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Osman K, Rodgers J, Fordham M, Covington W, Hand DT, Ross-Davis K, Walter LA. Feasibility and assessment of a comprehensive emergency department-based intervention for patients at risk of HIV. PLoS One 2024; 19:e0310596. [PMID: 39325764 PMCID: PMC11426474 DOI: 10.1371/journal.pone.0310596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 09/03/2024] [Indexed: 09/28/2024] Open
Abstract
Behavioral factors increase the risk of contracting HIV. A comprehensive prevention services (CPS) intervention includes risk assessment and referral for those with confirmed risk. This project sought to assess the feasibility of an emergency department (ED)-based CPS program. A prospective cross-sectional assessment was conducted from October, 2021 through May, 2023, at a single ED in Birmingham, Alabama. Either of two screening methods were subjected to HIV negative adults: 1) manual chief complaint review or 2) objective electronic medical record (EMR) query. Manual and EMR screening methods considered sexually transmitted infections (STIs) or a positive urine drug test (to observe for commonly injectable drugs) within 12 months of current ED visit. Identified patients were approached in the ED (manual review) or via phone (EMR alert). Persons confirmed at risk for HIV following engagement questionnaire completion were made aware of their risk and offered referral to local CPS clinics. Primary outcome was CPS linkage. Descriptive analysis was performed. Of 184 patients approached, 147 agreed to engagement (79.9%), 117 in-person and 30 via phone; 125 (85.1%) were confirmed at risk for HIV; majority were white (66.4%), male (63.2%), between the ages of 30 and 49 (64.8%), uninsured (78.4%), and without a primary care provider (93.6%). Sexual behavior was identified as a recent (within six months) risk factor in 97 (77.6%) patients. Injection drug use was identified as a recent (within six months) risk factor in 71 (56.8%) patients. Fifty-four (43.2%) expressed interest in obtaining CPS follow-up. To-date, ten patients (18.5%) have connected with a CPS counsellor via phone and five (9.3%) have had a subsequent follow-up appointment to discuss CPS with a medical provider. Thirty at-risk patients (24.0%) received ED-initiated buprenorphine/naloxone. Targeted screening tools can aid in the identification of persons at risk for HIV in the ED; further, subsequent engagement and CPS implementation amongst this cohort is feasible. CPS clinic linkage may be challenging however, a CPS definition inclusive of ED-initiated medication for opioid use disorder, may offer opportunity for increased uptake.
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Affiliation(s)
- Khaldia Osman
- University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, United States of America
| | - Joel Rodgers
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Michael Fordham
- 1917 (HIV) Clinic, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Whitney Covington
- Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Delissa T Hand
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Kelly Ross-Davis
- 1917 (HIV) Clinic, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Lauren A Walter
- Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, AL, United States of America
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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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Hill PL, Stoové M, Agius PA, Maher L, Hickman M, Crawford S, Dietze P. Mortality in the SuperMIX cohort of people who inject drugs in Melbourne, Australia: a prospective observational study. Addiction 2022; 117:3091-3098. [PMID: 35712795 PMCID: PMC9796078 DOI: 10.1111/add.15975] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 05/19/2022] [Indexed: 12/30/2022]
Abstract
AIMS To measure mortality rates and factors associated with mortality risk among participants in the SuperMIX study, a prospective cohort study of people who inject drugs. DESIGN A prospective observational study using self-reported behavioural and linked mortality data. SETTING Melbourne, Australia. PARTICIPANTS/CASES A total of 1209 people who inject drugs (67% male) followed-up between 2008 and 2019 for 6913 person-years (PY). MEASUREMENTS We linked participant identifiers from SuperMIX to the Australian National Death Index and estimated all-cause and drug-related mortality rates and standardized mortality ratios (SMRs). We used Cox regression to examine associations between mortality and fixed and time-varying socio-demographic, alcohol and other drug use and health service-related exposures. FINDINGS Between 2008 and 2019 there were 76 deaths in the SuperMIX cohort. Of those with a known cause of death (n = 68), 35 (51%) were drug-related, yielding an all-cause mortality rate of 1.1 per 100 PY [95% confidence interval (CI) = 0.88-1.37] with an estimated SMR of 16.64 (95% CI = 13.29-20.83) and overall accidental drug-induced mortality rate of 0.5 per 100 PY (95% CI = 0.36-0.71). Reports of recent use of ambulance services [adjusted hazard ratio (aHR) = 3.77, 95% CI =1.78-7.97] and four or more incarcerations (aHR = 2.78, 95% CI = 1.55-4.99) were associated with increased mortality risk. CONCLUSIONS In Melbourne, Australia, mortality among people who inject drugs appears to be positively associated with recent ambulance attendance and experience of incarceration.
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Affiliation(s)
- Penelope L. Hill
- Behaviours and Health RisksBurnet InstituteMelbourneVICAustralia
- School of Public Health and Preventative MedicineMonash UniversityMelbourneVICAustralia
- The National Centre for Clinical Research on Emerging Drugs (NCCRED)SydneyNSWAustralia
- National Drug and Alcohol Research Centre (NDARC)The University of New South WalesSydneyNSWAustralia
| | - Mark Stoové
- Behaviours and Health RisksBurnet InstituteMelbourneVICAustralia
- School of Public Health and Preventative MedicineMonash UniversityMelbourneVICAustralia
| | - Paul A. Agius
- Behaviours and Health RisksBurnet InstituteMelbourneVICAustralia
- School of Public Health and Preventative MedicineMonash UniversityMelbourneVICAustralia
| | - Lisa Maher
- Behaviours and Health RisksBurnet InstituteMelbourneVICAustralia
- Faculty of MedicineKirby Institute for Infection and ImmunityUNSW SydneyNSWAustralia
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
| | | | - Paul Dietze
- Behaviours and Health RisksBurnet InstituteMelbourneVICAustralia
- School of Public Health and Preventative MedicineMonash UniversityMelbourneVICAustralia
- National Drug Research InstituteCurtin UniversityMelbourneVICAustralia
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Van Den Boom W, Quiroga MDM, O'Keefe D, Kumar D, Hill PL, Scott N, Agius PA, Higgs P, Kerr T, Maher L, Hickman M, Stoové M, Dietze P. Cohort Profile: The Melbourne Injecting Drug User Cohort Study (SuperMIX). Int J Epidemiol 2022; 51:e123-e130. [PMID: 34961882 DOI: 10.1093/ije/dyab231] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 10/19/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Maria Del Mar Quiroga
- Behaviours and Health Risks, Burnet Institute, Melbourne, VIC, Australia.,Melbourne Data Analytics Platform (MDAP), The University of Melbourne, Melbourne, Australia
| | - Daniel O'Keefe
- Behaviours and Health Risks, Burnet Institute, Melbourne, VIC, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Dhanya Kumar
- Behaviours and Health Risks, Burnet Institute, Melbourne, VIC, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Penelope L Hill
- Behaviours and Health Risks, Burnet Institute, Melbourne, VIC, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Nick Scott
- Behaviours and Health Risks, Burnet Institute, Melbourne, VIC, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Paul A Agius
- Behaviours and Health Risks, Burnet Institute, Melbourne, VIC, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.,Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
| | - Peter Higgs
- Behaviours and Health Risks, Burnet Institute, Melbourne, VIC, Australia.,Department of Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Thomas Kerr
- Division of Social Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Lisa Maher
- Behaviours and Health Risks, Burnet Institute, Melbourne, VIC, Australia.,Kirby Institute for Infection and Immunity, UNSW, Sydney, NSW, Australia
| | - Matthew Hickman
- Behaviours and Health Risks, Burnet Institute, Melbourne, VIC, Australia.,Population Health Sciences, University of Bristol, Bristol, UK
| | - Mark Stoové
- Behaviours and Health Risks, Burnet Institute, Melbourne, VIC, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Paul Dietze
- Behaviours and Health Risks, Burnet Institute, Melbourne, VIC, Australia.,National Drug Research Institute, Curtin University, Melbourne, VIC, Australia
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Anderson NC, Kesten JM, Ayres R, Hickman M, Amlôt R, Michie S, Lorencatto F. Acceptability of, and barriers and facilitators to, a pilot physical health service for people who inject drugs: A qualitative study with service users and providers. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 99:103437. [PMID: 34600415 DOI: 10.1016/j.drugpo.2021.103437] [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: 02/25/2021] [Revised: 07/27/2021] [Accepted: 08/25/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND People who inject drugs may experience difficulty accessing or maintaining involvement with traditional healthcare services. This is associated with increased health inequalities and bio-psychosocial difficulties. Embedding physical healthcare services within community-based drug services may provide a practical and feasible approach to increase access and delivery of healthcare. This study explored the acceptability of, and barriers and facilitators to, embedding a pilot physical healthcare service within a community-based drug service in the United Kingdom (Bristol, England). METHODS Semi-structured interviews were conducted with service users (people who inject drugs) (n = 13), and a focus group was conducted with service providers (n = 11: nine harm reduction workers, two nurses, one service manager). Topic guides included questions to explore barriers and facilitators to using and delivering the service (based on the COM-B Model), and acceptability of the service (using the Theoretical Framework of Acceptability). Transcripts were analysed using a combined deductive framework and inductive thematic analysis approach. RESULTS The service was viewed as highly acceptable. Service users and providers were confident they could access and provide the service respectively, and perceived it to be effective. Barriers included competing priorities of service users (e.g. drug use) and the wider service (e.g. equipment), and the potential impact of the service being removed in future was viewed as a barrier to overall healthcare access. Both service users and providers viewed embedding the physical health service within an existing community-based drug service as facilitating accessible and holistic care which reduced stigma and discrimination. CONCLUSIONS The current study demonstrated embedding a physical health service within an existing community-drug based and alcohol service was acceptable and beneficial. Future studies are required to demonstrate cost-effectiveness and ensure long-term sustainability, and to determine transferability of findings to other settings, organisations and countries.
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Affiliation(s)
- Niall C Anderson
- Centre for Behaviour Change, University College London, London, WC1E 7HB, UK; National Institute for Health Research (NIHR) Health Protection Research Unit in Behavioural Science and Evaluation, Bristol, BS8 2BN, UK.
| | - Joanna M Kesten
- National Institute for Health Research (NIHR) Health Protection Research Unit in Behavioural Science and Evaluation, Bristol, BS8 2BN, UK; Population Health Sciences, University of Bristol, BS8 1QU, UK; NIHR Applied Research Collaboration West (ARC West), Bristol, BS1 2NT, UK
| | | | - Matthew Hickman
- National Institute for Health Research (NIHR) Health Protection Research Unit in Behavioural Science and Evaluation, Bristol, BS8 2BN, UK; Population Health Sciences, University of Bristol, BS8 1QU, UK
| | - Richard Amlôt
- National Institute for Health Research (NIHR) Health Protection Research Unit in Behavioural Science and Evaluation, Bristol, BS8 2BN, UK; Health Protection Agency, Public Health England, Bristol, BS1 6EH, UK; Health Protection Research Unit in Emergency Preparedness and Response, Public Health England, Salisbury, SP4 0JG, UK
| | - Susan Michie
- Centre for Behaviour Change, University College London, London, WC1E 7HB, UK
| | - Fabiana Lorencatto
- Centre for Behaviour Change, University College London, London, WC1E 7HB, UK
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Cossar RD, Stewart AC, Wilkinson AL, Dietze P, Ogloff JRP, Aitken C, Butler T, Kinner SA, Curtis M, Walker S, Kirwan A, Stoové M. Emergency department presentations in the first weeks following release from prison among men with a history of injecting drug use in Victoria, Australia: A prospective cohort study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 101:103532. [PMID: 34871944 DOI: 10.1016/j.drugpo.2021.103532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 10/26/2021] [Accepted: 11/11/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Rates of emergency department (ED) use are higher among people released from prison than in the general population. However, little is known about ED presentations specifically among people with a history of injecting drug use (IDU) leaving prison. We measured the incidence of ED presentation in the three months following release from prison, among a cohort of men with histories of IDU, and determined pre-release characteristics associated with presenting to an ED during this period. METHODS We analysed linked survey and administrative data from the Prison and Transition Health (PATH) study (N = 400) using multiple-failure survival analysis. RESULTS Twenty-one percent (n = 81/393) of the cohort presented to an ED at least once within the three months after release from prison. The incidence of ED presentation was highest in the first six days after release. Cox proportional hazards modelling showed that a history of in-patient psychiatric admission and housing instability were associated with increased hazard of an ED presentation, and identifying as Aboriginal and Torres Strait Islander was associated with decreased hazard. CONCLUSIONS In our study, ED presentations following release from prison among people with a history of IDU was linked to acute health risks related to known mental health and social vulnerabilities in this population. Greater collaboration and systems integration between prison and community health and support services is needed to reduce presentations to ED and associated morbidities among people with a history of IDU after release from prison.
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Affiliation(s)
- Reece David Cossar
- Behaviours and Health Risks, Burnet Institute, Melbourne, VIC, Australia; Centre for Forensic Behavioural Science, Swinburne University of Technology and Forensicare, Melbourne, VIC, Australia.
| | - Ashleigh Cara Stewart
- Behaviours and Health Risks, Burnet Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Anna Lee Wilkinson
- Behaviours and Health Risks, Burnet Institute, Melbourne, VIC, Australia; Centre for Forensic Behavioural Science, Swinburne University of Technology and Forensicare, Melbourne, VIC, Australia
| | - Paul Dietze
- Behaviours and Health Risks, Burnet Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; National Drug Research Institute, Curtin University, Perth, Australia
| | - James R P Ogloff
- Centre for Forensic Behavioural Science, Swinburne University of Technology and Forensicare, Melbourne, VIC, Australia
| | - Campbell Aitken
- Behaviours and Health Risks, Burnet Institute, Melbourne, VIC, Australia
| | - Tony Butler
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Stuart A Kinner
- Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Justice Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia; Griffith Criminology Institute, Griffith University, Brisbane, QLD, Australia; Mater Research Institute-UQ, University of Queensland, Brisbane, QLD, Australia
| | - Michael Curtis
- Behaviours and Health Risks, Burnet Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Monash Addiction Research Centre, Monash University, Melbourne, VIC, Australia
| | - Shelley Walker
- Behaviours and Health Risks, Burnet Institute, Melbourne, VIC, Australia
| | - Amy Kirwan
- Behaviours and Health Risks, Burnet Institute, Melbourne, VIC, Australia
| | - Mark Stoové
- Behaviours and Health Risks, Burnet Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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Walter LA, Li L, Rodgers JB, Hess JJ, Skains RM, Delaney MC, Booth J, Hess EP. Development of an Emergency Department-Based Intervention to Expand Access to Medications for Opioid Use Disorder in a Medicaid Nonexpansion Setting: Protocol for Engagement and Community Collaboration. JMIR Res Protoc 2021; 10:e18734. [PMID: 33913818 PMCID: PMC8120420 DOI: 10.2196/18734] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 10/07/2020] [Accepted: 11/03/2020] [Indexed: 12/28/2022] Open
Abstract
Background The opioid epidemic has disproportionately impacted areas in the Appalachian region of the United States. Characterized by persistent Medicaid nonexpansion, higher poverty rates, and health care access challenges, populations residing in these areas of the United States have experienced higher opioid overdose death rates than those in other parts of the country. Jefferson County, Alabama, located in Southern Appalachia, has been especially affected, with overdose rates over 2 times greater than the statewide average (48.8 vs 19.9 overdoses per 10,000 persons). Emergency departments (EDs) have been recognized as a major health care source for persons with opioid use disorder (OUD). A program to initiate medications for OUD in the ED has been shown to be effective in treatment retention. Likewise, continued patient engagement in a recovery or treatment program after ED discharge has been shown to be efficient for long-term treatment success. Objective This protocol outlines a framework for ED-initiated medications for OUD in a resource-limited region of the United States; the study will be made possible through community partnerships with referral resources for definitive OUD care. Methods When a patient presents to the ED with symptoms of opioid withdrawal, nonfatal opioid overdose, or requesting opioid detoxification, clinicians will consider the diagnosis of OUD using the Diagnostic and Statistical Manual of Mental Disorders (fifth edition) criteria. All patients meeting the diagnostic criteria for moderate to severe OUD will be further engaged and assessed for study eligibility. Recruited subjects will be evaluated for signs and symptoms of withdrawal, treated with buprenorphine-naloxone as appropriate, and given a prescription for take-home induction along with an intranasal naloxone kit. At the time of ED discharge, a peer navigator from a local substance use coordinating center will be engaged to facilitate patient referral to a regional substance abuse coordinating center for longitudinal addiction treatment. Results This project is currently ongoing; it received funding in February 2019 and was approved by the institutional review board of the University of Alabama at Birmingham in June 2019. Data collection began on July 7, 2019, with a projected end date in February 2022. In total, 79 subjects have been enrolled to date. Results will be published in the summer of 2022. Conclusions ED recognition of OUD accompanied by buprenorphine-naloxone induction and referral for subsequent long-term treatment engagement have been shown to be components of an effective strategy for addressing the ongoing opioid crisis. Establishing community and local partnerships, particularly in resource-limited areas, is crucial for the continuity of addiction care and rehabilitation outcomes. International Registered Report Identifier (IRRID) DERR1-10.2196/18734
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Affiliation(s)
- Lauren A Walter
- Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Li Li
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Joel B Rodgers
- Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Jennifer J Hess
- Department of Emergency Medicine, Vanderbilt University, Nashville, TN, United States
| | - Rachel M Skains
- Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Matthew C Delaney
- Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - James Booth
- Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Erik P Hess
- Department of Emergency Medicine, Vanderbilt University, Nashville, TN, United States
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David M, Richter R, Naghavi B, Borde T, Razum O, Somasundaram R, Stein H, Sehouli J. [Use of emergency rooms by so-called multiple users: results of a prospective study with special consideration of the migration status]. Notf Rett Med 2021; 25:252-259. [PMID: 33649703 PMCID: PMC7904028 DOI: 10.1007/s10049-021-00851-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2021] [Indexed: 11/24/2022]
Abstract
Fragestellung Welche prädiktiven Faktoren lassen sich für die Gruppe der sog. Mehrfachnutzer (MFN; 4 und mehr Inanspruchnahmen einer Notaufnahme [NA] in den letzten 12 Monaten) finden? Sind Personen mit Migrationshintergrund häufiger in die Gruppe der MFN einzuordnen? Methodik Konsekutive Patienten, die von Juli 2017 bis Juli 2018 drei Klinik-NA in Berlin aufsuchten. Mittels Fragebogen Erfassung von Erkrankungen, Gründen für den NA-Besuch und sozioökonomischen Faktoren. Die Unterschiede zwischen Migranten (1. Generation), ihren Nachkommen (2. Generation) und Nichtmigranten wurden mithilfe der logistischen Regression bewertet. Ergebnisse 2339 Patienten konnten in die Auswertung einbezogen werden (Rücklaufrate 56 %), davon hatten 901 einen Migrationshintergrund. Bei jungen Frauen (<30 Jahre), chronisch Kranken, Schwangeren, Patientinnen und Patienten mit starken Beschwerden und Personen mit (selbsteingeschätzter) mittlerer und schlechter „Gesundheitsqualität“ sowie solchen ohne ärztliche Zuweisung war die Chance für eine Mehrfachnutzung der NA größer. Schlussfolgerung MFN belasten das ohnehin zunehmende Patientenvolumen von NA. Sie stellen jedoch eine heterogene Patientengruppe dar, unter der Menschen mit Migrationshintergrund nicht häufiger vertreten sind. Weitere Untersuchungen sind erforderlich, um die Faktoren, die zu einer häufigen Inanspruchnahme führen, besser zu verstehen und wirksame Strategien zu entwickeln, um den komplexen Gesundheitsbedürfnissen von MFN gerecht zu werden.
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Affiliation(s)
- Matthias David
- Campus Virchow-Klinikum, Klinik für Gynäkologie mit Zentrum für onkologische Chirurgie, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Deutschland
| | - Rolf Richter
- Campus Virchow-Klinikum, Klinik für Gynäkologie mit Zentrum für onkologische Chirurgie, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Deutschland
| | - Baharan Naghavi
- Charité Comprehensive Cancer Center, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Theda Borde
- Alice Salomon-Hochschule Berlin, Berlin, Deutschland
| | - Oliver Razum
- Fakultät für Gesundheitswissenschaften, AG 3: Epidemiologie und International Public Health, Universität Bielefeld, Bielefeld, Deutschland
| | - Rajan Somasundaram
- Zentrale Notaufnahme, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Hendrike Stein
- Rettungsstelle, Vivantes Klinikum Berlin-Neukölln, Berlin, Deutschland
| | - Jalid Sehouli
- Campus Virchow-Klinikum, Klinik für Gynäkologie mit Zentrum für onkologische Chirurgie, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Deutschland
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Lewer D, Freer J, King E, Larney S, Degenhardt L, Tweed EJ, Hope VD, Harris M, Millar T, Hayward A, Ciccarone D, Morley KI. Frequency of health-care utilization by adults who use illicit drugs: a systematic review and meta-analysis. Addiction 2020; 115:1011-1023. [PMID: 31705770 PMCID: PMC7210080 DOI: 10.1111/add.14892] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 06/04/2019] [Accepted: 11/04/2019] [Indexed: 11/26/2022]
Abstract
AIMS To summarize evidence on the frequency and predictors of health-care utilization among people who use illicit drugs. DESIGN Systematic search of MEDLINE, EMBASE and PsychINFO for observational studies reporting health-care utilization published between 1 January 2000 and 3 December 2018. We conducted narrative synthesis and meta-analysis following a registered protocol (identifier: CRD42017076525). SETTING AND PARTICIPANTS People who use heroin, powder cocaine, crack cocaine, methamphetamine, amphetamine, ecstasy/3,4-methylenedioxymethamphetamine (MDMA), cannabis, hallucinogens or novel psychoactive substances; have a diagnosis of 'substance use disorder'; or use drug treatment services. MEASUREMENTS Primary outcomes were the cumulative incidence (risk) and rate of care episodes in three settings: primary care, hospital admissions (in-patient) and emergency department (ED). FINDINGS Ninety-two studies were included, 84% from North America and Australia. Most studies focused on people using heroin, methamphetamine or crack cocaine, or who had a diagnosis of drug dependence. We were able to conduct a meta-analysis of rates across 25 studies reporting ED episodes and 25 reporting hospital admissions, finding pooled rates of 151 [95% confidence interval (CI) = 114-201] and 41 (95% CI = 30-57) per 100 person-years, respectively; on average 4.8 and 7.1 times more often than the general population. Heterogeneity was very high and was not explained by drugs used, country of study, recruitment setting or demographic characteristics. Predictors of health-care utilization were consistent across studies and included unstable housing, drug injection and mental health problems. Opioid substitution therapy was consistently associated with reduced ED presentation and hospital admission. There was minimal research on health-care utilization by people using ecstasy/MDMA, powder cocaine, hallucinogens or novel psychoactive substances. CONCLUSIONS People who use illicit drugs are admitted to emergency department or hospital several times more often than the general population.
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Affiliation(s)
- Dan Lewer
- UCL Collaborative Centre for Inclusion HealthInstitute of Epidemiology and Health Care UCLLondonUK
- National Addictions Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
| | - Joseph Freer
- Centre for Primary Care and Public HealthQueen Mary University of LondonLondonUK
| | - Emma King
- UCL Collaborative Centre for Inclusion HealthInstitute of Epidemiology and Health Care UCLLondonUK
| | - Sarah Larney
- National Drug and Alcohol Research Centre (NDARC)University of New South WalesRandwick,NSWAustralia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre (NDARC)University of New South WalesRandwick,NSWAustralia
| | - Emily J. Tweed
- MRC/CSO Social and Public Health Sciences UnitUniversity of GlasgowGlasgowUK
| | - Vivian D. Hope
- Public Health InstituteLiverpool John Moores UniversityLiverpoolUK
| | - Magdalena Harris
- Department of Public Health, Environments and SocietyLondon School of Hygiene and Tropical Medicine, LondonUK
| | - Tim Millar
- Centre for Mental Health and SafetyThe University of ManchesterManchesterUK
| | - Andrew Hayward
- UCL Collaborative Centre for Inclusion HealthInstitute of Epidemiology and Health Care UCLLondonUK
| | - Dan Ciccarone
- Department of Family and Community MedicineUniversity of CaliforniaSan FranciscoCAUSA
| | - Katherine I. Morley
- National Addictions Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
- Centre for Epidemiology and Biostatistics, Melbourne School of Global and Population HealthThe University of MelbourneMelbourneAustralia
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Jones NR, Shanahan M, Dobbins T, Degenhardt L, Montebello M, Gisev N, Larney S. Reductions in emergency department presentations associated with opioid agonist treatment vary by geographic location: A retrospective study in New South Wales, Australia. Drug Alcohol Rev 2020; 38:690-698. [PMID: 31577058 DOI: 10.1111/dar.12976] [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: 04/02/2019] [Revised: 07/19/2019] [Accepted: 07/22/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND AIMS It is not known if the reduction in ED use during periods of OAT occurs across urgent and low acuity presentations. We aimed to compare the incidence and costs of urgent and low acuity ED presentations of people with opioid use disorder (OUD) in and out of opioid agonist treatment (OAT). DESIGN AND METHODS This was a retrospective cohort study (N=24,875), using linked administrative health data from New South Wales (NSW), Australia. Urgent and low acuity ED incidence and associated costs were calculated for periods in and out of OAT. GEE models estimated the adjusted incidence rate ratio (IRR) for ED presentations. Average costs per person-day were calculated with bootstrap confidence intervals. RESULTS Incidence of urgent presentations was lower in OAT compared to out of OAT [IRR (95%CI): 0.65 (0.61-0.69)]. In major cities, low acuity presentations were lower during OAT compared to timeout of OAT [IRR (95%CI): 0.82 (0.70-0.96)], in regional/remote areas, low acuity presentations were higher during OAT [IRR (95%CI): 2.65 (1.66-4.21)]. In major cities, average costs for low acuity presentations in OAT were 28% lower atA$0.50 (95%CI: A$0.48-A$0.52) and A$0.69 (95%CI: A$0.66-A$0.71) out of OAT, but 103% higher in regional/remote NSW, at A$2.12 (95%CI: A$1.91-A$2.34) in OAT and A$1.04 (95%CI: A$0.91-A$1.16) out of OAT. DISCUSSION AND CONCLUSIONS OAT was associated with reductions in urgent ED presentations and associated costs among people with OUD. Geographical variation was evident for low acuity ED presentations, highlighting the need to increase access to OAT in regional/remote areas.
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Affiliation(s)
- Nicola R Jones
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Marian Shanahan
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Timothy Dobbins
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Mark Montebello
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.,Northern Sydney Local Health District, Sydney, Australia
| | - Natasa Gisev
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Sarah Larney
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
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11
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Field H, Hudson B, Hewett N, Khan Z. Secondary care usage and characteristics of hospital inpatients referred to a UK homeless health team: a retrospective service evaluation. BMC Health Serv Res 2019; 19:857. [PMID: 31752857 PMCID: PMC6868755 DOI: 10.1186/s12913-019-4620-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 10/03/2019] [Indexed: 11/16/2022] Open
Abstract
Background UK “Pathway” teams offer specialist hospital care coordination for people experiencing homelessness. Emergency healthcare use is high among homeless people, yet “homelessness” is not routinely coded in National Health Service (NHS) data. Pathway team records provide an opportunity to assess patterns in admissions and outcomes for inpatients identified as homeless. Methods Retrospective analysis of patients referred to “Pathway” homelessness teams in seven UK hospitals to explore the patterns of hospital admission, morbidity, secondary healthcare utilisation and housing status. Each patient was individually identified as experiencing homelessness. Within a six-month period, demographic data, reason for admission, morbidity, mortality and secondary care hospital usage 120-days before and 120-days after the index admission was collected. Results A total of 1009 patients were referred, resulting in 1135 admissions. Most admissions had an acute physical health need (94.9%). Co-morbid mental illness and/or substance misuse was common (55.7%). Reasons for admission included mental and behavioral disorders (overdose, alcohol withdrawal or depression, 28.3%), external causes of morbidity and mortality (assault or trauma, 18.7%), and injury, poisoning and external causes (head injury, falls and fractures, 12.4%). Unplanned Emergency Department attendances reduced after index admission and unplanned hospital admissions increased slightly. Planned admissions doubled and total bed days increased. Housing status was maintained or improved for over 60% of inpatients upon discharge. Within 12 months of index admission, 50 patients (5%) died, 15 deaths (30%) occurred during the index admission. Conclusions Disengagement with health services is common among homeless people. Many deaths are due to treatable medical conditions (heart disease, pneumonia, cancer). Observed increases in planned admissions suggests intervention from Pathway teams facilitates necessary investigations and treatment for homeless people. Equity, parity of care, and value should be inbuilt interventions for inclusion health groups and evaluations need to move beyond simply seeking cost reductions.
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Affiliation(s)
- Hannah Field
- Royal Surrey County Hospital, Egerton Road, Guildford, GU2 7XX, UK. .,Pathway, 250 Euston Road, London, NW1 2PG, UK.
| | - Briony Hudson
- Pathway, 250 Euston Road, London, NW1 2PG, UK.,Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, 6th Floor Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | | | - Zana Khan
- Pathway, 250 Euston Road, London, NW1 2PG, UK.,UCL Collaborative centre for inclusion health, Department of Primary Care and Population Health, University College London, London, UK
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12
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Chiu Y, Racine-Hemmings F, Dufour I, Vanasse A, Chouinard MC, Bisson M, Hudon C. Statistical tools used for analyses of frequent users of emergency department: a scoping review. BMJ Open 2019; 9:e027750. [PMID: 31129592 PMCID: PMC6537981 DOI: 10.1136/bmjopen-2018-027750] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Frequent users represent a small proportion of emergency department users, but they account for a disproportionately large number of visits. Their use of emergency departments is often considered suboptimal. It would be more efficient to identify and treat those patients earlier in their health problem trajectory. It is therefore essential to describe their characteristics and to predict their emergency department use. In order to do so, adequate statistical tools are needed. The objective of this study was to determine the statistical tools used in identifying variables associated with frequent use or predicting the risk of becoming a frequent user. METHODS We performed a scoping review following an established 5-stage methodological framework. We searched PubMed, Scopus and CINAHL databases in February 2019 using search strategies defined with the help of an information specialist. Out of 4534 potential abstracts, we selected 114 articles based on defined criteria and presented in a content analysis. RESULTS We identified four classes of statistical tools. Regression models were found to be the most common practice, followed by hypothesis testing. The logistic regression was found to be the most used statistical tool, followed by χ2 test and t-test of associations between variables. Other tools were marginally used. CONCLUSIONS This scoping review lists common statistical tools used for analysing frequent users in emergency departments. It highlights the fact that some are well established while others are much less so. More research is needed to apply appropriate techniques to health data or to diversify statistical point of views.
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Affiliation(s)
- Yohann Chiu
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - François Racine-Hemmings
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Isabelle Dufour
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Alain Vanasse
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | | | - Mathieu Bisson
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Catherine Hudon
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
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13
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Liang SY, Lulla A. Commentary. Ann Emerg Med 2019; 70:578-579. [PMID: 28946977 DOI: 10.1016/j.annemergmed.2017.07.480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Stephen Y Liang
- Division of Emergency Medicine, Washington University School of Medicine, St. Louis, MO; Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO
| | - Al Lulla
- Division of Emergency Medicine, Washington University School of Medicine, St. Louis, MO
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14
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Di Rico R, Nambiar D, Stoové M, Dietze P. Drug overdose in the ED: a record linkage study examining emergency department ICD-10 coding practices in a cohort of people who inject drugs. BMC Health Serv Res 2018; 18:945. [PMID: 30518362 PMCID: PMC6282274 DOI: 10.1186/s12913-018-3756-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 11/22/2018] [Indexed: 11/12/2022] Open
Abstract
Background Drug overdose is a leading cause of mortality and morbidity amongst people who inject drugs (PWID). Drug overdose surveillance typically relies on the International Classification of Diseases (ICD-10) coding system, however its real world utilisation and the implications for surveillance have not been well characterised. This study examines the patterns of ICD-10 coding pertaining to drug overdoses within emergency departments for a cohort of known PWID. Methods Cohort data from 688 PWID was linked to statewide emergency department administrative data between January 2008 and June 2013. ICD-10 diagnostic codes pertaining to poisonings by drugs, medicaments and biological substances (T-codes T36-T50) as well as mental and behavioural disorders due to psychoactive substance use (F-codes F10-F19) were examined. Results There were 449 unique ED presentations with T or F code mentions contributed by 168 individuals. Nearly half of the T and F codes used were non-specific and did not identify either a drug class (n = 160, 36%) or clinical reaction (n = 46, 10%) and 8% represented withdrawal states. T and F codes could therefore be used to reasonably infer an illicit drug overdose in only 42% (n = 188) of cases. Majority of presentations with T or F overdose codes recorded only one diagnostic code per encounter (83%) and representing multiple-drug overdose (F19.- = 18%) or unidentified substances (T50.9 = 17%) using a single, broad diagnostic code was common. Conclusions Reliance on diagnoses alone when examining ED data will likely significantly underestimate incidence of specific drug overdose due to frequent use of non-specific ICD-10 codes and the use of single diagnostic codes to represent polysubstance overdose. Measures to improve coding specificity should be considered and further work is needed to determine the best way to use ED data in overdose surveillance.
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Affiliation(s)
- Rehana Di Rico
- Centre For Population Health, Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia.
| | - Dhanya Nambiar
- Centre For Population Health, Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia.,Department of Epidemiology & Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, 3004, VIC, Australia
| | - Mark Stoové
- Centre For Population Health, Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia.,Department of Epidemiology & Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, 3004, VIC, Australia
| | - Paul Dietze
- Centre For Population Health, Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia.,Department of Epidemiology & Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, 3004, VIC, Australia
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15
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Wollina U, Lotti T, Tchernev G. Acute Forefoot Phlegmon - A Complication of Intravenous Heroin-Addiction. Open Access Maced J Med Sci 2018; 6:85-86. [PMID: 29483992 PMCID: PMC5816326 DOI: 10.3889/oamjms.2018.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 11/25/2017] [Accepted: 11/26/2017] [Indexed: 11/25/2022] Open
Abstract
Infections of the skin and soft tissues (SSTI) are clinical entities with variable presentations, causes, and levels of clinical severity. They are frequent in emergency departments. The most common pathogen in the Western World is Staphylococcus aureus. SSTI may provide a hint to underlying pathologies such as diabetes and other states of immune compromise. Here we present a 41-year-old non-diabetic male patient with pain and swelling of the left forefoot but not any recent trauma. Microbiology identified streptococci. The medical history was positive for intravenous heroin abuse. The diagnosis of forefoot phlegm due to drug addition was confirmed. Treatment was realised by a combination of intravenous antibiosis and drainage. Intravenous drug addiction is a significant risk factor for SSTI.
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Affiliation(s)
- Uwe Wollina
- Stadtisches Klinikum Dresden - Department of Dermatology and Allergology, Dresden, Sachsen, Germany
| | - Torello Lotti
- University G. Marconi of Rome - Dermatology and Venereology, Rome, Italy
| | - Georgi Tchernev
- Department of Dermatology, Venereology and Dermatologic Surgery, Medical Institute of Ministry of Interior, Sofia, Bulgaria.,Onkoderma, Policlinic for Dermatology and Dermatologic Surgery, Sofia, Bulgaria
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