a MD in 2014-15 (index year) were included. Negative binomial models comparing the two groups estimated risk of ED use and hospitalization at 12-month follow-up to index ED visit, controlling for clinical, sociodemographic, and service use variables. Results: Patients with MD, more severe overall clinical conditions and those who received more intensive specialized MH care had higher risks of frequent ED use and hospitalization. Continuity of medical care protected against both ED use and hospitalization, while general practitioner (GP) consultations protected against hospitalization only. Patients aged 65+ had lower risk of ED use, whereas risk of hospitalization was higher for the 45-64- vs. 12-24-year age groups, and for men vs. women. Conclusion: Strategies including assertive community treatment, intensive case management, integrated co-occurring treatment, home treatment, and shared care may improve adequacy of care for patients with MD-CPI, as well as those with MD only whose clinical profiles were severe. Prevention and outreach strategies may also be promoted, especially among men and older age groups.
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Affiliation(s)
- Lia Gentil
- Douglas Mental Health University Institute Research Centre, Montréal, QC, Canada.,Department of Psychiatry, McGill University, Montréal, QC, Canada
| | - Guy Grenier
- Douglas Mental Health University Institute Research Centre, Montréal, QC, Canada
| | - Xiangfei Meng
- Douglas Mental Health University Institute Research Centre, Montréal, QC, Canada.,Department of Psychiatry, McGill University, Montréal, QC, Canada
| | - Marie-Josée Fleury
- Douglas Mental Health University Institute Research Centre, Montréal, QC, Canada.,Department of Psychiatry, McGill University, Montréal, QC, Canada
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15
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Gentil L, Grenier G, Fleury MJ. Factors Related to 30-day Readmission following Hospitalization for Any Medical Reason among Patients with Mental Disorders: Facteurs liés à la réhospitalisation à 30 jours suivant une hospitalisation pour une raison médicale chez des patients souffrant de troubles mentaux. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2021; 66:43-55. [PMID: 33063531 PMCID: PMC7890589 DOI: 10.1177/0706743720963905] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This study evaluated the contributions of clinical, sociodemographic, and service use variables to the risk of early readmission, defined as readmission within 30 days of discharge following hospitalization for any medical reason (mental or physical illnesses), among patients with mental disorders in Quebec (Canada). METHODS In this longitudinal study, 2,954 hospitalized patients who had visited 1 of 6 Quebec emergency departments (ED) in 2014 to 2015 (index year) were identified through clinical administrative databanks. The first hospitalization was considered that may have occurred at any Quebec hospital. Data collected between 2012 and 2013 and 2013 and 2014 on clinical, sociodemographic, and service use variables were assessed as related to readmission/no readmission within 30 days of discharge using hierarchical binary logistic regression. RESULTS Patients with co-occurring substance-related disorders/chronic physical illnesses, serious mental disorders, or adjustment disorders (clinical variables); 4+ outpatient psychiatric consultations with the same psychiatrist; and patients hospitalized for any medical reason within 12 months prior to index hospitalization (service use variables) were more likely to be readmitted within 30 days of discharge. Patients who made 1 to 3 ED visits within 1 year prior to the index hospitalization, had their index hospitalization stay of 16 to 29 days, or consulted a physician for any medical reason within 30 days after discharge or prior to the readmission (service use variables) were less likely to be rehospitalized. CONCLUSIONS Early hospital readmission was more strongly associated with clinical variables, followed by service use variables, both playing a key role in preventing early readmission. Results suggest the importance of developing specific interventions for patients at high risk of readmission such as better discharge planning, integrated and collaborative care, and case management. Overall, better access to services and continuity of care before and after hospital discharge should be provided to prevent early hospital readmission.
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Affiliation(s)
- Lia Gentil
- Douglas Mental Health University Institute, Montréal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Guy Grenier
- Douglas Mental Health University Institute, Montréal, Quebec, Canada
| | - Marie-Josée Fleury
- Douglas Mental Health University Institute, Montréal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
- Marie-Josée Fleury, PhD, Douglas Mental Health University Institute, 6875 La Salle Blvd., Montreal, Quebec, Canada H4H 1R3.
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16
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Aubut V, Wagner V, Cousineau MM, Bertrand K. Problematic Substance Use, Help-Seeking, and Service Utilization Trajectories among Seniors: An Exploratory Qualitative Study. J Psychoactive Drugs 2020; 53:18-26. [PMID: 32990172 DOI: 10.1080/02791072.2020.1824045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Problematic substance use has a significant impact on the health of a large proportion of people aged 65 years and older. Along with population growth, there is an increase in seniors enrolling for treatment in Québec (Canada). This study explores the perspectives of older adults related to their substance use experiences, help-seeking and utilization of addiction treatment services. In-depth interviews were conducted with 11 seniors receiving addiction treatment in two area in Québec. Thematic analysis highlight that seniors' experiences, life contexts, and social participation influence their substance use. Help-seeking process can be triggered by realizing the extent of substance use, while barriers and facilitators shape this experience. Utilization of addiction treatment services was mainly perceived positively. Several characteristics and components of services enable seniors to have positive experiences. Substance use can be employed as an adaptation strategy to get through hardships or ease loneliness and boredom. Talking to people, such as family, friends or professionals, is important to older adults' developing trust and engaging in a process to change substance use habits. Based upon these results, clinical recommendations to take into account the complex needs of seniors seeking treatment and related to their social environment are formulated.
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Affiliation(s)
- Valérie Aubut
- Department of Psychoeducation, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada.,Institut universitaire sur les dépendances, Direction de l'enseignement universitaire et de la recherche, CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, QC,Canada.,Recherche et intervention sur les substances psychoactives-Québec group, Université du Québec à Trois-Rivières - Centre universitaire de Québec, Trois-Rivières, QC, Canada
| | - Vincent Wagner
- Institut universitaire sur les dépendances, Direction de l'enseignement universitaire et de la recherche, CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, QC,Canada.,Recherche et intervention sur les substances psychoactives-Québec group, Université du Québec à Trois-Rivières - Centre universitaire de Québec, Trois-Rivières, QC, Canada.,Department of Community Health Sciences, Addiction Research Study Program, University of Sherbrooke, Sherbrooke, QC, Canada
| | - Marie-Marthe Cousineau
- School of Criminology, Assistant Dean, Graduate Studies, Professional Training and Partners, Faculty of Arts and Sciences, Université de Montréal, Montréal, QC, Canada
| | - Karine Bertrand
- Institut universitaire sur les dépendances, Direction de l'enseignement universitaire et de la recherche, CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, QC,Canada.,Recherche et intervention sur les substances psychoactives-Québec group, Université du Québec à Trois-Rivières - Centre universitaire de Québec, Trois-Rivières, QC, Canada.,Department of Community Health Sciences, Addiction Research Study Program, University of Sherbrooke, Sherbrooke, QC, Canada
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17
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Penzenstadler L, Gentil L, Grenier G, Khazaal Y, Fleury MJ. Risk factors of hospitalization for any medical condition among patients with prior emergency department visits for mental health conditions. BMC Psychiatry 2020; 20:431. [PMID: 32883239 PMCID: PMC7469095 DOI: 10.1186/s12888-020-02835-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 08/24/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND This longitudinal study identified risk factors for frequency of hospitalization among patients with any medical condition who had previously visited one of six Quebec (Canada) emergency departments (ED) at least once for mental health (MH) conditions as the primary diagnosis. METHODS Records of n = 11,367 patients were investigated using administrative databanks (2012-13/2014-15). Hospitalization rates in the 12 months after a first ED visit in 2014-15 were categorized as no hospitalizations (0 times), moderate hospitalizations (1-2 times), and frequent hospitalizations (3+ times). Based on the Andersen Behavioral Model, data on risk factors were gathered for the 2 years prior to the first visit in 2014-15, and were identified as predisposing, enabling or needs factors. They were tested using a hierarchical multinomial logistic regression according to the three groups of hospitalization rate. RESULTS Enabling factors accounted for the largest percentage of total variance explained in the study model, followed by needs and predisposing factors. Co-occurring mental disorders (MD)/substance-related disorders (SRD), alcohol-related disorders, depressive disorders, frequency of consultations with outpatient psychiatrists, prior ED visits for any medical condition and number of physicians consulted in specialized care, were risk factors for both moderate and frequent hospitalizations. Schizophrenia spectrum and other psychotic disorders, bipolar disorders, and age (except 12-17 years) were risk factors for moderate hospitalizations, while higher numbers (4+) of overall interventions in local community health service centers were a risk factor for frequent hospitalizations only. Patients with personality disorders, drug-related disorders, suicidal behaviors, and those who visited a psychiatric ED integrated with a general ED in a separate site, or who visited a general ED without psychiatric services were also less likely to be hospitalized. Less urgent and non-urgent illness acuity prevented moderate hospitalizations only. CONCLUSIONS Patients with severe and complex health conditions, and higher numbers of both prior outpatient psychiatrist consultations and ED visits for medical conditions had more moderate and frequent hospitalizations as compared with non-hospitalized patients. Patients at risk for frequent hospitalizations were more vulnerable overall and had important biopsychosocial problems. Improved primary care and integrated outpatient services may prevent post-ED hospitalization.
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Affiliation(s)
- Louise Penzenstadler
- grid.14709.3b0000 0004 1936 8649Douglas Hospital Research Center, Douglas Mental Health University Institute, McGill University, 6875 LaSalle Boulevard, Montréal, Québec, H4H 1R3 Canada ,grid.150338.c0000 0001 0721 9812Hôpitaux Universitaires Genève, Département de psychiatrie, Service d’addictologie, Rue du Grand-Pré 70c, 1202 Geneva, Switzerland
| | - Lia Gentil
- grid.14709.3b0000 0004 1936 8649Douglas Hospital Research Center, Douglas Mental Health University Institute, McGill University, 6875 LaSalle Boulevard, Montréal, Québec, H4H 1R3 Canada ,Institut universitaire sur les dépendances du Centre intégré universitaire de santé et des services sociaux du Centre-Sud-de-l’Île-de-Montréal, 950 Louvain East, Montréal, Québec, H2M 2E8 Canada
| | - Guy Grenier
- grid.14709.3b0000 0004 1936 8649Douglas Hospital Research Center, Douglas Mental Health University Institute, McGill University, 6875 LaSalle Boulevard, Montréal, Québec, H4H 1R3 Canada
| | - Yasser Khazaal
- grid.8515.90000 0001 0423 4662Centre hospitalier universitaire vaudois, Département de psychiatrie, Service de médecine des addictions, Policlinique d’addictologie, Rue du Bugnon 23, 1011 Lausanne, Switzerland ,grid.14848.310000 0001 2292 3357Département de psychiatrie et d’addictologie, Université de Montréal, 2900 bld Eduard-Montpetit, Montréal, Québec, H3T1J4 Canada
| | - Marie-Josée Fleury
- Douglas Hospital Research Center, Douglas Mental Health University Institute, McGill University, 6875 LaSalle Boulevard, Montréal, Québec, H4H 1R3, Canada. .,Institut universitaire sur les dépendances du Centre intégré universitaire de santé et des services sociaux du Centre-Sud-de-l'Île-de-Montréal, 950 Louvain East, Montréal, Québec, H2M 2E8, Canada.
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18
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Fleury MJ, Grenier G, Bamvita JM, Ferland F. Typology of patients who use emergency departments for mental and substance use disorders. BJPsych Open 2020; 6:e59. [PMID: 32489163 PMCID: PMC7345525 DOI: 10.1192/bjo.2020.39] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Identifying profiles of people with mental and substance use disorders who use emergency departments may help guide the development of interventions more appropriate to their particular characteristics and needs. AIMS To develop a typology for the frequency of visits to the emergency department for mental health reasons based on the Andersen model. METHOD Questionnaires were completed by patients who attended an emergency department (n = 320), recruited in Quebec (Canada), and administrative data were obtained related to sociodemographic/socioeconomic characteristics, mental health diagnoses including alcohol and drug use, and emergency department and mental health service utilization. A cluster analysis was performed, identifying needs, predisposing and enabling factors that differentiated subclasses of participants according to frequency of emergency department visits for mental health reasons. RESULTS Four classes were identified. Class 1 comprised individuals with moderate emergency department use and low use of other health services; mostly young, economically disadvantaged males with substance use disorders. Class 2 comprised individuals with high emergency department and specialized health service use, with multiple mental and substance use disorders. Class 3 comprised middle-aged, economically advantaged females with common mental disorders, who made moderate use of emergency departments but consulted general practitioners. Class 4 comprised older individuals with multiple chronic physical illnesses co-occurring with mental disorders, who made moderate use of the emergency department, but mainly consulted general practitioners. CONCLUSIONS The study found heterogeneity in emergency department use for mental health reasons, as each of the four classes represented distinct needs, predisposing and enabling factors. As such, interventions should be tailored to different classes of patients who use emergency departments, based on their characteristics.
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Affiliation(s)
- Marie-Josée Fleury
- Department of Psychiatry, McGill University; and Douglas Mental Health University Institute Research Centre, Quebec, Canada
| | - Guy Grenier
- Douglas Mental Health University Institute Research Centre, Quebec, Canada
| | - Jean-Marie Bamvita
- Douglas Mental Health University Institute Research Centre, Quebec, Canada
| | - Francine Ferland
- School of Social Work, Laval University; and Addiction Rehabilitation Centre, University Integrated Health and Social Services Centre - Capitale-Nationale, Quebec, Canada
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19
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Alunni-Menichini K, Bertrand K, Roy L, Brousselle A. Current emergency response in montreal: How does it fit in the services offered to homeless people who use substances? THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 82:102758. [PMID: 32482488 DOI: 10.1016/j.drugpo.2020.102758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 04/09/2020] [Accepted: 04/10/2020] [Indexed: 11/19/2022]
Abstract
Background This paper presents an assessment of the current emergency response to homeless people who use substances in Montreal, a major North American city. This project addresses the rising concern about homelessness in high-income countries. Several studies have shown that homeless people frequently use emergency services (i.e., police, paramedical, and hospital), especially in the context of substance use. Yet, the key actors' perspectives are poorly documented. Method Our team conducted a needs analysis using a deliberative democratic evaluation. Data collection strategies included an intersectoral World Café (n = 34, including police, specialized professionals, community stakeholders, political representatives, researchers, and people who have been homeless) and individual interviews with health professionals (n = 5) and homeless people (n = 8). We performed a thematic content analysis based on a conceptual framework of access to health care and of collaboration. Findings This study provided key information on the role of emergency services and the needs of key actors, in terms of the dimensions of access to health care (approachability, acceptability, availability, and appropriateness) and continuity. Our main results show that, according to the participants, the emergency response is relevant when homeless people are a danger to themselves or to others, and during episodes of acute physical and psychological care. However, emergency service providers still stigmatize homelessness and substance use, which negatively affects intervention quality. Finally, our main results highlight the interdependence between the emergency services and health, social, and community services. Conclusion The emergency response is necessary and appropriate in some situations. It remains important to intervene upstream and to improve the attitudes and practices of emergency service providers. Finally, it is necessary to adapt services to the needs of homeless substance users and improve service continuity, for example, by adopting a population-based approach.
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Affiliation(s)
- Kristelle Alunni-Menichini
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, University of Sherbrooke, Institut Universitaire en Dépendance, 150, place Charles-Le Moyne, bureau 200, Longueuil (QC), J4K 0A8, Canada; Institut universitaire sur les dépendances, Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal, 950 rue de Louvain Est, Montréal (QC), H2M 2E8
| | - Karine Bertrand
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, University of Sherbrooke, Institut Universitaire en Dépendance, 150, place Charles-Le Moyne, bureau 200, Longueuil (QC), J4K 0A8, Canada; Institut universitaire sur les dépendances, Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal, 950 rue de Louvain Est, Montréal (QC), H2M 2E8
| | - Laurence Roy
- School of Physical & Occupational Therapy, McGill University, Davis House, 3654 Promenade Sir-William-Osler, Montreal (QC), H3G 1Y5, Canada; Douglas Mental Health University Institute, Centre intégré universitaire de santé et de services sociaux de l'Ouest-de-l'Île-de-Montréal, 6875 LaSalle Boulevard, Montreal (QC), H4H 1R3, Canada
| | - Astrid Brousselle
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, University of Sherbrooke, Institut Universitaire en Dépendance, 150, place Charles-Le Moyne, bureau 200, Longueuil (QC), J4K 0A8, Canada; School of Public Administration, Faculty of Human and Social Development, University of Victoria, 3800 Finnerty Rd (Ring Rd), Human & Social Development Building, Room A302, Victoria (BC), V8P 5C2, Canada
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20
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Penzenstadler L, Gentil L, Huỳnh C, Grenier G, Fleury MJ. Variables associated with low, moderate and high emergency department use among patients with substance-related disorders. Drug Alcohol Depend 2020; 207:107817. [PMID: 31887605 DOI: 10.1016/j.drugalcdep.2019.107817] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 12/12/2019] [Accepted: 12/14/2019] [Indexed: 11/27/2022]
Abstract
AIMS This study identified factors associated with frequency of emergency department (ED) use for medical reasons among patients with substance-related disorders (SRD) in Quebec (Canada) for 2014-15. METHODS Participants (n = 4731) were categorized as: 1) low (1 visit/year), 2) moderate (2 visits/year), and 3) high (3+ visits/year) ED users. Independent variables included predisposing, enabling and needs factors based on the Andersen Behavioral Model. Multinomial logistic regression identified associated variables. RESULTS Factors positively associated with moderate and high ED use included adjustment disorders, suicidal behavior, alcohol-induced disorders, less urgent to non-urgent illness acuity, referral to local health community services centers (LHCSC) at discharge, and living in a materially deprived area. Factors positively associated with high ED use only included anxiety disorders, alcohol use disorders, drug use disorders, chronic physical illness, subacute problems, prior ED use for MD and/or SRD, prior LHCSC medical interventions, physician consultation within one month after discharge, living in very deprived or middle-class areas, and, negatively, being hospitalized for medical reasons in second ED visit. Moderate ED use only was negatively associated with alcohol intoxication and being referred to a GP at ED discharge. CONCLUSIONS Compared to low ED users, most high users with SRD were men presenting more complex and severe conditions. They visited ED mainly for subacute or non-urgent problems. Compared to low ED users, most moderate users had alcohol-induced disorders, less alcohol intoxication, and acute common MD. They visited ED mainly for non-urgent care. Diverse strategies should be implemented to reduce ED visits, targeting each group.
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Affiliation(s)
- Louise Penzenstadler
- Douglas Mental Health University Institute (Research Centre), McGill University, Department of Psychiatry, 6875 LaSalle Boulevard, Montréal, Québec H4H 1R3, Canada; Service d'addictologie, Département de psychiatrie, Hôpitaux Universitaires Genève, Rue du Grand-Pré 70c, 1202 Genève, Switzerland
| | - Lia Gentil
- Douglas Mental Health University Institute (Research Centre), McGill University, Department of Psychiatry, 6875 LaSalle Boulevard, Montréal, Québec H4H 1R3, Canada; Institut universitaire sur les dépendances, Centre intégré universitaire de santé et des services sociaux du Centre-Sud-de-l'Île-de-Montréal, 950 Louvain East, Montréal, Québec H2M 2E8, Canada
| | - Christophe Huỳnh
- Institut universitaire sur les dépendances, Centre intégré universitaire de santé et des services sociaux du Centre-Sud-de-l'Île-de-Montréal, 950 Louvain East, Montréal, Québec H2M 2E8, Canada
| | - Guy Grenier
- Douglas Mental Health University Institute (Research Centre), McGill University, Department of Psychiatry, 6875 LaSalle Boulevard, Montréal, Québec H4H 1R3, Canada
| | - Marie-Josée Fleury
- Douglas Mental Health University Institute (Research Centre), McGill University, Department of Psychiatry, 6875 LaSalle Boulevard, Montréal, Québec H4H 1R3, Canada.
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21
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Wani RJ, Watanabe-Galloway S, Tak HJ, Chen LW, Wehbi N, Wilson F. Utilisation of emergency departments of behavioural disorders and supply of workforce in Nebraska. EVIDENCE-BASED MENTAL HEALTH 2020; 23:57-66. [PMID: 31907210 DOI: 10.1136/ebmental-2019-300125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 12/12/2019] [Accepted: 12/15/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND Emergency departments (EDs) have become entry points for treating behavioural health (BH) conditions, thereby rendering the evaluation of their utilisation necessary. OBJECTIVES This study estimated behavioural-related hospital-based ED visits and outcomes of leaving against medical advice as well as the incurred charges within the primarily rural State of Nebraska. Also, the study correlated behavioural workforce distribution and location of EDs with ED utilisation. METHODS Nebraska State Emergency Department Database provided information on utilisation of services, charges, diagnoses and demographic. Health Professional Tracking Services survey provided the distribution of EDs and BH workforce by region. To examine the effect of patient characteristics on discharge against medical advice, multivariable logistic regression modelling was used. FINDINGS US$96.4 million were ED charges for 52 035 visits for BH disorders over 3 years. Of these, 35% and 50% were between 25 and 44-years old and privately insured, respectively. The uninsured (OR:1.53, p=0.0047) and 45-64 years old (OR:2.31, p<0.001) had higher odds of leaving against medical advice. The findings from this study identified ED outcomes among high-risk cohort. CONCLUSIONS There were high ED rates among the limited number EDs facilities in rural Nebraska. Rural regions of Nebraska faced workforce shortages and had high numbers of ED visits at relatively few accessible EDs. CLINICAL IMPLICATIONS Customised rural-centric public health programmes, which are based in clinical settings, can encourage patients to adhere to ED-treatment. Also, increasing the availability of BH workforce (either via telehealth or part-time presence) in rural areas can alleviate the problem and reduce ED revisits.
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Affiliation(s)
- Rajvi Jayant Wani
- Department of Health Services Research, Administration and Policy, University of Medical Center, Omaha, Nebraska, USA
| | - Shinobu Watanabe-Galloway
- Department of Health Services Research, Administration and Policy, University of Medical Center, Omaha, Nebraska, USA.,University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Hyo Jung Tak
- Department of Health Services Research, Administration and Policy, University of Medical Center, Omaha, Nebraska, USA
| | - Li-Wu Chen
- Department of Health Services Research, Administration and Policy, University of Medical Center, Omaha, Nebraska, USA
| | - Nizar Wehbi
- Department of Health Services Research, Administration and Policy, University of Medical Center, Omaha, Nebraska, USA
| | - Fernando Wilson
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, Utah, United States
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22
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Gabet M, Grenier G, Cao Z, Fleury MJ. Predictors of Emergency Department Use among Individuals with Current or Previous Experience of Homelessness. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E4965. [PMID: 31817747 PMCID: PMC6950268 DOI: 10.3390/ijerph16244965] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 11/15/2019] [Accepted: 12/02/2019] [Indexed: 11/22/2022]
Abstract
This study assessed the contributions of predisposing, enabling, and needs factors in predicting emergency department (ED) use among 270 individuals with current or previous experience of homelessness. Participants were recruited from three different types of housing (shelter, temporary housing and permanent housing) in Montreal, Quebec (Canada). They were interviewed at baseline (T0), and again 12 months after recruitment (T1). Longitudinal data analyses were conducted on associations between a set of baseline predictors (T0) with the dependent variable (ED users vs. non-users) from T1. Predictors were identified according to the Gelberg-Andersen Behavioral Model. Findings revealed two needs factors associated with ED use: having a substance use disorder (SUD) and low perceived physical health. Two enabling factors, use of ambulatory specialized services and stigma, were also related to ED use. No predisposing factors were retained in the model, and ED use was not associated with type of housing. Improvements are needed in SUD and physical health management in order to reduce ED use, as well as interventions aimed at stigma prevention for this vulnerable population.
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Affiliation(s)
- Morgane Gabet
- Département de Gestion, Évaluation et Politiques de Santé, École de santé publique, Université de Montréal, 7101 av. du Parc, Montréal, QC H3X1X9, Canada;
- Research Center, Douglas MH University Institute, 6875 LaSalle Blvd, Montreal, QC H4H 1R3, Canada; (G.G.); (Z.C.)
| | - Guy Grenier
- Research Center, Douglas MH University Institute, 6875 LaSalle Blvd, Montreal, QC H4H 1R3, Canada; (G.G.); (Z.C.)
| | - Zhirong Cao
- Research Center, Douglas MH University Institute, 6875 LaSalle Blvd, Montreal, QC H4H 1R3, Canada; (G.G.); (Z.C.)
| | - Marie-Josée Fleury
- Research Center, Douglas MH University Institute, 6875 LaSalle Blvd, Montreal, QC H4H 1R3, Canada; (G.G.); (Z.C.)
- Department of Psychiatry, McGill University, 1033, Pine Avenue West, Montreal, QC H3A 1A1, Canada
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23
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Fleury MJ, Rochette L, Grenier G, Huỳnh C, Vasiliadis HM, Pelletier É, Lesage A. Factors associated with emergency department use for mental health reasons among low, moderate and high users. Gen Hosp Psychiatry 2019; 60:111-119. [PMID: 31404825 DOI: 10.1016/j.genhosppsych.2019.07.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 07/05/2019] [Accepted: 07/08/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVES This study identified factors associated with frequency of emergency department (ED) use for mental health (MH) reasons in Quebec during 2015-2016. METHODS Participants (n = 115,066) were categorized as: 1) low (1 visit/year; 76%); 2) moderate (2 visits/year; 14%); and 3) high (3+ visits/year; 10%) ED users. Independent variables included predisposing, enabling and needs factors based on the Andersen Behavioral Model. Variables significantly associated with frequency of ED use were entered into a multinomial logistic regression. RESULTS Patients with mental illness (MI), especially substance-related disorders (SRD) and schizophrenia spectrum disorders; bipolar, depressive, anxiety or personality disorders; and those with severe chronic physical illness (needs factors) were more likely to use ED for MH reasons, as were male participants 18-64 years old, and those living in metropolitan areas with high social or material deprivation (predisposing factors). Regarding enabling factors, consultations with outpatient psychiatrists and not seeing a general practitioner (GP) in the year prior to ED visit were associated with high ED use. CONCLUSION The severity of MI/SRD contributed most to frequent ED use, while social and material deprivation in metropolitan areas, and intensity of medical care also influenced ED use for MH reasons.
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Affiliation(s)
- Marie-Josée Fleury
- Department of Psychiatry, McGill University, Montreal, QC, Canada; Douglas Mental Health University Institute, Montréal, QC, Canada.
| | - Louis Rochette
- Insitut national de santé publique du Québec, Québec, QC, Canada
| | - Guy Grenier
- Douglas Mental Health University Institute, Montréal, QC, Canada
| | - Christophe Huỳnh
- University Institute on Addictions, Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal, Montréal, QC, Canada; Department of Psychiatry, University of Montreal, Montréal, QC, Canada; School of Psychoeducation, University of Montreal, Montréal, QC, Canada
| | - Helen-Maria Vasiliadis
- Département des sciences de la santé communautaire, Université de Sherbrooke, Sherbrooke, QC, Canada; Centre de recherche Charles LeMoyne - Saguenay-Lac-Saint-Jean sur les innovations en santé, Longueuil, QC, Canada
| | - Éric Pelletier
- Insitut national de santé publique du Québec, Québec, QC, Canada
| | - Alain Lesage
- Department of Psychiatry, University of Montreal, Montréal, QC, Canada; Centre de recherche Fernand-Séguin, Institut universitaire en santé mentale de Montréal, Montréal, QC, Canada
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24
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Florentin S, Rosca P, Raskin S, Bdolah-Abram T, Neumark Y. Psychiatric Hospitalizations of Chronic Psychotic Disorder Patients With and Without Dual Diagnosis, Israel, 1963-2016. J Dual Diagn 2019; 15:130-139. [PMID: 31079564 DOI: 10.1080/15504263.2019.1609149] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: A significant proportion of patients with severe mental illness also experience substance use disorder. For these dual diagnosis (DD) patients, treatment is more complicated and prognosis is worse. Despite the introduction of the Community Rehabilitation of Persons With Mental Health Disability Law in 2000 and ongoing national mental health reforms, psychiatric services in Israel are not meeting the needs of an increasing number of DD patients. This study examines, for the first time in Israel, the prevalence of DD and patterns of psychiatric hospitalizations of chronic psychotic disorder patients with and without substance use disorder. Methods: The National Psychiatric Case Registry provided data on 18,684 persons with schizophrenia/schizoaffective disorders, aged 18-65, with a psychiatric hospitalization during the period 1963-2016 (with at least one hospitalization in 2010-15). Patients were considered as having DD if their substance use disorder was indicated in at least two, or 20%, of hospitalizations. Regression modeling predicted hospitalization measures (number of hospitalizations, total days hospitalized, length of stay). Results were also analyzed by legal status of admission (voluntary or involuntary; psychiatrist-ordered and court-ordered). Results: One-third of patients with chronic psychotic disorder met DD criteria, with a threefold higher rate among males (37.1%) than females (12.8%). Particularly high rates of DD (nearly 50%) were noted among male immigrants from Ethiopia. Compared with non-substance use disorder patients, DD patients had a significantly younger mean age at first hospitalization and shorter average length of stay per hospitalization but a greater number of hospitalizations and total hospital days (p < .0001 for all comparisons). The associations between DD status and hospitalization characteristics remained significant even after accounting for the effects of confounding factors. Hospitalization characteristics were also associated significantly with sex, population group, age, age at first hospitalization, and country of origin. The rate of court-ordered observation or hospitalization was threefold higher in the DD group. Conclusions: These findings, which broadly align with other countries, reflect a scarcity of outpatient services for DD patients with schizophrenia/schizoaffective disorder and substance use disorder. To achieve long-term mental health improvements, an expansion of community-based integrative treatment and rehabilitation services is needed in Israel.
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Affiliation(s)
- S Florentin
- The Hebrew University of Jerusalem , Jerusalem , Israel
| | - P Rosca
- Department for the Treatment of Substance Abuse, Ministry of Health , The Hebrew University of Jerusalem, Jerusalem , Israel
| | - S Raskin
- Jerusalem Mental Health Center, The Hebrew University of Jerusalem , Jerusalem , Israel
| | - T Bdolah-Abram
- Faculty of Medicine, The Hebrew University of Jerusalem , Jerusalem , Israel
| | - Y Neumark
- Hebrew University-Hadassah Braun School of Public Health & Community Medicine, The Hebrew University of Jerusalem , Jerusalem , Israel
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25
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Chiu Y, Racine-Hemmings F, Dufour I, Vanasse A, Chouinard MC, Bisson M, Hudon C. Statistical tools used for analyses of frequent users of emergency department: a scoping review. BMJ Open 2019; 9:e027750. [PMID: 31129592 PMCID: PMC6537981 DOI: 10.1136/bmjopen-2018-027750] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Frequent users represent a small proportion of emergency department users, but they account for a disproportionately large number of visits. Their use of emergency departments is often considered suboptimal. It would be more efficient to identify and treat those patients earlier in their health problem trajectory. It is therefore essential to describe their characteristics and to predict their emergency department use. In order to do so, adequate statistical tools are needed. The objective of this study was to determine the statistical tools used in identifying variables associated with frequent use or predicting the risk of becoming a frequent user. METHODS We performed a scoping review following an established 5-stage methodological framework. We searched PubMed, Scopus and CINAHL databases in February 2019 using search strategies defined with the help of an information specialist. Out of 4534 potential abstracts, we selected 114 articles based on defined criteria and presented in a content analysis. RESULTS We identified four classes of statistical tools. Regression models were found to be the most common practice, followed by hypothesis testing. The logistic regression was found to be the most used statistical tool, followed by χ2 test and t-test of associations between variables. Other tools were marginally used. CONCLUSIONS This scoping review lists common statistical tools used for analysing frequent users in emergency departments. It highlights the fact that some are well established while others are much less so. More research is needed to apply appropriate techniques to health data or to diversify statistical point of views.
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Affiliation(s)
- Yohann Chiu
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - François Racine-Hemmings
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Isabelle Dufour
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Alain Vanasse
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | | | - Mathieu Bisson
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Catherine Hudon
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
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Wani RJ, Wisdom JP, Wilson FA. Emergency Department Utilization for Substance Use-Related Disorders and Assessment of Treatment Facilities in New York State, 2011-2013. Subst Use Misuse 2019; 54:482-494. [PMID: 30380976 DOI: 10.1080/10826084.2018.1517801] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Annually, 1.8 million New York (NY) residents experience substance use disorders (SUDs). Even though emergency departments (EDs) continue to experience high numbers of SUD-related visits, only 15% receive treatment. OBJECTIVES This study estimates hospital-based EDs rates for SUDs in the State of New York. Also, the geographic distribution of substance use treatment centers and EDs are mapped to correlate utilization with access to care. METHODS The 2011-2013 Healthcare Cost and Utilization Project's NY State Emergency Department Database provided information on utilization of services in EDs, charges, diagnoses, and discharge, as well as patient demographic variables. All patients within NY who had visited the ED for SUDs comprised the study population. Geographic mapping of EDs and substance abuse treatment centers at the county-level is based on data from the National Emergency Department Inventory and National Survey of Substance Abuse Treatment Services, respectively. RESULTS A total of 492,419 ED visits for SUDs were reported through 2011-2013. Despite NY's Medicaid expansion in 2012, ED visits increased in 2013. About $856 million was spent in treating SUDs in EDs, with average charge of $1,764 per visit. Conclusions/Importance: Alcohol and drug-induced mental disorders are increasingly prevalent in New York's EDs. There is a need to develop health policies and programs to improve access to care for SUDs in urban states.
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Affiliation(s)
- Rajvi J Wani
- a Department of Health Services Research, Administration and Policy, College of Public Health , University of Nebraska Medical Center , Omaha , Nebraska , USA
| | - Jennifer P Wisdom
- b Graduate School of Public Health and Health Policy, Department of Health Policy and Management, Center for Innovation in Mental Health , City University of New York , New York , New York , USA
| | - Fernando A Wilson
- a Department of Health Services Research, Administration and Policy, College of Public Health , University of Nebraska Medical Center , Omaha , Nebraska , USA
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Kirchner H, Kirchner-Overfeld EC, Juckel G, Schäfer M. Häufigkeitsentwicklung alkoholassoziierter Vorstellungen in einer interdisziplinären großstädtischen Notaufnahme: Vergleich 2009 vs. 2014. SUCHT 2018. [DOI: 10.1024/0939-5911/a000534] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Zusammenfassung. Einleitung: Das Ziel dieser Untersuchung war es, anhand eines 5-Jahres-Vergleiches in einer interdisziplinären Zentralen Notaufnahme (ZNA) mit psychiatrischer Vollversorgung bei alkoholbezogenen Patientenvorstellungen mögliche Veränderungen des Patientengutes herauszuarbeiten. Methodik: Hierzu erfolgte eine retrospektive Datenerhebung von alkoholbedingten ZNA-Vorstellungen in den Jahren 2009 und 2014. Patienten von mindestens 18 Jahren und mit einer alkoholassoziierten Vorstellung wurden in die Studie aufgenommen. In einem ersten Schritt erfolgte die Analyse der ZNA-Dokumentation. Danach wurde die digitale Klinikdokumentation hinsichtlich psychiatrischer und somatischer Komorbiditäten, erneuter C2-bedingter ZNA-Wiedervorstellungen und einer konsekutiven Inanspruchnahme eines suchtspezifischen stationären Behandlungsangebotes untersucht. Ergebnis: Im Jahr 2009 wurden in der Zentralen Notaufnahme 2267 psychiatrische Patientenvorstellungen erfasst. Davon konnten 596 (26.30 %) als alkoholassoziiert identifiziert werden. Im Jahr 2014 wurden 3.400 psychiatrische ZNA-Kontakte identifiziert, davon waren 1.021 Kontakte alkoholbedingt (30 %). Am Gesamtaufkommen aller ZNA-Kontakte machte die rein alkoholassoziierte Vorstellung im Jahr 2009 ca. 3,5 % aus, im Jahr 2014 lag der Anteil mit 4,2 % etwas höher. Es fand sich eine Erhöhung der produzierten Fälle pro Patient von 1,5 im Jahr 2009 auf 2 Fälle im Jahr 2014. Die Patientengruppen waren in beiden Jahren zu 70 % männlich und das Alter der Patienten, die sich alkoholassoziiert in der ZNA vorstellten, lag im Jahr 2009 im Mittel bei 45 Jahren (SD 11.7) und unterschied sich somit von Patienten aus dem Jahr 2014 mit einem Alter von 46 Jahren kaum (SD 13.1). Ein Großteil der Patienten nahm in den 12 Folgemonaten eine stationäre Behandlung wahr. Im Jahr 2009 waren hiervon 78,5 % der Pat. stationär im Jahr 2014 waren es 70,2 %. Es überwog im Jahr 2014 die kurze Verweildauer mit fast 50 % aller stationären Behandlungen (bis zu Zwei-Tage-Behandlung). Somatische Komorbidität hatte Einfluss auf die Verweildauer, psychiatrische Komorbidität erhöhte die Inanspruchnahme einer stationären Behandlung. Diskussion: Zwischen 2009 und 2014 hat sich die Charakteristik der alkoholbezogenen Patientenvorstellungen nicht wesentlich verändert. Jedoch konnte eine deutliche quantitative Veränderung i. S. einer Zunahme der alkoholassoziierten ZNA-Vorstellungen beobachtet werden.
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Affiliation(s)
| | | | - Georg Juckel
- Klinik für Psychiatrie, Psychotherapie und Präventivmedizin der Ruhr-Universität Bochum, LWL-Universitätsklinikum
| | - Martin Schäfer
- Kliniken Essen-Mitte, Abteilung für Psychiatrie, Psychotherapie, Psychosomatik und Suchtmedizin
- Charité-Universitätsmedizin Berlin
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Blonigen DM, Macia KS, Bi X, Suarez P, Manfredi L, Wagner TH. Factors associated with emergency department useamong veteran psychiatric patients. Psychiatr Q 2017; 88:721-732. [PMID: 28108941 DOI: 10.1007/s11126-017-9490-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Frequent utilization of emergency department (ED) services contributes substantially to the cost of healthcare nationally and is often driven by psychiatric factors. Using national-level data from the Veterans Health Administration (VHA), the present study examined patient-level factors associated with ED use among veteran psychiatric patients. Veterans who had at least one ED visit with a psychiatric diagnosis in fiscal years 2011-2012 (n = 226,122) were identified in VHA administrative records. Andersen's behavioral model of healthcare utilization was used to identify need, enabling, and predisposing factors associated with frequency of ED use (primary outcome) in multivariate regression models. Greater ED use was primarily linked with need (psychotic, anxiety, personality, substance use, and bipolar disorders) and enabling (detoxification-related service utilization and homelessness) factors. Chronic medical conditions, receipt of an opioid prescription, and predisposing factors (e.g., younger age) were also linked to greater ED use; however, the effect sizes for these factors were markedly lower than those of most psychiatric and psychosocial factors. The findings suggest that intensive case management programs aimed reducing frequent ED use among psychiatric patients may require greater emphasis on homelessness and other psychosocial deficits that are common among these patients, and future research should explore cost-effective approaches to implementing these programs.
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Affiliation(s)
- Daniel M Blonigen
- HSR&D Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, CA, 94025, USA. .,Palo Alto University, 1791 Arastradero Road, Palo Alto, CA, 94304, USA.
| | - Kathryn S Macia
- Palo Alto University, 1791 Arastradero Road, Palo Alto, CA, 94304, USA
| | - Xiaoyu Bi
- HSR&D Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, CA, 94025, USA
| | - Paola Suarez
- HSR&D Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, CA, 94025, USA.,Stanford University School of Medicine, 291 Campus Drive, Stanford, CA, 94305, USA
| | - Luisa Manfredi
- HSR&D Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, CA, 94025, USA
| | - Todd H Wagner
- HSR&D Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, CA, 94025, USA.,Health Economics Resource Center, Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, CA, 94025, USA
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