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Nugent SM, Anderson J, Young SK. Behavioural mental health interventions delivered in the emergency department for suicide, overdose and psychosis: a scoping review. BMJ Open 2024; 14:e080023. [PMID: 38531581 DOI: 10.1136/bmjopen-2023-080023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/28/2024] Open
Abstract
OBJECTIVE To identify and describe evidence on brief emergency department (ED)-delivered behavioural and care process interventions among patients presenting with suicide attempt or acute ideation, substance overdose or psychosis. DESIGN We employed a scoping review design and searched multiple data sources, clinical trial registries and references lists through March 2023. We included English-language trials and rigorously designed observational studies. In alignment with scoping review guidelines, we did not assess the quality of included studies or rate the strength of evidence of intervention effectiveness. POPULATION Our population of interest was adults presenting to the ED with suicidality (eg, attempt or acute ideation), any substance overdose or acute psychosis from a primary mental health condition. INTERVENTION We included studies of brief behavioural or care process interventions delivered in the ED. OUTCOME MEASURES Health outcomes (eg, symptom reduction), healthcare utilisation and harms. RESULTS Our search identified 2034 potentially relevant articles. We included 40 studies: 3 systematic reviews and 39 primary studies. Most studies (n=34) examined ED interventions in patients with suicide attempt or suicidal ideation, while eight studies examined interventions in patients with opioid overdose. No studies examined ED interventions in patients with acute psychosis. Most suicide prevention studies reported that brief psychological, psychosocial or screening and triage interventions reduce suicide and suicide attempt following an ED visit. Most clinical trial interventions were multicomponent and included at least one follow-up. All substance overdose studies focused on opioids. These studies often contained medication and referral or consultation components. Multiple studies reported increases in substance use disorder treatment utilisation; evidence on repeat overdose events was limited. CONCLUSIONS A wide range of multicomponent ED-delivered behavioural health interventions for suicidality and opioid use disorder show short-term improvement on primary outcomes such as suicide reattempt. Few studies on non-opioid substances and psychosis are available.
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Affiliation(s)
- Shannon M Nugent
- Center to Improve Veteran Involvement in Care, Portland VA Medical Center, Portland, Oregon, USA
- Department of Psychiatry, Oregon Health & Science University, Portland, Oregon, USA
| | - Johanna Anderson
- Evidence Synthesis Program, Portland VA Medical Center, Portland, Oregon, USA
| | - Sarah K Young
- Evidence Synthesis Program, Portland VA Medical Center, Portland, Oregon, USA
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Armoon B, Griffiths MD, Mohammadi R, Ahounbar E, Fleury MJ. Acute care utilization and its associated determinants among patients with substance-related disorders: A worldwide systematic review and meta-analysis. J Psychiatr Ment Health Nurs 2023; 30:1096-1113. [PMID: 37211655 DOI: 10.1111/jpm.12936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 05/03/2023] [Accepted: 05/07/2023] [Indexed: 05/23/2023]
Abstract
INTRODUCTION Identifying determinants of emergency department (ED) use and hospitalization among patients with substance-related disorders (SRDs) can improve health services to address unmet health needs. AIM The present study aimed to identify the prevalence rates of ED use and hospitalization, and their associated determinants among patients with SRDs. METHODS Studies in English published from January 1, 1995, to December 1, 2022, were searched on PubMed, Scopus, Cochrane Library, and Web of Science to identify primary studies. RESULTS The pooled prevalence rates of ED use and hospitalization among patients with SRDs were 36% and 41%, respectively. Patients with SRDs who were the most at risk of being both ED users and hospitalized were those (i) having medical insurance, (ii) having other drug and alcohol use disorders, (iii) having mental health disorders, and (iv) having chronic physical illnesses. A lower level of education increased the risk of ED use only. DISCUSSION To decrease ED use and hospitalization, more comprehensive services may be offered to these vulnerable patients with diversified needs. IMPLICATIONS FOR PRACTICE Chronic care integrating outreach interventions could be more provided for patients with SRDs after discharge from acute care units or hospitals.
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Affiliation(s)
- Bahram Armoon
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
| | - Mark D Griffiths
- International Gaming Research Unit, Psychology Department, Nottingham Trent University, Nottingham, UK
| | - Rasool Mohammadi
- Social Determinants of Health Research Center, School of Public Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran
- Department of Biostatistics and Epidemiology, School of Public Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Elaheh Ahounbar
- Orygen, The National Center of Excellence in Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia
- Center for Youth Mental Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Marie-Josée Fleury
- Douglas Hospital Research Centre, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
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Fleury MJ, Cao Z, Grenier G, Ferland F. Profiles of quality of life among patients using emergency departments for mental health reasons. Health Qual Life Outcomes 2023; 21:116. [PMID: 37880748 PMCID: PMC10601205 DOI: 10.1186/s12955-023-02200-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 10/11/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND This study identified profiles associated with quality of life (QoL) and sociodemographic and clinical characteristics of patients using emergency departments (ED) for mental health reasons and associated these profiles with patient service use. METHODS Recruited in four Quebec (Canada) ED networks, 299 patients with mental disorders (MD) were surveyed from March 1st, 2021, to May 13th, 2022. Data from medical records were collected and merged with survey data. Cluster analysis was conducted to identify QoL profiles, and comparison analyses used to assess differences between them. RESULTS Four QoL profiles were identified: (1) Unemployed or retired men with low QoL, education and household income, mostly having substance-related disorders and bad perceived mental/physical health conditions; (2) Men who are employed or students, have good QoL, high education and household income, the least personality disorders, and fair perceived mental/physical health conditions; (3) Women with low QoL, multiple mental health problems, and very bad perceived mental/physical health conditions; (4) Mostly women with very good QoL, serious MD, and very good perceived mental/physical health conditions. CONCLUSION The profiles with the highest QoL (4 and 2) had better overall social characteristics and perceived their health conditions as superior. Profile 4 reported the highest level of satisfaction with services used. To improve QoL programs like permanent supportive housing, individual placement and support might be better implemented, and satisfaction with care more routinely assessed in response to patient needs - especially for Profiles 1 and 3, that show complex health and social conditions.
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Affiliation(s)
- Marie-Josée Fleury
- Department of Psychiatry, McGill University, Douglas Mental Health University Institute Research Centre Montreal, Montreal, QC, Canada.
- Douglas Mental Health University Institute Research Centre Montreal, Montreal, QC, Canada.
- Douglas Hospital Research Centre, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada.
| | - Zhirong Cao
- Douglas Mental Health University Institute Research Centre Montreal, Montreal, QC, Canada
| | - Guy Grenier
- Douglas Mental Health University Institute Research Centre Montreal, Montreal, QC, Canada
| | - Francine Ferland
- School of Social Work, Addiction Rehabilitation Center, Laval University, National Capital University Integrated Health and Social Services Center, Quebec City, QC, Canada
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Parish CL, Feaster DJ, Pollack HA, Horigian VE, Wang X, Jacobs P, Pereyra MR, Drymon C, Allen E, Gooden LK, Del Rio C, Metsch LR. Health Care Provider Stigma Toward Patients With Substance Use Disorders: Protocol for a Nationally Representative Survey. JMIR Res Protoc 2023; 12:e47548. [PMID: 37751236 PMCID: PMC10565625 DOI: 10.2196/47548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/04/2023] [Accepted: 08/07/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND The US overdose epidemic is an escalating public health emergency, accounting for over 100,000 deaths annually. Despite the availability of medications for opioid use disorders, provider-level barriers, such as negative attitudes, exacerbate the treatment gap in clinical care settings. Assessing the prevalence and intensity of provider stigma, defined as the negative perceptions and behaviors that providers embody and enact toward patients with substance use disorders, across providers with different specialties, is critical to expanding the delivery of substance use treatment. OBJECTIVE To thoroughly understand provider stigma toward patients with substance use disorders, we conducted a nationwide survey of emergency medicine and primary care physicians and dentists using a questionnaire designed to reveal how widely and intensely provider attitudes and stigma can impact these providers' clinical practices in caring for their patients. The survey also queried providers' stigma and clinical practices toward other chronic conditions, which can then be compared with their stigma and practices related to substance use disorders. METHODS Our cross-sectional survey was mailed to a nationally representative sample of primary care physicians, emergency medicine physicians, and dentists (N=3011), obtained by American Medical Association and American Dental Association licensees based on specified selection criteria. We oversampled nonmetropolitan practice areas, given the potential differences in provider stigma and available resources in these regions compared with metropolitan areas. Data collection followed a recommended series of contacts with participants per the Dillman Total Design Method, with mixed-modality options offered (email, mail, fax, and phone). A gradually increasing compensation scale (maximum US$250) was implemented to recruit chronic nonresponders and assess the association between requiring higher incentives to participate and providers stigma. The primary outcome, provider stigma, was measured using the Medical Condition Regard Scale, which inquired about participants' views on substance use and other chronic conditions. Additional survey measures included familiarity and social engagement with people with substance use disorders; clinical practices (screening, treating, and referring for a range of chronic conditions); subjective norms and social desirability; knowledge and prior education; and descriptions of their patient populations. RESULTS Data collection was facilitated through collaboration with the National Opinion Research Center between October 2020 and October 2022. The overall Council of American Survey Research Organizations completion rate was 53.62% (1240/2312.7; physicians overall: 855/1681.9, 50.83% [primary care physicians: 506/1081.3, 46.79%; emergency medicine physicians: 349/599.8, 58.2%]; dentists: 385/627.1, 61.4%). The ineligibility rate among those screened is applied to those not screened, causing denominators to include fractional numbers. CONCLUSIONS Using systematically quantified data on the prevalence and intensity of provider stigma toward substance use disorders in health care, we can provide evidence-based improvement strategies and policies to inform the development and implementation of stigma-reduction interventions for providers to address their perceptions and treatment of substance use. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/47548.
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Affiliation(s)
- Carrigan Leigh Parish
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, Miami, FL, United States
| | - Daniel J Feaster
- Department of Biostatistics, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Harold A Pollack
- Crown Family School of Social Work, Policy, and Practice, University of Chicago, Chicago, IL, United States
| | - Viviana E Horigian
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Xiaoming Wang
- Office of Behavioral and Social Clinical Trials, Division of Behavioral and Social Research, National Institute on Aging/National Institute of Health, Bethesda, MD, United States
| | - Petra Jacobs
- Office of Behavioral and Social Clinical Trials, Division of Behavioral and Social Research, National Institute on Aging/National Institute of Health, Bethesda, MD, United States
| | - Margaret R Pereyra
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, Miami, FL, United States
| | | | - Elizabeth Allen
- National Opinion Research Center, Chicago, IL, United States
| | - Lauren K Gooden
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, Miami, FL, United States
| | - Carlos Del Rio
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Lisa R Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
- School of General Studies, Columbia University, New York, NY, United States
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Courchesne-Krak NS, Marienfeld CB, Kepner W. What Brings You in Today? Sex, Race, Substance Type, and Other Sociodemographic and Health-Related Characteristics Predict if Substance Use is the Main Reason for a Clinical Encounter. THE YALE JOURNAL OF BIOLOGY AND MEDICINE 2023; 96:277-291. [PMID: 37780998 PMCID: PMC10524817 DOI: 10.59249/udrg5942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
Background: Substance-related diagnoses (SRDs) are a common healthcare presentation. This study identified sociodemographic and health-related characteristics associated with having an SRD as the primary reason for a clinical encounter compared to those with an SRD who are treated for other reasons. Methods: Electronic health record (EHR) data on patients with an SRD (n=12,358, ages 18-90) were used to assess if an SRD was the primary reason for a clinical encounter from January 1, 2012-January 1, 2018. Patients were matched on key demographic characteristics at a 1:1 ratio. Adjusting for covariates, odds ratios, and 95% confidence intervals were calculated. Results: In the matched cohort of 8,630, most reported male sex (65.8%), White race (70.0%), and single marital status (62.7%) with a mean age of 47.2 (SD=14.6). Patient reported female sex, Black race, age 70+, married status, and low-income (<$50,000) were associated with a lower likelihood of presenting to care for an SRD as the primary reason for a clinical encounter. A nicotine-, alcohol-, opioid-, or stimulant-related diagnosis was associated with a higher likelihood of presenting to care for an SRD as the primary reason for the clinical visit. Conclusion: This is the first study to investigate whether sociodemographic and health-related characteristics were associated with having an SRD as the primary reason for a clinical encounter. Using rigorous methods, we investigated a unique clinical question adding new knowledge to predictors of patients seeking clinical care. Understanding these predictors can help us better align service provision with population needs and inform new approaches to tailoring care.
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Affiliation(s)
| | - Carla B. Marienfeld
- Department of Psychiatry, University of California, San Diego, La Jolla, CA,
USA
| | - Wayne Kepner
- Department of Psychiatry, University of California, San Diego, La Jolla, CA,
USA
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Armoon B, Fleury MJ, Griffiths MD, Bayani A, Mohammadi R, Ahounbar E. Emergency Department Use, Hospitalization, and Their Sociodemographic Determinants among Patients with Substance-Related Disorders: A Worldwide Systematic Review and Meta-Analysis. Subst Use Misuse 2023; 58:331-345. [PMID: 36592043 DOI: 10.1080/10826084.2022.2161313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background: Identifying the determinants of emergency department (ED) use and hospitalization among patients with substance-related disorders (SRD) can help inform healthcare services and case management regarding their unmet health needs and strategies to reduce their acute care. Objectives: The present study aimed to identify sociodemographic characteristics, type of used drug, and risky behaviors associated with ED use and hospitalization among patients with SRD. Methods: Studies in English published from January 1st, 1995 to April 30th, 2022 were searched from PubMed, Scopus, Cochrane Library, and Web of Science to identify primary studies on ED use and hospitalization among patients with SRD. Results: Of the 17,348 outputs found, a total of 39 studies met the eligibility criteria. Higher ED use and hospitalization among patients with SRD were associated with a history of homelessness (ED use: OR = 1.93, 95%CI = 1.32-2.83; hospitalization: OR = 1.53, 95%CI = 1.36-1.73) or of injection drug use (ED use: OR = 1.34, 95%CI = 1.13-1.59; hospitalization: OR = 1.42, 95%CI = 1.20-1.69). Being female (OR = 1.24, 95%CI = 1.14-1.35), using methamphetamine (OR = 1.99, 95%CI = 1.24-3.21) and tobacco (OR = 1.25, 95%CI = 1.11-1.42), having HIV (OR = 1.70, 95%CI = 1.47-1.96), a history of incarceration (OR = 1.90, 95%CI = 1.27-2.85) and injury (OR = 2.62, 95%CI = 1.08-6.35) increased ED use only, while having age over 30 years (OR = 1.40, 95%CI = 1.08-1.81) and using cocaine (OR = 1.60, 95%CI = 1.32-1.95) increased hospitalization only among patients with SRD. Conclusions: The finding outline the necessity of developing outreach program and primary care referral for patients with SRD. Establishing a harm reduction program, incorporating needle/syringe exchange programs, and safe injection training with the aim of declining ED use and hospitalization, is likely be another beneficial strategy for patients with SRD.
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Affiliation(s)
- Bahram Armoon
- Douglas Hospital Research Centre, Douglas Mental Health University InstituteMontreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Marie-Josée Fleury
- Douglas Hospital Research Centre, Douglas Mental Health University InstituteMontreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Mark D Griffiths
- International Gaming Research Unit, Psychology Department, Nottingham Trent University, Nottingham, UK
| | - Azadeh Bayani
- Student Research Committee, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Rasool Mohammadi
- Social Determinants of Health Research Center, School of Public Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran.,Department of Biostatistics and Epidemiology, School of Public Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Elaheh Ahounbar
- Orygen, The National Center of Excellence in Youth Mental Health, University of Melbourne, Parkville, VIC, Australia.,Center for Youth Mental Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Australia
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7
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Knaub RJ, Evans J, Yang C, Roura R, McGinn T, Verschoore B, Ricketts EP, Rothman RE, Latkin CA, Hsieh YH. A pilot study of a mixed-method approach to design an ED-based peer mHealth referral tool for HIV/HCV and opioid overdose prevention services. Drug Alcohol Depend 2022; 238:109585. [PMID: 35926299 PMCID: PMC9620482 DOI: 10.1016/j.drugalcdep.2022.109585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 07/20/2022] [Accepted: 07/20/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND The intersecting epidemics of opioid misuse, injection drug use, and HIV/HCV have resulted in record overdose deaths and sustained high levels of HIV/HCV transmissions. Literature on social networks suggests opportunities to connect people who use drugs (PWUD) and their peers to HIV/HCV and opioid overdose prevention services. However, little evidence exists on how to design such peer referral interventions in emergency department (ED) settings. METHODS A mixed-method study was conducted to assess the feasibility of an mHealth-facilitated 'patient to peer social network referral program' for PWUD. In-depth interviews (IDIs) and quantitative surveys were conducted with urban ED patients (n = 15), along with 3 focus group discussions (FGDs) (n = 19). RESULTS Overall, 34 participants were enrolled (71 % males, 53 % Black). 13/15 IDI participants reported a history of opioid overdose; all had witnessed overdose events; all received HIV/HCV testing. From survey responses, most would invite their peers for HIV/HCV testing and naloxone training; and anticipated peers to accept referrals (HIV: 60 %, HCV: 73 %, naloxone: 93 %). Qualitative data showed PWUD shared health-related information with each other but preferred word of mouth rather than text messages. Participants used smartphones regularly and suggested using Internet advertising for prevention services. Participants expressed enthusiasm for ED-based peer mHealth referral platform to prevention services, as well as referring their peers to proposed services, with monetary incentives. CONCLUSION ED-based peer referral intervention to HIV/HCV testing and naloxone training was viewed favorably by PWUD. Frequent smartphone use among PWUD suggests that the medium could be a promising mode for peer referral.
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Affiliation(s)
- Ross J. Knaub
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Julie Evans
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Cui Yang
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, U.S.A
| | - Raúl Roura
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Tanner McGinn
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Benjamin Verschoore
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Erin P. Ricketts
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Richard E. Rothman
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Carl A. Latkin
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, U.S.A
| | - Yu-Hsiang Hsieh
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 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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9
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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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10
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COURCHESNE-Krak NS, KEPNER W, RUBANO A, MARIENFELD C. Differences in outpatient, emergency, and inpatient use among pregnant women with a substance-related diagnosis. Am J Obstet Gynecol MFM 2022; 4:100559. [PMID: 34990875 PMCID: PMC8891059 DOI: 10.1016/j.ajogmf.2021.100559] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 12/15/2021] [Accepted: 12/29/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND As a vulnerable population, pregnant women with a substance-related diagnosis (ie, substance use, misuse, or dependence) may use healthcare disproportionately. OBJECTIVE The primary goal of this study was to evaluate the differences in the use of outpatient clinical visits, emergency department visits, and inpatient days in the hospital among women with and without a substance-related diagnosis during the antepartum period. STUDY DESIGN This retrospective study retrieved electronic health record data on women (age, 18-44 years) who delivered a single live birth or stillbirth at ≥20 weeks of gestation from April 1, 2012, to September 30, 2019. Imbalance in measured maternal sociodemographic and obstetrical characteristics between women with and without a substance-related diagnosis was attenuated using propensity score matching on key demographic characteristics (eg, age), yielding a matched 1:1 sample. Unadjusted and adjusted logistic regressions models were used to determine the association between a substance-related diagnosis and outpatient visits, emergency visits, and inpatient days. RESULTS From the total sample (n=16,770), the matched cohort consisted of 1986 deliveries. Of these, most were White (51.0%), or mixed or of some other race (31.1%). The mean age was 29.8 (standard deviation, 5.6). A substance-related diagnosis was identified in 993 women (50%) because of matching. Women with a substance-related diagnosis were more likely to have ≤10 outpatient visits than women without a substance-related diagnosis (adjusted odds ratio, 1.81 [95% confidence interval, 1.44-2.28]; P<.0001). Alcohol-, opioid-, and stimulant-related diagnoses were independently associated with ≤10 outpatient visits (adjusted odds ratio, 3.16 [95% confidence interval, 1.67-6.04]; P=.0005; adjusted odds ratio, 3.02 [95% confidence interval, 1.79-5.09]; P<.0001; adjusted odds ratio, 2.18 [95% confidence interval, 1.39-3.41]; P=.0007, respectively). Women with a substance-related diagnosis were more likely to have ≥1 emergency visit than women without a substance-related diagnosis (adjusted odds ratio, 1.36 [95% confidence interval, 1.00-1.85]; P<.0001). Opioid-, stimulant-, and nicotine-related diagnoses were independently associated with ≥1 emergency visit (adjusted odds ratio, 2.28 [95% confidence interval, 1.09-4.77]; P=.0287; adjusted odds ratio, 2.01 [95% confidence interval, 1.07-3.78]; P=.0301; adjusted odds ratio, 3.38 [95% confidence interval, 1.90-6.02]; P<.0001, respectively). Women with a substance-related diagnosis were more likely to have ≥3 inpatient days than women without a substance-related diagnosis (adjusted odds ratio, 1.69 [95% confidence interval, 1.07-2.67]; P=.0256). Opioid-, stimulant-, and nicotine-related diagnosis were independently associated with ≥3 inpatient days (adjusted odds ratio, 3.52 [95% confidence interval, 1.42-8.75]; P=.0067; adjusted odds ratio, 3.51 [95% confidence interval, 1.31-9.34]; P=.0123; adjusted odds ratio, 2.74 [95% confidence interval, 1.11-6.73]; P=.0285, respectively). CONCLUSION Women with a substance-related diagnosis during the antepartum period who delivered a single live birth or stillbirth at ≥20 weeks of gestation were experiencing fewer outpatient visits, more emergency department visits, and more inpatient days than women without a substance-related diagnosis. The type of substance-related diagnosis (eg, alcohol, opioids, stimulants, or nicotine) was associated with different patterns of healthcare use. The results from this study have reinforced the need to identify substance-related diagnoses in pregnant women early to minimize disproportionate healthcare service utilization through intervention and treatment.
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Affiliation(s)
- Natasia S. COURCHESNE-Krak
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, MC0957, La Jolla, CA 92093, USA
| | - Wayne KEPNER
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, MC0957, La Jolla, CA 92093, USA
| | - Amanda RUBANO
- Medicine, University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, Rochester, NY 14642, USA
| | - Carla MARIENFELD
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, MC0957, La Jolla, CA 92093, USA
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Stanojlović M, Allen R, Valentine P, Davidson L, O’Connell M. Recovery Coaching In and Out of Emergency Departments: an Overview of the Connecticut Community for Addiction Recovery’s (CCAR) Emergency Department Recovery Coaching Program. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-022-00772-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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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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13
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Pacella-LaBarbara ML, Maltese C, McConaghy M, Porter J, Young ML, Suffoletto B. Distress Tolerance Among Emergency Department Patients in Acute Pain: Associations with Substance Use Treatment. Stress Health 2021; 37:588-595. [PMID: 33369098 PMCID: PMC8713510 DOI: 10.1002/smi.3020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 12/14/2020] [Accepted: 12/17/2020] [Indexed: 11/08/2022]
Abstract
Managing acute pain in individuals with a history of substance use disorders (SUD) is complex. Distress tolerance (DT) (e.g., the ability to handle uncomfortable sensations) may serve as an ideal non-pharmacological intervention target in this population. Among 293 emergency department (ED) patients seeking treatment for pain (Mage = 41; 42% Female; 43% Black), we examined rates of SUD treatment and DT, whether an objective DT task is feasible to conduct in the ED, and relationships between DT and SUD. Patients completed a self-report DT survey, an objective DT task, and brief surveys of pain, drug use, current or past SUD treatment, and depression/anxiety. Average DT was 18.50 (SD = 9.4) out of 50; patients with past or current SUD treatment (n = 43; 14.7%) reported lower DT than patients with no SUD treatment history (n = 250; 85.3%). Controlling for demographics, depression/anxiety, and pain severity, lower subjective DT (adjusted odds ratio [aOR] = 1.05) and objective DT (aOR = 1.02) was associated a current or past history or SUD treatment. Assessing subjective and objective DT in ED patients with acute pain is feasible; interventions aimed at boosting DT may improve outcomes among patients with acute pain and SUD.
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Affiliation(s)
| | - Caroline Maltese
- University of Pittsburgh School of Medicine, Department of Emergency Medicine
| | - Madelyn McConaghy
- University of Pittsburgh School of Medicine, Department of Emergency Medicine
| | - James Porter
- University of Pittsburgh School of Medicine, Department of Emergency Medicine
| | - Michael L. Young
- University of Pittsburgh School of Medicine, Department of Emergency Medicine
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14
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Hensel M, Stuhr M, Geppert D, Kersten JF, Lorenz J, Kerner T. Relationship between ambient temperature and severe acute poisoning by alcohol and drugs. Alcohol 2021; 94:57-63. [PMID: 33864852 DOI: 10.1016/j.alcohol.2021.04.001] [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: 07/16/2020] [Revised: 04/04/2021] [Accepted: 04/06/2021] [Indexed: 11/25/2022]
Abstract
AIM To test the hypothesis that severe acute poisoning by alcohol and drugs is more frequent at higher rather than at lower ambient temperatures. METHOD This was a prospective observational study performed in a prehospital setting under marine west coast climate conditions. Data from the Emergency Medical Service in Hamburg (Germany) and data from the local weather station were evaluated over a 5-year period. Temperature data were obtained and matched with the associated rescue mission data, which were divided into the following groups: 1) alcohol poisoning, 2) opioid poisoning, 3) poisoning by sedatives/hypnotics, multiple drugs, volatile solvents, and other psychoactive substances. Lowess-Regression analysis was performed to assess the relationship between ambient temperature and frequency of severe acute poisoning. Additionally, three temperature ranges were defined in order to compare them with each other with regard to frequency of severe poisoning (<10 °C vs. 10-20 °C vs. >20 °C). The severity of emergencies was assessed using the National Advisory Committee for Aeronautics (NACA) scoring system. RESULTS In 1535 patients, severe acute alcohol or drug poisoning associated with loss of consciousness, hypotension, and impaired respiratory function was treated (alcohol: n = 604; opioids: n = 295; sedatives/hypnotics/multiple drugs: n = 636). Compared to mild temperatures (10-20 °C), the frequency of poisoning increased in all three groups at higher temperatures and decreased at lower temperatures (p < 0.01). No significant correlation was found between severity of emergencies and temperature. CONCLUSIONS Our results suggest a continuously increasing probability of occurrence of severe acute poisoning by alcohol and drugs with rising temperature.
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15
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Spagnolello O, Reed MJ. Targeted HIV screening in the emergency department. Intern Emerg Med 2021; 16:1273-1287. [PMID: 33550535 DOI: 10.1007/s11739-021-02648-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 01/19/2021] [Indexed: 12/18/2022]
Abstract
Despite considerable improvement in human immunodeficiency virus (HIV) knowledge and treatment in the last 3 decades, the overall number of people living with HIV (PLHIV) is still rising with up to one quarter being unaware of their HIV status. Early HIV diagnosis and treatment prolongs life, reduces transmission, improves quality of life, and is a cost-effective public health intervention. The emergency department (ED) sees a large number of patients from marginalized and traditionally underserved populations in whom HIV is known to be more prevalent and who may not attend traditional services because of either cultural reasons or because of a chaotic lifestyle. This article discusses the two main approaches to screening; 'Opt-out' screening offers testing routinely in all clinical settings, and 'Targeted' screening offers testing to individuals presenting with indicator conditions. There are many studies of 'Opt-out' ED HIV screening in urban areas of high-HIV prevalence. However, little is known about the effectiveness of 'targeted' HIV screening, especially in areas of low prevalence. This review discusses the background to HIV screening in the ED and reviews the evidence around 'targeted' HIV screening in adult EDs in different HIV prevalence settings, concluding that targeted HIV screening at the ED can be impactful, cost-effective, and well accepted in the ED population, but its long-term implementation requires extra funding and increased staffing resource limiting its application in low resource setting. Despite most evidence being from areas of high-HIV prevalence, targeted screening might also be appropriate in low-HIV prevalence areas.
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Affiliation(s)
- Ornella Spagnolello
- Department of Public Health and Infectious Diseases, University of Rome Sapienza, Rome, Italy
| | - Matthew J Reed
- Emergency Medicine Research Group Edinburgh (EMERGE), Department of Emergency Medicine, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK.
- Usher Institute, University of Edinburgh, NINE, 9 Little France Road, Edinburgh BioQuarter, Edinburgh, EH16 4UX, UK.
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16
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Allen MK, Parrish JM, Vakharia R, Kaplan JRM, Vulcano E, Roche MW, Aiyer AA. The Influence of Opioid Use Disorder on Open Reduction and Internal Fixation Following Ankle Fracture. Foot Ankle Spec 2021; 14:232-237. [PMID: 32270705 DOI: 10.1177/1938640020914715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Ankle fractures are common and may require open reduction and internal fixation (ORIF). Literature is scarce evaluating the associations of opioid use disorder (OUD) with ORIF postoperative outcomes. This study investigates whether OUD patients have increased (1) costs of care, (2) emergency room visits, and (3) readmission rates. METHODS ORIF patients with a 90-day history of OUD were identified using an administrative claims database. OUD patients were matched (1:4) to controls by age, sex, and medical comorbidities. The Welch t-test determined the significance of cost of care. Logistic regression yielded odds ratios (ORs) for emergency room visits and 90-day readmission rates. RESULTS A total of 2183 patients underwent ORIF (n = 485 with OUD vs n = 1698 without OUD). OUD patients incurred significantly higher costs of care compared with controls ($5921.59 vs $5128.22, P < .0001). OUD patients had a higher incidence and odds of emergency room visits compared with controls (3.50% vs 0.64%; OR = 5.57, 95% CI = 2.59-11.97, P < .0001). The 90-day readmission rates were not significantly different between patients with and without OUD (8.65% vs 7.30%; OR = 1.20, 95% CI = 0.83-1.73, P = .320). CONCLUSION OUD patients have greater costs of care and odds of emergency room visits within 90 days following ORIF.Levels of Evidence: Level III: Retrospective cohort study.
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Affiliation(s)
- Megan K Allen
- Department of Orthopedic Surgery, University of Miami Hospital, Miami, Florida
| | - James M Parrish
- Department of Orthopedic Surgery, University of Miami Hospital, Miami, Florida
| | - Rushabh Vakharia
- Holy Cross Hospital, Orthopedic Research Institute, Ft Lauderdale, Florida
| | | | | | - Martin W Roche
- Holy Cross Hospital, Orthopedic Research Institute, Ft Lauderdale, Florida
| | - Amiethab A Aiyer
- Department of Orthopedic Surgery, University of Miami Hospital, Miami, Florida
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17
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Bobashev G, Warren L, Wu LT. Predictive model of multiple emergency department visits among adults: analysis of the data from the National Survey of Drug Use and Health (NSDUH). BMC Health Serv Res 2021; 21:280. [PMID: 33766009 PMCID: PMC7995604 DOI: 10.1186/s12913-021-06221-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 02/28/2021] [Indexed: 11/22/2022] Open
Abstract
Background In this methodological paper, we use a novel, predictive approach to examine how demographics, substance use, mental and other health indicators predict multiple visits (≥3) to emergency departments (ED) within a year. Methods State-of-the-art predictive methods were used to evaluate predictive ability and factors predicting multiple visits to ED within a year and to identify factors that influenced the strength of the prediction. The analysis used public-use datasets from the 2015–2018 National Surveys on Drug Use and Health (NSDUH), which used the same questionnaire on the variables of interest. Analysis focused on adults aged ≥18 years. Several predictive models (regressions, trees, and random forests) were validated and compared on independent datasets. Results Predictive ability on a test set for multiple ED visits (≥3 times within a year) measured as the area under the receiver operating characteristic (ROC) reached 0.8, which is good for a national survey. Models revealed consistency in predictive factors across the 4 survey years. The most influential variables for predicting ≥3 ED visits per year were fair/poor self-rated health, being nervous or restless/fidgety, having a lower income, asthma, heart condition/disease, having chronic obstructive pulmonary disease (COPD), nicotine dependence, African-American race, female sex, having diabetes, and being of younger age (18–20). Conclusions The findings reveal the need to address behavioral and mental health contributors to ED visits and reinforce the importance of developing integrated care models in primary care settings to improve mental health for medically vulnerable patients. The presented modeling approach can be broadly applied to national and other large surveys. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06221-w.
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Affiliation(s)
- Georgiy Bobashev
- RTI International, 3040 Cornwallis Rd., P.O. Box 12194, Research Triangle Park, NC, 27709, USA.
| | - Lauren Warren
- RTI International, 3040 Cornwallis Rd., P.O. Box 12194, Research Triangle Park, NC, 27709, USA
| | - Li-Tzy Wu
- Department of Psychiatry and Behavioral Sciences and Department of Medicine, Duke University School of Medicine, Box 3903, Durham, NC, 27710, USA.
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18
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Spagnolello O, Gallagher B, Lone N, Ceccarelli G, D'Ettorre G, Reed MJ. The Role of Targeted HIV Screening in the Emergency Department: A Scoping Review. Curr HIV Res 2021; 19:106-120. [PMID: 33231157 DOI: 10.2174/1570162x18666201123113905] [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: 06/24/2020] [Revised: 10/22/2020] [Accepted: 10/26/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Human immunodeficiency virus (HIV) infection continues to expand worldwide, and a significant proportion of infection is still undiagnosed. Recent studies have addressed the impact and feasibility of 'opt-out' HIV screening in Emergency Departments (EDs) in urban settings at high HIV prevalence, whereas little is known about the yield of implementing 'targeted' HIV testing, especially in low-prevalence areas. OBJECTIVE The present study undertakes a scoping review of research carried out on the implementation of targeted HIV screening of adult in EDs to determine the impact, feasibility and acceptability of HIV testing in different HIV prevalence settings. DESIGN Online databases (EMBASE, MEDLINE) were used to identify papers published between 2000 to 2020. A three-concept search was employed with HIV (HIV, Human immunodeficiency virus infection, HIV infections), targeted testing (Target, screening or testing) and emergency medicine (Emergency Service, emergency ward, A&E, accident and emergency or Emergency Department) (28th February 2020). Only full-text articles written in English, French, Spanish or Italian and using impact and/or feasibility and/or acceptability of the program as primary or secondary outcomes were analysed. RESULTS The search provided 416 articles. Of these, 12 met inclusion criteria and were included in the final review. Most of the included studies were carried out in the United States (n=8; 67%) and in areas of high HIV prevalence (n=11; 92%). Three (20%) were randomized control studies. While the rate of newly diagnosed HIV cases varied widely (0.03-2.2%), likely due to methodological heterogeneity between studies, the linkage of new HIV diagnosis was often high (80-100%) and median CD4+ cell count was always greater than 200 cells per microliter. Targeted HIV screening was found to be cost-effective (out of 2 studies) and well accepted by participants (out 2 studies). CONCLUSIONS Targeted HIV screening at the ED can be impactful, feasible and well accepted, but often requires extra funding and staff. Most previous work has focused on areas of high disease prevalence.
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Affiliation(s)
- Ornella Spagnolello
- Department of Public Health and Infectious Diseases, University of Rome Sapienza, Rome, Italy
| | - Bernadette Gallagher
- Emergency Medicine Research Group Edinburgh (EMERGE), Department of Emergency Medicine, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, United Kingdom
| | - Nazir Lone
- Department of Critical Care, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, EH16 4SA, United Kingdom
| | - Giancarlo Ceccarelli
- Department of Public Health and Infectious Diseases, University of Rome Sapienza, Rome, Italy
| | - Gabriella D'Ettorre
- Department of Public Health and Infectious Diseases, University of Rome Sapienza, Rome, Italy
| | - Matthew J Reed
- Emergency Medicine Research Group Edinburgh (EMERGE), Department of Emergency Medicine, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, United Kingdom
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Rahman F, Evans N, Bernhardt J. Access to OUD Treatment and Maintenance of Sobriety amid the COVID-19 Pandemic. Subst Use Misuse 2021; 56:1005-1009. [PMID: 33754956 DOI: 10.1080/10826084.2021.1901935] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVES The COVID-19 pandemic changed the way that healthcare is delivered, with non-urgent care becoming almost entirely virtual. Underserved communities already battling the opioid epidemic had new challenges in accessing medication assisted treatment (MAT). The investigators sought to determine if patients were retaining access to their opioid use disorder (OUD) treatment and maintaining sobriety during the pandemic, with the intention of using this information to improve subsequent patient care while the pandemic continues. METHODS In the assessment, seventy-five patient Epic EMR (electronic medical record) charts were reviewed to collect information on demographics, socioeconomic factors, healthcare access and sobriety during the pandemic period between March 1st, 2020 and June 15th, 2020. Patient charts were selected based on those receiving office-based opioid treatment (OBOT) for OUD at an urban healthcare center. RESULTS 98.7% of patients accessed the healthcare center in some form since March 1st, 2020. The most common form of communication was through telemedicine with 94.6% of calls over audio. Out of the 21 toxicology screens performed during the pandemic period, 16 (76%) patients were found to be adhering to their buprenorphine treatment. Only 78.7% had documented they had Narcan at their disposal. Among all patients, 11 (14.6%) reoccurrences in opioid use were documented during the pandemic period. Few patients (76%) were adhering to their prescribed buprenorphine treatment, revealing that patients may not be receiving needed MAT support amid the pandemic. CONCLUSION This assessment reveals short-comings of patient education in managing craving and the maintenance of support systems amid social-isolating conditions.
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Affiliation(s)
- Fatima Rahman
- University of Kansas School of Medicine-Wichita, Wichita, Kansas
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Bountress KE, Cohen JR, Ruggiero K, Davidson T, Calhoun CD, Nelson F, Fields C, Danielson CK, Russell WS, Gilmore AK. Offspring Self-Disclosure Predicts Substance-Related Outcomes in an Emergency Department Sample of Young Adults with Traumatic Injury. JOURNAL OF SUBSTANCE USE 2020; 25:313-317. [PMID: 33013196 DOI: 10.1080/14659891.2019.1692925] [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: 10/25/2022]
Abstract
Background Hundreds of thousands of individuals visit the emergency department (ED) every year, with many visits occurring following alcohol misuse. Parent-child relationship factors are associated with alcohol-related outcomes. For example, offspring choice to self-disclose information about their lives to parents, rather than parents actively soliciting this information, is associated with substance use. However, it is unclear whether self-disclosure uniquely predicts alcohol-related outcomes in a young adult ED sample. Methods Data were collected from young adults (age 18-30 years) visiting an ED for a traumatic injury (n=79). Participants were about 24.4 years old, majority male (53.7%), and Caucasian (76%; 24% African-American). A bifactor model within a structural equation model tested unique effects of self-disclosure on age at first drink, propensity for risky drinking, and likelihood of consuming substances prior to ED visit, over and above parental solicitation and a general factor and gender. Results Those who shared more information with their caregivers reported an older age at first drink, lower propensity for risky drinking and lower propensity to consume substances prior to their ED visit. Conclusions These findings suggest that self-disclosure may be a unique risk factor in the initiation of alcohol use, development of problem use, and consequences following use.
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Affiliation(s)
- Kaitlin E Bountress
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA
| | - Joseph R Cohen
- Department of Psychology, University of Illinois at Urbana-Champaign, Champaign, IL
| | - Kenneth Ruggiero
- College of Nursing, Medical University of South Carolina, Charleston, SC
| | - Tatiana Davidson
- College of Nursing, Medical University of South Carolina, Charleston, SC
| | - Casey D Calhoun
- National Crime Victims Research & Treatment Center, Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC
| | - Fletcher Nelson
- The Citadel, The Military College of South Carolina, Charleston, SC
| | | | - Carla Kmett Danielson
- National Crime Victims Research & Treatment Center, Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC
| | - W Scott Russell
- Pediatric Emergency Medicine, Medical University of South Carolina, Charleston, SC
| | - Amanda K Gilmore
- College of Nursing, Medical University of South Carolina, Charleston, SC
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Williams J, Vickerman P, Douthwaite S, Nebbia G, Hunter L, Wong T, Ruf M, Miners A. An Economic Evaluation of the Cost-Effectiveness of Opt-Out Hepatitis B and Hepatitis C Testing in an Emergency Department Setting in the United Kingdom. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:1003-1011. [PMID: 32828211 DOI: 10.1016/j.jval.2020.03.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 02/14/2020] [Accepted: 03/30/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES The prevalence of hepatitis is high in emergency department (ED) attendees in the United Kingdom, with a prevalence of up to 2% for hepatitis B (HBV) HBsAg, and 2.9% for hepatitis C (HCV) RNA. The aim of this paper is to perform an economic evaluation of opt-out ED-based HCV and HBV testing. METHODS A Markov model was developed to analyze the cost-effectiveness of opt-out HCV and HBV testing in EDs in the UK. The model used data from UK studies of ED testing to parameterize the HCV and HBV prevalence (1.4% HCV RNA, 0.84% HBsAg), test costs, and intervention effects (contact rates and linkage to care). For HCV, we used an antibody test cost of £3.64 and RNA test cost of £68.38, and assumed direct-acting antiviral treatment costs of £10 000. For HBV, we used a combined HBsAg and confirmatory test cost of £5.79. We also modeled the minimum prevalence of HCV (RNA-positive) and HBV (HBsAg) required to make ED testing cost-effective at a £20 000 willingness to pay per quality-adjusted life-year threshold. RESULTS In the base case, ED testing was highly cost-effective, with HCV and HBV testing costing £8019 and £9858 per quality-adjusted life-year gained, respectively. HCV and HBV ED testing remained cost-effective at 0.25% HCV RNA or HBsAg prevalence or higher. CONCLUSIONS Emergency department testing for HCV and HBV is highly likely to be cost-effective in many areas across the UK depending on their prevalence. Ongoing studies will help evaluate ED testing across different regions to inform testing guidelines.
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Affiliation(s)
- Jack Williams
- Department of Health Service Research and Policy, London School of Hygiene & Tropical Medicine, London, England, UK; The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at University College, London, England, UK.
| | - Peter Vickerman
- The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at University College, London, England, UK; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England, UK
| | - Sam Douthwaite
- Department of Infection, Guy's and St Thomas' NHS Trust, London, England, UK
| | - Gaia Nebbia
- Department of Infection, Guy's and St Thomas' NHS Trust, London, England, UK
| | - Laura Hunter
- Emergency Department, Guy's and St Thomas' NHS Trust, London, England, UK
| | - Terry Wong
- Department of HIV/GU Medicine, Guy's and St Thomas' NHS Trust, London, England, UK
| | - Murad Ruf
- Gilead Sciences Medical Department, London, England, UK
| | - Alec Miners
- Department of Health Service Research and Policy, London School of Hygiene & Tropical Medicine, London, England, UK; The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at University College, London, England, UK
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Monico LB, Oros M, Smith S, Mitchell SG, Gryczynski J, Schwartz R. One million screened: Scaling up SBIRT and buprenorphine treatment in hospital emergency departments across Maryland. Am J Emerg Med 2020; 38:1466-1469. [DOI: 10.1016/j.ajem.2020.03.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 01/30/2020] [Accepted: 03/06/2020] [Indexed: 10/24/2022] Open
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Anderson ES, Russell C, Basham K, Montgomery M, Lozier H, Crocker A, Zuluaga M, White DAE. High prevalence of injection drug use and blood-borne viral infections among patients in an urban emergency department. PLoS One 2020; 15:e0233927. [PMID: 32497108 PMCID: PMC7272082 DOI: 10.1371/journal.pone.0233927] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 05/14/2020] [Indexed: 01/03/2023] Open
Abstract
Background The opioid epidemic has led to an increase in the number of persons who inject drugs, and this population accounts for 12% of new human immunodeficiency virus (HIV) and 60% of new hepatitis C virus (HCV) infections in the United States annually. While persons who inject drugs disproportionately utilize the emergency department (ED), accurate data is lacking on the prevalence and patterns of injection drug use, and prevalence of co-occurring HIV and HCV infections among ED patients. Objective The primary outcome was to assess the prevalence of injection drug use and co-occurring HIV and HCV infection among patients presenting to an urban ED. Methods This was a cross sectional study conducted at an urban ED, with an annual census of 65,000 visits. A closed-response questionnaire was developed based on publicly available validated surveys to assess patterns of injection drug use and HIV and HCV infection status, and administered by trained research assistants to all registered adult patients during 4-hour blocks of time. Results Of the 2,319 eligible patients, 2,200 (94.9%) consented and completed the survey. 241 (11.0%) had ever used injection drugs, 103 (4.7%) currently used injection drugs, and 138 (6.3%) formerly used injection drugs. White patients age 25 to 34 years and white patients age 55 to 64 years had the highest prevalence of current (25.6%) and former (27.1%) injection drug use, respectively. Persons who use injection drugs had a higher prevalence of HCV infection (52.7% vs. 3.4%) and HIV infection (6.2% vs. 1.8%) than the rest of the population. Conclusion A high prevalence of ED patients report injection drug use, and this population self-reports a high prevalence of HIV and HCV infection. Emergency departments are in a unique position to engage with this population with regards to substance use treatment and linkage to care for HIV and HCV infection.
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Affiliation(s)
- Erik S. Anderson
- Department of Emergency Medicine, Alameda Health System, Highland Hospital, Oakland, CA, United States of America
- * E-mail:
| | - Carly Russell
- Department of Emergency Medicine, Alameda Health System, Highland Hospital, Oakland, CA, United States of America
| | - Kellie Basham
- Department of Emergency Medicine, Alameda Health System, Highland Hospital, Oakland, CA, United States of America
| | - Martha Montgomery
- Department of Emergency Medicine, Alameda Health System, Highland Hospital, Oakland, CA, United States of America
| | - Helen Lozier
- Department of Emergency Medicine, Alameda Health System, Highland Hospital, Oakland, CA, United States of America
| | - Abigail Crocker
- Department of Emergency Medicine, Alameda Health System, Highland Hospital, Oakland, CA, United States of America
| | - Marisa Zuluaga
- Department of Emergency Medicine, Alameda Health System, Highland Hospital, Oakland, CA, United States of America
| | - Douglas A. E. White
- Department of Emergency Medicine, Alameda Health System, Highland Hospital, Oakland, CA, United States of America
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Amaducci AM, Greenberg MR, Sheen AW, Warren HR, Parikh PM, Roth P, Weaver KR, Richardson DM, Burmeister DB, Stephens JL, Cannon RD. Sex-specific Outcomes in a Substance Use Intervention Program. Clin Ther 2020; 42:419-426. [PMID: 32160970 DOI: 10.1016/j.clinthera.2020.01.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 01/27/2020] [Accepted: 01/30/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE We performed an emergency department (ED)-based substance use screening, motivational interview-based intervention, and treatment referral program with the goal of determining sex-specific outcomes. Specifically, in this quality improvement project, we aimed to determine whether there was a difference among sexes in the type of substances used; the frequency of positive screening results for substance use disorder; agreeing to an intervention; the type of follow-up evaluation, participation, and referral; and attempts to change substance use after intervention. METHODS We prospectively studied a convenience sample of patients at 3 hospitals in Northeastern Pennsylvania from May 2017 through February 2018. Inclusion criteria for participation in this study were age ≥18 years; ability to answer survey questions; willingness and ability (not being too ill) to participate in intervention(s); and when screened, admitting to use of alcohol, tobacco, potentially addictive prescription drugs, or street drugs. Practitioners in the ED screened patients. For those with unhealthy substance use, a brief motivational interview was performed. Participants were each given referrals and information in accordance with the particular substance used and their assessed readiness to change. Individuals who completed the intervention were contacted by telephone for follow-up. Self-reported outcomes and the frequency of successful warm hand-off referrals were assessed. FINDINGS Of the 2209 individuals screened, 976 (44.2%) were male. Overall, 547 patients screened positive for at least 1 of the unhealthy substances for a prevalence of 24.8% (95% confidence interval, 22.9%-26.6%). In this population, a greater proportion of men screened positive than women (30.5% vs 20.2%, P = 0.01). Although the finding was not statistically significant, men (106 [35.6%]) were more likely than women (81 [32.5%]) to agree to an ED intervention. At telephone follow-up, men were more likely to report participating in a treatment or support program than women (32.9% vs 18.2%, P = 0.035). Frequencies of warm hand-off referrals were 11 of 106 (10.4%) for men and 2 of 81 (2.5%) for women. IMPLICATIONS Our small study found that unhealthy substance use rates were greater overall in men than women. Overall participation differences between men and women who agreed to take part in substance intervention and accepted a referral for follow-up treatment were not statistically significant. At telephone follow-up, more men reported participating in a treatment program than women. Direct referral (warm hand-off) rates to treatment programs were small in both sexes but greater in men than women.
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Affiliation(s)
- Alexandra M Amaducci
- University of South Florida Morsani College of Medicine, Lehigh Valley Campus, Allentown, PA, USA; Department of Emergency and Hospital Medicine, Lehigh Valley Health Network, Allentown, PA, USA
| | - Marna Rayl Greenberg
- University of South Florida Morsani College of Medicine, Lehigh Valley Campus, Allentown, PA, USA; Department of Emergency and Hospital Medicine, Lehigh Valley Health Network, Allentown, PA, USA.
| | - Andrew W Sheen
- University of South Florida Morsani College of Medicine, Lehigh Valley Campus, Allentown, PA, USA; Department of Emergency and Hospital Medicine, Lehigh Valley Health Network, Allentown, PA, USA
| | - Hanna R Warren
- University of South Florida Morsani College of Medicine, Lehigh Valley Campus, Allentown, PA, USA; Department of Emergency and Hospital Medicine, Lehigh Valley Health Network, Allentown, PA, USA
| | - Pratik M Parikh
- University of South Florida Morsani College of Medicine, Lehigh Valley Campus, Allentown, PA, USA; Department of Emergency and Hospital Medicine, Lehigh Valley Health Network, Allentown, PA, USA
| | - Paige Roth
- University of South Florida Morsani College of Medicine, Lehigh Valley Campus, Allentown, PA, USA; Department of Emergency and Hospital Medicine, Lehigh Valley Health Network, Allentown, PA, USA
| | - Kevin R Weaver
- University of South Florida Morsani College of Medicine, Lehigh Valley Campus, Allentown, PA, USA; Department of Emergency and Hospital Medicine, Lehigh Valley Health Network, Allentown, PA, USA
| | - David M Richardson
- University of South Florida Morsani College of Medicine, Lehigh Valley Campus, Allentown, PA, USA; Department of Emergency and Hospital Medicine, Lehigh Valley Health Network, Allentown, PA, USA
| | - David B Burmeister
- University of South Florida Morsani College of Medicine, Lehigh Valley Campus, Allentown, PA, USA; Department of Emergency and Hospital Medicine, Lehigh Valley Health Network, Allentown, PA, USA
| | - Jennifer L Stephens
- University of South Florida Morsani College of Medicine, Lehigh Valley Campus, Allentown, PA, USA; Department of Medicine, Lehigh Valley Health Network, Allentown, PA, USA
| | - Robert D Cannon
- University of South Florida Morsani College of Medicine, Lehigh Valley Campus, Allentown, PA, USA; Department of Emergency and Hospital Medicine, Lehigh Valley Health Network, Allentown, PA, USA
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Frequent emergency department use and mortality in patients with substance and opioid use in Alberta: A population-based retrospective cohort study. CAN J EMERG MED 2019; 21:482-491. [PMID: 30983561 DOI: 10.1017/cem.2019.15] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES In the current opioid epidemic, identifying high-risk patients among those with substance and opioid use may prevent deaths. The objective of this study was to determine whether frequent emergency department (ED) use and degree of frequent use are associated with mortality among ED patients with substance and opioid use. METHODS This cohort study used linked population-based ED (National Ambulatory Care Reporting System) and mortality data from Alberta. All adults ≥ 18 years with substance or opioid use-related visits based on diagnostic codes from April 1, 2012, to March 31, 2013, were included (n = 16,389). Frequent use was defined by ≥ 5 visits in the previous year. Outcomes were unadjusted and adjusted (for age, sex, income) mortality within 90 days (primary), and 30 days, 365 days, and 2 years (secondary). To examine degree, frequent use was subcategorized into 5-10, 11-15, 16-20, and > 20 visits. RESULTS Frequent users were older, lower income, and made lower acuity visits than non-frequent users. Frequent users with substance use had higher mortality at 365 days (hazard ratio [HR] 1.36 [1.04, 1.77]) and 2 years (HR 1.32 [1.04, 1.67]), but not at 90 or 30 days. Mortality did not differ for frequent users with opioid use overall. By degree, patients with substance use and > 20 visits/year and with opioid use and 16-20 visits/year demonstrated a higher 365-day and 2-year mortality. CONCLUSIONS Among patients with substance use, frequent ED use and extremely frequent use (> 20 visits/year) were associated with long-term but not short-term mortality. These findings suggest a role for targeted screening and preventive intervention.
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Otterstatter MC, Crabtree A, Dobrer S, Kinniburgh B, Klar S, Leamon A, May-Hadford J, Mill C, Park M, Tu AW, Zheng L. Patterns of health care utilization among people who overdosed from illegal drugs: a descriptive analysis using the BC Provincial Overdose Cohort. HEALTH PROMOTION AND CHRONIC DISEASE PREVENTION IN CANADA-RESEARCH POLICY AND PRACTICE 2019; 38:328-333. [PMID: 30226726 DOI: 10.24095/hpcdp.38.9.04] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION British Columbia (BC) declared a public health emergency in April 2016 in response to a rapid rise in overdose deaths. Further understanding of health care utilization is needed to inform prevention strategies for individuals who overdose from illegal drugs. METHODS The Provincial Overdose Cohort includes linked administrative data on health care utilization by individuals who experienced an illegal drug overdose event in BC between 1 January 2015 and 30 November 2016. Overdose cases were identified using data from ambulance services, coroners' investigations, poison control centre calls and hospital, emergency department and physician administrative records. In total, 10 455 overdose cases were identified and compared with 52 275 controls matched on age, sex and area of residence for a descriptive analysis of health care utilization. RESULTS Two-thirds (66%) of overdose cases were male and about half (49%) were 20-39 years old. Over half of the cases (54%) visited the emergency department and about one-quarter (26%) were admitted to hospital in the year before the overdose event, compared with 17% and 9% of controls, respectively. Nevertheless, nearly onefifth (19%) of cases were recorded leaving the emergency department without being seen or against medical advice. High proportions of both cases (75%) and controls (72%) visited community-based physicians. Substance use and mental health-related concerns were the most common diagnoses among people who went on to overdose. CONCLUSION People who overdosed frequently accessed the health care system in the year before the overdose event. In light of the high rates of health care use, there may be opportunities to identify at-risk individuals before they overdose and connect them with targeted programs and evidence-based interventions. Further work using the BC Provincial Overdose Cohort will focus on identifying risk factors for overdose events and death by overdose.
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Affiliation(s)
- Michael C Otterstatter
- BC Centre for Disease Control, Vancouver, British Columbia, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alexis Crabtree
- BC Centre for Disease Control, Vancouver, British Columbia, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sabina Dobrer
- BC Centre for Disease Control, Vancouver, British Columbia, Canada
| | | | - Salman Klar
- Fraser Health Authority, Surrey, British Columbia, Canada
| | - Anthony Leamon
- Island Health Authority, Victoria, British Columbia, Canada.,BC Observatory for Population and Public Health, BC Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Jennifer May-Hadford
- First Nations Health Authority, Vancouver, British Columbia, Canada.,Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Christopher Mill
- BC Centre for Disease Control, Vancouver, British Columbia, Canada.,Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Mina Park
- BC Centre for Disease Control, Vancouver, British Columbia, Canada.,BC Observatory for Population and Public Health, BC Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Andrew W Tu
- BC Coroners Service, Burnaby, British Columbia, Canada
| | - Lu Zheng
- BC Emergency Health Services, Victoria, British Columbia, Canada
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MacDougall L, Smolina K, Otterstatter M, Zhao B, Chong M, Godfrey D, Mussavi-Rizi A, Sutherland J, Kuo M, Kendall P. Development and characteristics of the Provincial Overdose Cohort in British Columbia, Canada. PLoS One 2019; 14:e0210129. [PMID: 30629607 PMCID: PMC6328267 DOI: 10.1371/journal.pone.0210129] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 12/17/2018] [Indexed: 11/28/2022] Open
Abstract
Introduction British Columbia (BC), Canada declared a public health emergency in April 2016 for opioid overdose. Comprehensive data was needed to identify risk factors, inform interventions, and evaluate response actions. We describe the development of an overdose cohort, including linkage strategy, case definitions, and data governance model, and present the resulting characteristics, including data linkage yields and case overlap among data sources. Methods Overdose events from hospital admissions, physician visits, poison centre and ambulance calls, emergency department visits, and coroner’s data were grouped into episodes if records were present in multiple sources. A minimum of five years of universal health care records (all prescription dispensations, fee-for-service physician billings, emergency department visits and hospitalizations) were appended for each individual. A 20% random sample of BC residents and a 1:5 matched case-control set were generated. Consultation and prioritization ensured analysts worked to address questions to directly inform public health actions. Results 10,456 individuals suffered 14,292 overdoses from January 1, 2015 to Nov 30, 2016. Only 28% of overdose events were found in more than one dataset with the unique contribution of cases highest from ambulance records (32%). Compared with fatal overdoses, non-fatal events more often involved females, younger individuals (20 to 29 years) and those 60 or older. In 78% of illegal drug deaths, there was no associated ambulance response. In the year prior to first recorded overdose, 60% of individuals had at least one ED visit, 31% at least one hospital admission, 80% at least one physician visit, and 87% had filled at least one prescription in a community pharmacy. Conclusion While resource-intensive to establish, a linked cohort is useful for characterizing the full extent of the epidemic, defining sub-populations at risk, and patterns of contact with the health system. Overdose studies in other jurisdictions should consider the inclusion of multiple data sources.
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Affiliation(s)
- Laura MacDougall
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
- * E-mail:
| | - Kate Smolina
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Michael Otterstatter
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Bin Zhao
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Mei Chong
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - David Godfrey
- Data Management and Stewardship Branch, British Columbia Ministry of Health, Victoria, BC, Canada
| | - Ali Mussavi-Rizi
- Performance Measurement and Reporting, Provincial Health Services Authority, Vancouver, BC, Canada
| | - Jenny Sutherland
- Office of the Provincial Health Officer, British Columbia Ministry of Health, Victoria, BC, Canada
| | - Margot Kuo
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Perry Kendall
- Office of the Provincial Health Officer, British Columbia Ministry of Health, Victoria, BC, Canada
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John WS, Wu LT. Sex differences in the prevalence and correlates of emergency department utilization among adults with prescription opioid use disorder. Subst Use Misuse 2019; 54:1178-1190. [PMID: 30727792 PMCID: PMC6483831 DOI: 10.1080/10826084.2019.1568495] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The emergency department (ED) is well-suited as an opportunity to increase treatment access for prescription opioid use disorder (POUD). We examined sex differences in ED utilization among individuals with POUD to understand potential sex-specific treatment barriers and needs. METHODS Data from the 2005-2014 National Surveys on Drug use and Health were analyzed to examine the prevalence and correlates of past-year ED utilization among male and female adults aged 18 or older with POUD (n = 4412). RESULTS Overall, 58.2% of adults with POUD reported past-year ED utilization. Adjusted logistic regression revealed that females (vs. males) with POUD were more likely to report past-year ED utilization. Among females with POUD, older age, lower income, obtaining opioids from a physician, major depressive episode, and greater POUD severity were associated with increased odds of ED utilization. Among males with POUD, public insurance and obtaining opioids from a physician were associated with ED utilization. A larger proportion of males with POUD reporting ED use had multiple substance use disorders than those with no ED use. Treatment history (lifetime or past-year) for alcohol, drugs, or opioid use was associated with increased odds of ED use among males and females with POUD. Conclusions/Importance: Males and females with POUD presenting to the ED may have distinct predisposing, enabling, and need-related correlates. Sex-specific screening and intervention strategies may be useful to maximize the utility of the ED to address POUD.
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Affiliation(s)
- William S John
- a Department of Psychiatry and Behavioral Sciences , Duke University Medical Center , Durham , North Carolina , USA
| | - Li-Tzy Wu
- a Department of Psychiatry and Behavioral Sciences , Duke University Medical Center , Durham , North Carolina , USA.,b Department of Medicine, Division of General Internal Medicine , Duke University Medical Center , Durham , North Carolina , USA.,c Duke Clinical Research Institute , Duke University Medical Center , Durham , North Carolina , USA.,d Center for Child and Family Policy, Sanford School of Public Policy , Duke University , Durham , North Carolina , USA
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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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Wu LT, Zhu H, Ghitza UE. Multicomorbidity of chronic diseases and substance use disorders and their association with hospitalization: Results from electronic health records data. Drug Alcohol Depend 2018; 192:316-323. [PMID: 30312893 PMCID: PMC6358206 DOI: 10.1016/j.drugalcdep.2018.08.013] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 08/14/2018] [Accepted: 08/14/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Chronic diseases are prevalent and the leading causes of mortality. Comorbidity of substance use disorders (SUDs) and chronic diseases is understudied to inform behavioral healthcare integration. OBJECTIVES This study leveraged electronic health record (EHR) data of 211,880 adults from a large health system to examine prevalence and correlates of comorbidity of SUDs and nine chronic disease groups and to determine their association with hospitalization. METHODS Logistic regression analyses were conducted to estimate associations between chronic diseases and SUDs. To control for severity of diagnosis, analyses of associations between SUD and hospitalization were stratified by the number of chronic conditions. RESULTS In the sample, 48.3% had ≥1 chronic condition (hypertension 33.7%, arthritis 16.2%, diabetes 13.7%, chronic kidney disease 9.9%, asthma 9.1%, chronic obstructive pulmonary disease 8.9%, ischemic heart disease 8.3%, cancer 4.6%, and hepatitis 1.3%). Prevalence of SUD (overall 13.3%) among patients increased with multiple chronic conditions (14.3% having SUD among patients with one condition; 21.2% having SUD among patients with two to three conditions; and 32.5% having SUD among patients with 4-9 conditions). Chronic conditions were associated with increased odds of SUDs. For all SUD groups, hospitalization was more prevalent among patients with SUD than those without it; prevalence of hospitalization increased with the number of comorbid chronic conditions. CONCLUSIONS Findings reveal a striking pattern of multicomorbidity of SUD and chronic diseases and its positive association with hospitalization. Behavioral healthcare integration should consider efforts to assess and treat comorbid SUD and chronic diseases, especially among adults with multiple chronic conditions.
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Affiliation(s)
- Li-Tzy Wu
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA; Department of Medicine, Division of General Internal Medicine, Duke University Medical Center, Durham, NC, USA; Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA; Center for Child and Family Policy, Sanford School of Public Policy, Duke University, Durham, NC, USA.
| | - He Zhu
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Udi E Ghitza
- National Institute on Drug Abuse, Bethesda, MD, USA
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Andrews CM, Westlake M, Wooten N. Availability of Outpatient Addiction Treatment and Use of Emergency Department Services Among Medicaid Enrollees. Psychiatr Serv 2018; 69:729-732. [PMID: 29695224 PMCID: PMC6511360 DOI: 10.1176/appi.ps.201700413] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The study examined whether the number of outpatient addiction programs accepting Medicaid in South Carolina counties is linked to repeat use of the emergency department for addiction-related conditions. METHODS The study included the population all adult Medicaid enrollees (N=2,401) in South Carolina with at least one addiction-related emergency service visit in 2012 or 2013. A random-effects logistic regression model was used to examine the association between outpatient addiction treatment availability and repeat use by Medicaid enrollees of emergency services for addiction-related conditions. RESULTS Enrollees in counties with two or more programs that accept Medicaid were less likely to have a repeat addiction-related emergency service visit than enrollees in counties with only one program that accepts Medicaid. CONCLUSIONS Availability of outpatient addiction treatment may reduce the need for addiction-related emergency services. Research is needed to explore potential causal mechanisms underlying this observed relationship.
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Affiliation(s)
- Christina M Andrews
- The authors are with the College of Social Work, University of South Carolina, Columbia
| | - Melissa Westlake
- The authors are with the College of Social Work, University of South Carolina, Columbia
| | - Nikki Wooten
- The authors are with the College of Social Work, University of South Carolina, Columbia
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Zhu H, Wu LT. Sex Differences in Cannabis Use Disorder Diagnosis Involved Hospitalizations in the United States. J Addict Med 2018; 11:357-367. [PMID: 28700366 PMCID: PMC5636049 DOI: 10.1097/adm.0000000000000330] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 06/02/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The study examined sex differences in trend and clinical characteristics of cannabis use disorder (CUD) diagnosis involved hospitalizations among adult patients. METHODS We analyzed hospitalization data from the 2007-2011 Nationwide Inpatient Samples for patients aged 18-64 years (N = 15,114,930). Descriptive statistics were used to characterize demographic variables and to compare the proportions of CUD diagnosis and comorbid patterns between male and female hospitalizations. Logistic regressions were performed to examine the association of sex and other demographic variables with CUD diagnosis. RESULTS During the study period, 3.3% of male and 1.5% of female hospitalizations had any-listed CUD diagnoses, and both sexes presented an upward trend in the number, rate, and proportion of CUD diagnosis. Among hospitalizations for patients aged 18-25 years, about 1 in 10 males and 1 in 20 females included a CUD diagnosis, and this proportion decreased with age strata. Mental disorders accounted for the highest proportion of CUD involved inpatient hospitalizations, and female CUD involved hospitalizations included a higher proportion of mental disorders that required hospitalized care compared with male hospitalizations (41% vs 36%). In each sex group, younger age, black race, lower household income, large metropolitan residence, non-private insurance, substance use diagnosis, and mental disorders were associated with elevated odds of having CUD diagnosis. CONCLUSION The large sample of clinical hospitalization data suggest an increased trend in CUD diagnosis and sex differences in several comorbidities with CUD-involved hospital admissions. Prevention and treatment for CUD should consider sex differences in clinical comorbidities.
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Affiliation(s)
- He Zhu
- Department of Psychiatry and Behavioral Sciences (HZ, L-TW); Duke University Medical Center, Department of Medicine, Division of General Internal Medicine, Duke University Medical Center (L-TW); Duke Clinical Research Institute (L-TW); and Center for Child and Family Policy, Sanford School of Public Policy, Duke University, Durham, NC (L-TW)
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Implementing routine blood-borne virus testing for HCV, HBV and HIV at a London Emergency Department - uncovering the iceberg? Epidemiol Infect 2018; 146:1026-1035. [PMID: 29661260 DOI: 10.1017/s0950268818000870] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
UK guidelines recommend routine HIV testing in high prevalence emergency departments (ED) and targeted testing for HBV and HCV. The 'Going Viral' campaign implemented opt-out blood-borne virus (BBV) testing in adults in a high prevalence ED, to assess seroprevalence, uptake, linkage to care (LTC) rates and staff time taken to achieve LTC. Diagnosis status (new/known/unknown), current engagement in care, and severity of disease was established. LTC was defined as patient informed plus ⩾1 clinic visit. A total of 6211/24 981 ED attendees were tested (uptake 25%); 257 (4.1%) were BBV positive (15 co-infected), 84 (33%) required LTC. 100/147 (68%) HCV positives were viraemic; 44 (30%) required LTC (13 new, 16 disengaged). 26/54 (48%) HBV required LTC (seven new, 11 disengaged). 16/71 (23%) HIV required LTC (10 new, five disengaged). 26/84 (31%) patients requiring LTC had advanced disease (CD4 1, Fibroscan F3/F4 or liver cancer), including five with AIDS-defining conditions and three hepatocellular carcinomas. There were five BBV-related deaths. BBV prevalence was high (4.1%); most were HCV (2.4%). HIV patients were more successfully and quickly LTC than HBV or HCV patients. ED testing was valuable as one-third of those requiring LTC (new, disengaged or unknown status patients) had advanced disease.
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Merchant RC, Romanoff J, Zhang Z, Liu T, Baird JR. Impact of a brief intervention on reducing alcohol use and increasing alcohol treatment services utilization among alcohol- and drug-using adult emergency department patients. Alcohol 2017; 65:71-80. [PMID: 29084632 PMCID: PMC5681406 DOI: 10.1016/j.alcohol.2017.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 05/30/2017] [Accepted: 07/13/2017] [Indexed: 11/22/2022]
Abstract
Most previous brief intervention (BI) studies have focused on alcohol or drug use, instead of both substances. Our primary aim was to determine if an alcohol- and drug-use BI reduced alcohol use and increased alcohol treatment services utilization among adult emergency department (ED) patients who drink alcohol and require an intervention for their drug use. Our secondary aims were to assess when the greatest relative reductions in alcohol use occurred, and which patients (stratified by need for an alcohol use intervention) reduced their alcohol use the most. In this secondary analysis, we studied a sub-sample of participants from the Brief Intervention for Drug Misuse in the Emergency Department (BIDMED) randomized, controlled trial of a BI vs. no BI, whose responses to the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) indicated a need for a BI for any drug use, and who also reported alcohol use. Participants were stratified by their ASSIST alcohol subscore: 1) no BI needed, 2) a BI needed, or 3) an intensive intervention needed for alcohol use. Alcohol use and alcohol treatment services utilization were measured every 3 months for 12 months post-enrollment. Of these 833 participants, median age was 29 years-old, 46% were female; 55% were white/non-Hispanic, 27% black/non-Hispanic, and 15% Hispanic. Although any alcohol use, alcohol use frequency, days of alcohol use, typical drinks consumed/day, and most drinks consumed/day decreased in both the BI and no BI arms, there were no differences between study arms. Few patients sought alcohol use treatment services in follow-up, and utilization also did not differ by study arm. Compared to baseline, alcohol use reduced the most during the first 3 months after enrollment, yet reduced little afterward. Participants whose ASSIST alcohol subscores indicated a need for an intensive intervention generally had the greatest relative decreases in alcohol use. These results indicate that the BI was not efficacious in reducing alcohol use among alcohol- and drug-using adult ED patients than the self-assessments alone, but suggest that self-assessments with or without a BI may confer reductions in alcohol use.
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Affiliation(s)
- Roland C Merchant
- Department of Emergency Medicine, Alpert Medical School, Brown University, Providence, RI, USA; Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA.
| | - Justin Romanoff
- Department of Biostatistics, Center for Statistical Sciences, School of Public Health, Brown University, Providence, RI, USA
| | - Zihao Zhang
- Department of Biostatistics, Center for Statistical Sciences, School of Public Health, Brown University, Providence, RI, USA
| | - Tao Liu
- Department of Biostatistics, Center for Statistical Sciences, School of Public Health, Brown University, Providence, RI, USA
| | - Janette R Baird
- Department of Emergency Medicine, Alpert Medical School, Brown University, Providence, RI, USA
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Gilmore D, Zorland J, Akin J, Johnson JA, Emshoff JG, Kuperminc GP. Mortality risk in a sample of emergency department patients who use cocaine with alcohol and/or cannabis. Subst Abus 2017; 39:266-270. [DOI: 10.1080/08897077.2017.1389799] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Devin Gilmore
- Department of Psychology, Georgia State University, Atlanta, Georgia, USA
| | - Jennifer Zorland
- Department of Psychology, Georgia State University, Atlanta, Georgia, USA
| | - Joanna Akin
- Department of Psychology, Georgia State University, Atlanta, Georgia, USA
| | - J. Aaron Johnson
- Department of Family Medicine, Medical Center of Central Georgia and Mercer University School of Medicine, Macon, Georgia, USA
| | - James G. Emshoff
- Department of Psychology, Georgia State University, Atlanta, Georgia, USA
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Risk characterization of hospitalizations for mental illness and/or behavioral disorders with concurrent heat-related illness. PLoS One 2017; 12:e0186509. [PMID: 29036206 PMCID: PMC5643126 DOI: 10.1371/journal.pone.0186509] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 10/03/2017] [Indexed: 01/23/2023] Open
Abstract
Background Many studies have found significant associations between high ambient temperatures and increases in heat-related morbidity and mortality. Several studies have demonstrated that increases in heat-related hospitalizations are elevated among individuals with diagnosed mental illnesses and/or behavioral disorders (MBD). However, there are a limited number of studies regarding risk factors associated with specific mental illnesses that contribute, at least in part, to heat-related illnesses (HRI) in the United States. Objective To identify and characterize individual and environmental risk factors associated with MBD hospitalizations with a concurrent HRI diagnosis. Methods This study uses hospitalization data from the Nationwide Inpatient Sample (2001–2010). Descriptive analyses of primary and secondary diagnoses of MBDs with an HRI were examined. Risk ratios (RR) were calculated from multivariable models to identify risk factors for hospitalizations among patients with mental illnesses and/or behavioral disorders and HRI. Results Nondependent alcohol/drug abuse, dementia, and schizophrenia were among the disorders that were associated with increased frequency of HRI hospitalizations among MBD patients. Increased risk of MBD hospitalizations with HRI was observed for Males (RR, 3.06), African Americans (RR, 1.16), Native Americans (RR, 1.70), uninsured (RR, 1.92), and those 40 years and older, compared to MBD hospitalizations alone. Conclusions Previous studies outside the U.S. have found that dementia and schizophrenia are significant risk factors for HRI hospitalizations. Our results suggest that hospitalizations among substance abusers may also be an important risk factor associated with heat morbidity. Improved understanding of these relative risks could help inform future public health strategies.
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Abstract
OBJECTIVES To examine trends and correlates of cannabis-involved emergency department (ED) visits in the United States from 2004 to 2011. METHODS Data were obtained from the 2004 to 2011 Drug Abuse Warning Network. We analyzed trend in cannabis-involved ED visits for persons aged ≥12 years and stratified by type of cannabis involvement (cannabis-only, cannabis-polydrug). We used logistic regressions to determine correlates of cannabis-involved hospitalization versus cannabis-involved ED visits only. RESULTS Between 2004 and 2011, the ED visit rate increased from 51 to 73 visits per 100,000 population aged ≥12 years for cannabis-only use (P value for trend = 0.004) and from 63 to 100 for cannabis-polydrug use (P value for trend < 0.001). Adolescents aged 12-17 years showed the largest increase in the cannabis-only-involved ED visit rate (rate difference = 80 per 100,000 adolescents). Across racial/ethnic groups, the most prevalent ED visits were noted among non-Hispanic blacks. Among cannabis-involved visits, the odds of hospitalization (vs ED visits only) increased with age strata compared with age 12 to 17 years. CONCLUSIONS These findings suggest a notable increase in the ED visit numbers and rates for both the use of cannabis-only and cannabis-polydrug during the studied period, particularly among young people and non-Hispanic blacks.
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Bahorik AL, Satre DD, Kline-Simon AH, Weisner CM, Young-Wolff KC, Campbell CI. Alcohol, marijuana, and opioid use disorders: 5-Year patterns and characteristics of emergency department encounters. Subst Abus 2017; 39:59-68. [PMID: 28723312 DOI: 10.1080/08897077.2017.1356789] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Changes in substance use patterns stemming from opioid misuse, ongoing drinking problems, and marijuana legalization may result in new populations of patients with substance use disorders (SUDs) using emergency department (ED) resources. This study examined ED admission trends in a large sample of patients with alcohol, marijuana, and opioid use disorders in an integrated health system. METHODS In a retrospective design, electronic health record (EHR) data identified patients with ≥1 of 3 common SUDs in 2010 (n = 17,574; alcohol, marijuana, or opioid use disorder) and patients without SUD (n = 17,574). Logistic regressions determined odds of ED use between patients with SUD versus controls (2010-2014); mixed-effect models examined 5-year differences in utilization; moderator models identified subsamples for which patients with SUD may have a greater impact on ED resources. RESULTS Odds of ED use were higher at each time point (2010-2014) for patients with alcohol (odds ratio [OR] range: 5.31-2.13, Ps < .001), marijuana (OR range: 5.45-1.97, Ps < .001), and opioid (OR range: 7.63-4.19, Ps < .001) use disorders compared with controls; odds decreased over time (Ps < .001). Patients with opioid use disorder were at risk of high ED utilization; patients were 7.63 times more likely to have an ED visit in 2010 compared with controls and remained 5.00 (average) times more likely to use ED services. ED use increased at greater rates for patients with alcohol and opioid use disorders with medical comorbidities relative to controls (Ps < .045). CONCLUSIONS ED use is frequent in patients with SUDs who have access to private insurance coverage and integrated medical services. ED settings provide important opportunities in health systems to identify patients with SUDs, particularly patients with opioid use disorder, to initiate treatment and facilitate ongoing care, which may be effective for reducing excess medical emergencies and ED encounters.
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Affiliation(s)
- Amber L Bahorik
- a Department of Psychiatry , University of California , San Francisco , California , USA
| | - Derek D Satre
- a Department of Psychiatry , University of California , San Francisco , California , USA.,b Division of Research, Kaiser Permanente Northern California , Oakland , California , USA
| | - Andrea H Kline-Simon
- b Division of Research, Kaiser Permanente Northern California , Oakland , California , USA
| | - Constance M Weisner
- a Department of Psychiatry , University of California , San Francisco , California , USA.,b Division of Research, Kaiser Permanente Northern California , Oakland , California , USA
| | - Kelly C Young-Wolff
- a Department of Psychiatry , University of California , San Francisco , California , USA.,b Division of Research, Kaiser Permanente Northern California , Oakland , California , USA
| | - Cynthia I Campbell
- a Department of Psychiatry , University of California , San Francisco , California , USA.,b Division of Research, Kaiser Permanente Northern California , Oakland , California , USA
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Campbell CI, Bahorik A, Kline-Simon AH, Satre DD. The role of marijuana use disorder in predicting emergency department and inpatient encounters: A retrospective cohort study. Drug Alcohol Depend 2017; 178. [PMID: 28651153 PMCID: PMC5605130 DOI: 10.1016/j.drugalcdep.2017.04.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Marijuana use disorder (MUD) is the most common illegal drug use disorder and its prevalence is increasing. It is associated with psychiatric and medical problems, but little is known about its impact on emergency department (ED) and inpatient utilization rates. DESIGN In a retrospective cohort design, we used electronic health record (EHR) data to identify patients with MUD (n=2752) and demographically matched patients without MUD (n=2752) in 2010. Logistic regressions determined risk of ED and inpatient visits each year from 2010 to 2014 for MUD patients versus controls; mixed-effect growth models examined differences in utilization rates over 5-years. Patient characteristics predicting increased risk of utilization were examined among the MUD sample only. KEY RESULTS Rates of ED (OR=0.87, p<0.001) and inpatient (OR=0.76, p<0.001) services use significantly declined over 5 years for all patients. Patients with MUD exhibited a significantly greater decline in ED (OR=0.81, p<0.001) and inpatient (OR=0.64, p<0.001) use relative to controls. However, MUD patients had significantly greater risk of having ED and inpatient visits at each time point (p's<0.001). MUD patients with co-occurring other substance use, medical, and/or psychiatric disorders had a greater risk of having ED or inpatient encounters over 5 years (p's<0.001). CONCLUSIONS MUD patients remain at high risk for ED and inpatient visits despite decreasing utilization rates over 5 years. Addressing MUD patients' comorbid conditions in outpatient settings may help reduce inappropriate service use.
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Affiliation(s)
- Cynthia I. Campbell
- Division of Research, Kaiser Permanente, Northern California, Oakland, CA, 94612-2304, USA,Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Avenue, Box 0984, San Francisco, CA 94143
| | - Amber Bahorik
- Division of Research, Kaiser Permanente, Northern California, Oakland, CA, 94612-2304, USA,Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Avenue, Box 0984, San Francisco, CA 94143
| | - Andrea H. Kline-Simon
- Division of Research, Kaiser Permanente, Northern California, Oakland, CA, 94612-2304, USA
| | - Derek D. Satre
- Division of Research, Kaiser Permanente, Northern California, Oakland, CA, 94612-2304, USA,Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Avenue, Box 0984, San Francisco, CA 94143
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Wu LT, Zhu H, Mannelli P, Swartz MS. Prevalence and correlates of treatment utilization among adults with cannabis use disorder in the United States. Drug Alcohol Depend 2017; 177:153-162. [PMID: 28599214 PMCID: PMC5538354 DOI: 10.1016/j.drugalcdep.2017.03.037] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 03/23/2017] [Accepted: 03/23/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND The increase in cannabis potency may have treatment implications for cannabis use disorder (CUD). Given the reported increase in prevalence of cannabis use among adults, there is a need to understand substance use treatment needs for CUD. METHODS We examined demographics and behavioral health indicators of adults aged ≥18 years that met criteria for past-year CUD (n=10,943) in the 2005-2013 National Surveys on Drug Use and Health. We determined prevalence and correlates of past-year treatment use for alcohol/drug, any drug, and cannabis use related problems, to inform treatment efforts for CUD. RESULTS The majority of adults with past-year CUD were young adults aged 18-25 or men, had low income, and did not attend college. Two-thirds of adults with CUD met criteria for cannabis dependence, which was comparatively common among younger adults, women, low-income or publicly insured adults, and college-educated adults. Nicotine dependence (40.92%) and alcohol (44.07%) or other drug use disorder (19.70%) were prevalent among adults with CUD. Overall, less than 13% of adults with CUD had received alcohol/drug use treatment the past year; only 7.8% received cannabis-specific treatment. There was no significant yearly variation in treatment use prevalence over 9 years. In particular, Asian-Americans, women, and college-educated adults underutilized cannabis-specific treatment. CONCLUSIONS This large sample of adults with CUD reveals pervasive underutilization of cannabis-related treatment, especially in women, married adults, and those with college education, despite a high proportion of comorbid behavioral health problems.
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Affiliation(s)
- Li-Tzy Wu
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA; Department of Medicine, Division of General Internal Medicine, Duke University Medical Center, Durham, NC, USA; Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA; Center for Child and Family Policy, Sanford School of Public Policy, Duke University, Durham, NC, USA.
| | - He Zhu
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham,NC, USA
| | - Paolo Mannelli
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham,NC, USA
| | - Marvin S. Swartz
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham,NC, USA
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Gonzalez M, Clarke DE, Pereira A, Boyce-Gaudreau K, Waldman C, Demczuk L, Legare C. The impact of educational interventions on attitudes of emergency department staff towards patients with substance-related presentations: a quantitative systematic review. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2017; 15:2153-2181. [PMID: 28800059 DOI: 10.11124/jbisrir-2016-003006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Visits to emergency departments for substance use/abuse are common worldwide. However, emergency department health care providers perceive substance-using patients as a challenging group to manage which can lead to negative attitudes. Providing education or experience-based exercises may impact positively on behaviors towards this patient population. Whether staff attitudes are similarly impacted by knowledge acquired through educational interventions remains unknown. OBJECTIVES To synthesize available evidence on the relationship between new knowledge gained through substance use educational interventions and emergency department health care providers' attitudes towards patients with substance-related presentations. INCLUSION CRITERIA TYPES OF PARTICIPANTS Health care providers working in urban and rural emergency departments of healthcare facilities worldwide providing care to adult patients with substance-related presentations. TYPE OF INTERVENTION Quantitative papers examining the impact of substance use educational interventions on health care providers' attitudes towards substance using patients. TYPES OF STUDIES Experimental and non-experimental study designs. OUTCOMES Emergency department staff attitudes towards patients presenting with substance use/abuse. SEARCH STRATEGY A three-step search strategy was conducted in August 2015 with a search update in March 2017. Studies published since 1995 in English, French or Spanish were considered for inclusion. METHODOLOGICAL QUALITY Two reviewers assessed studies for methodological quality using critical appraisal checklists from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI). Reviewers agreed on JBI-MAStARI methodological criteria a study must meet in order to be included in the review (e.g. appropriate use of statistical analysis). DATA EXTRACTION AND SYNTHESIS The data extraction instrument from JBI-MAStARI was used. As statistical pooling of the data was not possible, the findings are presented in narrative form. RESULTS A total of 900 articles were identified as relevant for this review. Following abstract and full text screening, four articles were selected and assessed for methodological quality. One article met methodological criteria for inclusion in the review: use of random assignment and comparable study groups and measurement outcomes in a reliable and consistent manner. The included study was a cluster randomized controlled trial. Participants were emergency medicine residents with a mean age of 30 years. The study assessed the impact of a skills-based educational intervention on residents' attitudes, knowledge and practice towards patients with alcohol problems. While knowledge and practice behaviors improved one year following the intervention, there were no significant differences between groups on attitudinal measures. CONCLUSIONS Employing educational interventions to improve the attitudes of emergency department staff towards individuals with drug and alcohol related presentations is not supported by evidence.
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Affiliation(s)
- Miriam Gonzalez
- 1College of Nursing, Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada 2Manitoba Centre for Nursing and Health Research, University of Manitoba, Winnipeg, Canada 3Health Sciences Centre, Winnipeg, Canada 4College of Nursing, Red River College, Winnipeg, Canada 5Elizabeth Dafoe Library, University of Manitoba, Winnipeg, Canada
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Rica M, Principe A, Le Reste JY, Guillou Landreat M. [Substance related disorder in emergency services: Which attitudes?]. L'ENCEPHALE 2017; 43:10-14. [PMID: 26796557 DOI: 10.1016/j.encep.2015.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 05/04/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Substance related disorders are more prevalent in emergency services than in the general population, about 20% of individuals in emergency care test positive for alcohol. Emergency services are strategic places to identify alcohol misuse. Attitudes to individuals presenting substance related disorders are important in developing therapeutic relationships and applying interventions. OBJECTIVE This study explores the attitudes of an emergency staff to these individuals across a range of roles, and evolution in face of an addictology care improvement. METHOD Data were gathered from an emergency service sample from the emergency department of a general hospital in Morlaix (France). We used a short questionnaire, adapted from previous similar French studies. RESULTS Twenty-five persons answered the first questionnaire and 18 the second. A self-administrated attitudes questionnaire showed its interest in our study and helped us to identify attitudes and to initiate a reflection on behaviours in emergency care. Moreover, it helped to change attitudes towards individuals presenting substance related disorders. The daily setting of an addictive disorders specialized unit in emergency changed the point of view on addictive disorders of both physicians and nurses. We showed differences in addictive related disorders prevalence perception among patients attending emergency care between the two evaluations. But we also showed that physicians and nurses stressed that it was more difficult to ask patients in emergency care on the second evaluation, after and despite a daily addictive disorders specialized setting. We showed several limits in emergency staff care relationship with patients with substance related disorders. They identified difficulties to talk about addictive disorders, especially in younger and older patients. Regarding literature, we discuss our study limits and different ways of improving addictology care in emergency services.
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Affiliation(s)
- M Rica
- Faculté de médecine, 22, avenue Camille-Desmoulins, 29238 Brest, France
| | - A Principe
- Service des urgences, centre hospitalier de Morlaix, 15, rue Alexandre-Gilly, 29600 Morlaix, France
| | - J-Y Le Reste
- ERCR SPURBO, département de médecine générale, faculté de médecine, 22, avenue Camille-Desmoulins, 29238 Brest, France
| | - M Guillou Landreat
- ERCR SPURBO, département d'addictologie, faculté de médecine de Brest, CHRU de Brest, 22, avenue Camille-Desmoulins, 29238 Brest, France.
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Brereton R, Gerdtz M. Alcohol and Other Drug (AOD) Education for Hospital Staff: An Integrative Literature Review. Issues Ment Health Nurs 2017; 38:42-60. [PMID: 27960576 DOI: 10.1080/01612840.2016.1248876] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Alcohol and Other Drug (AOD) education amongst hospital staff is often inadequate. This leads to suboptimal care of patients and is a missed opportunity for early identification and treatment. This integrative review evaluates the core features of current education for hospital-based doctors and nurses in AOD, including country of origin, content, duration, and pedagogy. The majority of included studies were conducted in the USA (72%), target alcohol rather than AOD in general (72%), adopted a purely medical model of treatment (94%), and utilised a Screening, Brief Intervention, and Referral to Treatment (SBIRT) model (94%). The overall quality of the studies was weak-moderate, which led to small effect sizes in most studies and limits the generalizability of any conclusions. More high quality research trials are needed to establish the core features of effective AOD education for hospital staff. Future research should include a focus on the psychosocial context of addiction, other drug use and the impact of negative attitudes on care delivery.
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Affiliation(s)
| | - Marie Gerdtz
- b School of Nursing, University of Melbourne , Melbourne , Australia
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Trends in cannabis use disorders among racial/ethnic population groups in the United States. Drug Alcohol Depend 2016; 165:181-90. [PMID: 27317045 PMCID: PMC4939114 DOI: 10.1016/j.drugalcdep.2016.06.002] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Revised: 05/30/2016] [Accepted: 06/03/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND Minority groups generally experience more disparities than whites in behavioral healthcare use. The population of racial/ethnic groups is growing faster than whites. Given increased concerns of cannabis use (CU) and its associations with health conditions, we examined national trends in cannabis use disorder (CUD) among adults aged ≥18 by race/ethnicity. METHODS Data were from the 2005-2013 National Surveys on Drug Use and Health (N=340,456). We compared CU patterns and the conditional prevalence of CUD among cannabis users by race/ethnicity to understand racial/ethnic variations in CUD. RESULTS Approximately 1.5% of adults met criteria for a CUD in the past year. Regardless of survey year, cannabis dependence was more common than cannabis abuse, representing 66% of adults with a CUD. Across racial/ethnic groups, the prevalence of cannabis abuse and dependence remained stable during 2005-2013. In the total adult sample, the odds of weekly CU, monthly CU, and cannabis dependence were greater among blacks, native-Americans, and mixed-race adults than whites. Among cannabis users, the odds of cannabis abuse and dependence were greater among blacks, native-Americans, and Hispanics than whites. Logistic regression controlling for age, sex, education, and survey year indicated an increased trend in monthly CU and weekly CU in the total sample and among past-year cannabis users. Younger age, male sex, and low education were associated with increased odds of cannabis dependence. CONCLUSIONS The large sample provides robust information that indicates a need for research to monitor CUD and identify culturally appropriate interventions especially for targeting minority populations.
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Implementing Key Strategies for Successful Network Integration in the Quebec Substance-Use Disorders Programme. Int J Integr Care 2016; 16:7. [PMID: 27616951 PMCID: PMC5015544 DOI: 10.5334/ijic.2457] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Fragmentation and lack of coordination often occur among organisations offering treatment for individuals with substance-use disorders. Better integration from a system perspective within a network of organisations offering substance-use disorder services can be developed using various integration strategies at the administrative and clinical levels. This study aims to identify integration strategies implemented in Quebec substance-use disorder networks and to assess their strengths and limitations. METHODS A total of 105 stakeholders representing two regions and four local substance-use disorder networks participated in focus groups or individual interviews. Thematic qualitative and descriptive quantitative analyses were conducted. RESULTS Six types of service integration strategies have been implemented to varying degrees in substance-use disorder networks. They are: 1) coordination activities-governance, 2) primary-care consolidation models, 3) information and monitoring management tools, 4) service coordination strategies, 5) clinical evaluation tools and 6) training activities. CONCLUSION Important investments have been made in Quebec for the training and assessment of individuals with substance-use disorders, particularly in terms of support for emergency room liaison teams and the introduction of standardised clinical evaluation tools. However, the development of integration strategies was insufficient to ensure the implementation of successful networks. Planning, consolidation of primary care for substance-use disorders and systematic implementation of various clinical and administrative integration strategies are needed in order to ensure a better continuum of care for individuals with substance-use disorders.
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Evaluation of a brief intervention to reduce the negative consequences of drug misuse among adult emergency department patients. Drug Alcohol Depend 2015; 157:44-53. [PMID: 26482090 PMCID: PMC4663151 DOI: 10.1016/j.drugalcdep.2015.10.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 08/19/2015] [Accepted: 10/01/2015] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Determine if a brief intervention (BI) reduces the negative consequences of drug use/misuse among adult emergency department (ED) patients, and identify patients more likely to benefit from the BI. METHODS This randomized, controlled trial enrolled 1026 18-64 year-old ED patients whose drug misuse indicated a needed for a BI. Differences in total Inventory of Drug Use Consequences (InDUC) scores between the treatment (BI) and control arms (no BI) were assessed every 90 days over a one-year period. Regression models were constructed to identify demographic and clinical factors associated with greater reductions in total InDUC scores. RESULTS Although total InDUC scores decreased for both the treatment and control arms, there were no differences in scores between the treatment and the control arms at baseline at each follow-up. In the regression analyses, participants who were not using drugs or received drug treatment in the past 90 days generally had lower InDUC scores at each follow-up. CONCLUSIONS Although negative consequences decreased in both study arms over time, receiving a BI did not lead to a greater reduction in the negative consequences of drug misuse than not receiving a BI. Of importance in the design of future ED drug misuse interventions, participants who were successful in stopping their drug misuse or receiving drug treatment did show fewer negative consequences of drug use/misuse.
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Clarke DE, Gonzalez M, Pereira A, Boyce-Gaudreau K, Waldman C, Demczuk L. The impact of knowledge on attitudes of emergency department staff towards patients with substance related presentations: a quantitative systematic review protocol. ACTA ACUST UNITED AC 2015; 13:133-45. [DOI: 10.11124/jbisrir-2015-2203] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Merchant RC, Baird JR, Liu T. Short-term Efficacy of a Brief Intervention to Reduce Drug Misuse and Increase Drug Treatment Utilization Among Adult Emergency Department Patients. Acad Emerg Med 2015; 22:1172-80. [PMID: 26375468 DOI: 10.1111/acem.12767] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 05/11/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Although brief interventions (BIs) have shown some success for smoking cessation and alcohol misuse, it is not known if they can be applied in the emergency department (ED) to drug use and misuse. The objectives of this investigation were to assess the 3-month efficacy of a BI to reduce drug use and misuse, increase drug treatment services utilization among adult ED patients, and identify subgroups more likely to benefit from the BI. METHODS This randomized, controlled trial enrolled 18- to 64-year-old English- or Spanish-speaking patients from two urban, academic EDs whose responses to the Alcohol, Smoking, and Substance Involvement Screening Test indicated a need for a brief or intensive intervention. Treatment participants received a tailored BI, while control participants only completed the study questionnaires. At the 3-month follow-up, each participant's past 3-month drug use and misuse and treatment utilization were compared to his or her baseline enrollment data. Regression modeling was used to identify subgroups of patients (per demographic and clinical factors) more likely to stop or reduce their drug use or misuse or engage in drug treatment by the 3-month follow-up assessment. RESULTS Of the 1,030 participants, the median age was 30 years (interquartile range = 24 to 42 years), and 46% were female; 57% were white/non-Hispanic, 24.9% were black/non-Hispanic, and 15% were Hispanic. The most commonly misused drugs were marijuana, prescription opioids, cocaine/crack, and benzodiazepines. Although at follow-up the proportions of participants reporting any past 3-month drug misuse had decreased in both study arms (control 84% vs. treatment 78%), the decreases were similar between the two study arms (Δ-6.3%; 95% confidence interval [CI] = -13.0% to 0.0). In addition, at follow-up there were no differences between study arms in those who were currently receiving drug treatment (Δ1.8; 95% CI = -3.5 to 6.8), who had received treatment during the past 3 months (Δ-2.0; 95% CI = -6.5 to 2.4), or who at least contacted a treatment program (Δ 1.7; 95% CI = -2.4 to 6.1). Those whose baseline screening indicated the need for a brief instead of a more intensive intervention, and those currently engaged in drug treatment at the 3-month follow-up, were generally more likely to stop or decrease their drug use/misuse. CONCLUSIONS The BI employed in this study did not reduce drug use and misuse or increase treatment utilization more than the control condition over a 3-month period. Future research should help determine what role, if any, BIs should play in affecting drug use and misuse among ED patients.
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Affiliation(s)
- Roland C. Merchant
- Department of Emergency Medicine; Alpert Medical School; School of Public Health; Brown University; Providence RI
- Department of Epidemiology; School of Public Health; Brown University; Providence RI
| | - Janette R. Baird
- Department of Emergency Medicine; Alpert Medical School; School of Public Health; Brown University; Providence RI
| | - Tao Liu
- Department of Biostatistics; Center for Statistical Sciences; School of Public Health; Brown University; Providence RI
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Brady JE, DiMaggio CJ, Keyes KM, Doyle JJ, Richardson LD, Li G. Emergency department utilization and subsequent prescription drug overdose death. Ann Epidemiol 2015; 25:613-619.e2. [PMID: 25935710 PMCID: PMC4675463 DOI: 10.1016/j.annepidem.2015.03.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 03/15/2015] [Accepted: 03/26/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE Prescription drug overdose (PDO) deaths are a critical public health problem in the United States. This study aims to assess the association between emergency department (ED) utilization patterns in a cohort of ED patients and the risk of subsequent unintentional PDO mortality. METHODS Using data from the New York Statewide Planning and Research Cooperative System for 2006-2010, a nested case-control design was used to examine the relationship between ED utilization patterns in New York State residents of age 18-64 years and subsequent PDO death. RESULTS The study sample consisted of 2732 case patients who died of PDO and 2732 control ED patients who were selected through incidence density sampling. With adjustment for demographic characteristics, and diagnoses of pain, substance abuse, and psychiatric disorders, the estimated odds ratios of PDO death relative to one ED visit or less in the previous year were 4.90 (95% confidence interval [CI]: 4.50-5.34) for those with two ED visits, 16.61 (95% CI: 14.72-18.75) for those with three ED visits, and 48.24 (95% CI: 43.23-53.83) for those with four ED visits or more. CONCLUSIONS Frequency of ED visits is strongly associated with the risk of subsequent PDO death. Intervention programs targeting frequent ED users are warranted to reduce PDO mortality.
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Affiliation(s)
- Joanne E Brady
- Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, New York, NY; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Center for Injury Epidemiology and Prevention, Columbia University Medical Center, New York, NY.
| | - Charles J DiMaggio
- Department of Surgery, New York University School of Medicine, New York, NY
| | - Katherine M Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Center for Injury Epidemiology and Prevention, Columbia University Medical Center, New York, NY
| | - John J Doyle
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Lynne D Richardson
- Department of Emergency Medicine, Mount Sinai School of Medicine, New York, NY
| | - Guohua Li
- Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, New York, NY; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Center for Injury Epidemiology and Prevention, Columbia University Medical Center, New York, NY
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Constant A, Le Gruyer A, Le Lan C, Riou F, Moirand R. Postdetoxification Factors Predicting Alcohol-Related Emergency Room Visits 12 to 24 Months After Discharge: Results from a Prospective Study of Patients with Alcohol Dependence. Alcohol Clin Exp Res 2015; 39:1236-42. [PMID: 26033309 DOI: 10.1111/acer.12753] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 04/14/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Relapse is common in patients with alcohol dependence, even after detoxification. The aims of this prospective study were to investigate changes affecting patients during the first 6 months after discharge from hospitalization for detoxification and to determine the influence of these changes on the likelihood of alcohol-related emergency room (ER) visits in the following 18-month period. METHODS The study included 88 patients hospitalized for participation in a detoxification program in the addiction department of a university hospital in Rennes, France. Alcohol consumption, psychiatric symptoms, and life events were investigated by addiction specialists during hospitalization and 6 months afterward. For each patient, the number of alcohol-related ER visits in the last 6 months was prospectively recorded at the hospital 12, 18, and 24 months after hospitalization. The rate ratios of ER visits as a function of sociodemographic variables and changes observed 6 months after discharge were estimated using Poisson regression with autoregressive errors. RESULTS Nearly half of the patients (47.7%) had ER visits in the 12- to 24-month period following discharge. The likelihood of ER visits was higher for patients living with friends/parents and for those with aggravated psychiatric symptoms, negative changes in their family life, and who had a medical follow-up in the 6 months after discharge. In contrast, the likelihood of ER visits was lower for patients living with children and those with improved psychiatric morbidity. Alcohol consumption and psychiatric symptoms at baseline had no significant effect. CONCLUSIONS Monitoring changes in psychiatric symptoms and family life early after a detoxification program may help identify patients who are vulnerable to relapse in the subsequent 18-month period. Systematic screening for these changes as early as possible, in combination with appropriate treatment and the establishment of a social support system, could be fundamental in avoiding further relapses and ER visits.
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Affiliation(s)
| | - Antonia Le Gruyer
- CHU de Rennes, Unité d'Addictologie, Rennes, France.,Faculté de Médecine, Univ Rennes 1, Rennes, France
| | | | - Francoise Riou
- Faculté de Médecine, Univ Rennes 1, Rennes, France.,Department of Public Health, Rennes University Hospital, Rennes, France
| | - Romain Moirand
- CHU de Rennes, Unité d'Addictologie, Rennes, France.,Faculté de Médecine, Univ Rennes 1, Rennes, France.,INSERM UMR 991, Rennes, France
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