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Dacosta-Sánchez D, Fernández-Calderón F, Díaz-Batanero C, Mancheño-Velasco C, Lozano ÓM. Modeling the Therapeutic Process of Patients with Cocaine Use Disorders: A Guide for Predicting Readmission. Eur Addict Res 2024; 30:80-93. [PMID: 38437822 DOI: 10.1159/000535689] [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: 07/14/2023] [Accepted: 11/29/2023] [Indexed: 03/06/2024]
Abstract
INTRODUCTION Patients with cocaine use disorders have very high readmission rates. Our aim was to model the relationships between attributes of patients with cocaine use disorder at the beginning of treatment, therapeutic process indicators of time in treatment or proportion of appointments attended, and treatment outcomes, including outcomes at discharge and non-readmissions posttreatment as indicators of therapeutic success. METHOD A retrospective observational design was used with 10,298 cocaine use disorder patients. Electronic health records were used for statistical analysis of the data. Randomized subsample 1 (n = 5,150) was used for exploratory analysis and subsample 2 (n = 5,148) for modeling relationships between the variables. RESULTS Patients attributes at intake (e.g., legal services as the source of referral) were of limited significance in explaining time in treatment, proportion of appointments attended, and treatment outcomes. Time in treatment and proportion of appointments attended emerged as significant factors in explaining outcomes at discharge. However, readmissions were primarily explained by time in treatment and outcomes at discharge, although referrals to addiction centers by health services also appeared to be relevant for explaining readmission. DISCUSSION/CONCLUSION Our study has shown that maintaining a sufficient appointment attendance rate and remaining in treatment for a longer duration are critical therapeutic process indicators for explaining outcomes at the point of discharge and therapeutic success, as indicated by a reduced likelihood of readmissions. Patients who remained in treatment for an extended period were found to have a reduced risk of future readmissions. In addition, our study highlights the importance of maintaining a satisfactory appointment attendance rate to attain successful short- and medium-term therapeutic discharge outcomes. These guidelines could help to increase the efficiency of patient treatment and alleviate the suffering of both patients and their families.
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Affiliation(s)
| | - Fermín Fernández-Calderón
- Department of Clinical and Experimental Psychology, University of Huelva, Huelva, Spain
- Research Center on Natural Resources, Health and the Environment, University of Huelva, Huelva, Spain
| | - Carmen Díaz-Batanero
- Department of Clinical and Experimental Psychology, University of Huelva, Huelva, Spain
- Research Center on Natural Resources, Health and the Environment, University of Huelva, Huelva, Spain
| | | | - Óscar M Lozano
- Department of Clinical and Experimental Psychology, University of Huelva, Huelva, Spain
- Research Center on Natural Resources, Health and the Environment, University of Huelva, Huelva, Spain
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Martin LJ, Bawor M, Bains S, Burns J, Khoshroo S, Massey M, DeJesus J, Lennox R, Cook-Chaimowitz L, O'Shea T, MacKillop J, Dennis BB. Clinical characteristics and prognostic factors among hospitalized patients with substance use disorders: Findings from a retrospective cohort study of a Canadian inpatient addiction medicine service. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 157:209210. [PMID: 37931685 DOI: 10.1016/j.josat.2023.209210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 05/19/2023] [Accepted: 10/24/2023] [Indexed: 11/08/2023]
Abstract
INTRODUCTION Inpatient addiction medicine services (AMS) were developed in response to the growing needs of hospitalized individuals with substance use disorders (SUDs). AMS aim to enable timely initiation of pharmacologic treatment, build hospital capacity to support patients who use substances, and facilitate transition to community services. As an emerging service being adopted in hospitals across North America, the model of care, populations served, substance use trends, and clinical trajectory has not been widely described. This work aims to characterize patients accessing care through the AMS, establishing predictors for clinical trajectories in hospital including patient-initiated discharge (PID) and hospital re-admission. METHODS Using a retrospective cohort design, we describe all patients seen by the AMS between 2018 and 2022 across four hospitals in Hamilton, Ontario. Patients seen by AMS were hospitalized and qualified for a SUD based on DSM-V criteria. The study used descriptive statistics to describe the cohort, where appropriate adjusted time-to-event survival models were constructed to identify predictors for hospital re-admission. RESULTS Patients seen by the AMS (n = 695) frequently lacked access to primary care (47.0 %) and less than half (44.3 %) were receiving community addiction services on admission. The majority met criteria for opioid use disorder (OUD), with injecting being the primary consumption route (54.8 %). Patients exhibited high acuity, with 34.2 % requiring critical care measures. Provision of OAT substantially increased to 77.9 % of patients (29 % on admission). PID occurred in 17.8 % of patients and was significantly associated with an admitting diagnosis of suicidal ideation, infection, heart failure, and distinct substance use profiles including methamphetamine, fentanyl, and heroin use (p < 0.05). PID conferred a 66 % increased risk for re-admission (Hazard-Ratio: 1.66; 95 % CI: 1.08, 2.54; p = 0.02). CONCLUSION Patients served by AMS primarily include individuals with OUD presenting with the associated medical complications and substantial deficits in the social determinants of health (e.g., high housing insecurity, poverty, and disability). PID occurs among 1 in 5 people and is associated with higher rates of re-admission. By identifying individuals at higher risk of adverse outcomes, these results provide an opportunity to improve outcomes in this high-risk, high-vulnerability population.
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Affiliation(s)
- Leslie J Martin
- Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON L8S4L8, Canada.
| | - Monica Bawor
- Department of Medicine, Imperial College Healthcare NHS Trust, Fulham Palace Road, London, UK, W68RF.
| | - Supriya Bains
- Department of Psychology, Neuroscience, and Behaviour, McMaster University, Hamilton, ON L8S4L8, Canada.
| | - Jacinda Burns
- Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton, Hamilton, ON L8S4L8, Canada.
| | - Saba Khoshroo
- Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton, Hamilton, ON L8S4L8, Canada.
| | - Myra Massey
- Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton, Hamilton, ON L8S4L8, Canada.
| | - Jane DeJesus
- Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton, Hamilton, ON L8S4L8, Canada.
| | - Robin Lennox
- Department of Family Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON L8S4L8, Canada.
| | - Lauren Cook-Chaimowitz
- Department of Emergency Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON L8S4L8, Canada.
| | - Tim O'Shea
- Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON L8S4L8, Canada.
| | - James MacKillop
- Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton, Hamilton, ON L8S4L8, Canada; Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON L8S4L8, Canada.
| | - Brittany B Dennis
- Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON L8S4L8, Canada; British Columbia Centre on Substance Use, Vancouver, BC V6Z2A9, Canada.
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Running Bear U, Hanson JD, Noonan C, Muller C, Trojan J, Manson SM. Factors associated with readmission to alcohol and opioid detoxification in the Alaska Interior. Am J Addict 2022; 31:406-414. [PMID: 35434885 PMCID: PMC9463080 DOI: 10.1111/ajad.13288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 02/16/2022] [Accepted: 03/28/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND OBJECTIVES A "revolving door" of repeated admissions to detoxification treatment facilities has long plagued alcohol and drug use patients, yet few studies examine factors associated with readmission. This study examined risk factors for readmission to alcohol and opioid detoxification in a sample from the Alaska Interior. METHODS Data were extracted from electronic medical records for admissions between 2012 and 2016 at an inpatient detoxification facility in Fairbanks, Alaska. Data from 1014 patients admitted for alcohol detoxification and 267 patients admitted for opioid detoxification were analyzed. The analysis employed descriptive statistics for risk factors (substance use history, adverse life experiences, and psychosocial functioning) and prevalence of readmission to either alcohol or opioid detoxification. Inferential analyses used marginal standardization to calculate differences in readmission risk by patient characteristics. RESULTS Male, Alaska Native/American Indian, single-never married patients, and those seeking work were at higher risk for readmission to alcohol detoxification, while those with stable housing were at reduced risk. Being single-never married and completing detoxification treatment reduced readmission to opioid detoxification. Family involvement in detoxification reduced readmission risk for both alcohol and opioid patients. DISCUSSION AND CONCLUSIONS Further research that investigates the mechanism(s) by which family may act as a protective factor may be efficacious in eliminating the "revolving door" of detoxification. SCIENTIFIC SIGNIFICANCE This study is the first to examine both alcohol and opioid use risk and protective factors in the Alaska Interior. The results can be used in the development of interventions for subpopulations with high detoxification readmission rates.
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Affiliation(s)
- Ursula Running Bear
- Department of Population HealthUniversity of North DakotaGrand ForksNorth DakotaUSA
| | - Jessica D. Hanson
- Department of Applied Human SciencesUniversity of Minnesota DuluthDuluthMinnesotaUSA
| | - Carolyn Noonan
- Institute for Research and Education to Address Community HealthWashington State UniversitySeattleWashingtonUSA
| | - Clemma Muller
- Department of Medical Education and Clinical Science, Elson S. Floyd College of Medicine, Institute for Research and Education to Address Community HealthWashington State UniversitySeattleWashingtonUSA
| | | | - Spero M. Manson
- Centers for American Indian and Alaska Native Health, Colorado School of Public HealthUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
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Armoon B, Higgs P, Mohammadi R. Mental health status, health service utilization, drug use behaviors associated with non-fatal overdose among people who use illicit drugs: A meta-analysis. JOURNAL OF SUBSTANCE USE 2021. [DOI: 10.1080/14659891.2021.2019331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Bahram Armoon
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Peter Higgs
- Department of Public Health, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Rasool Mohammadi
- Department of Biostatistics and Epidemiology, School of Public Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran
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Armoon B, Bayani A, Griffiths MD, Bayat AH, Mohammadi R, Fattah Moghaddam L, Ahounbar E. Prevalence and high-risk behaviors associated with non-fatal overdose among people who use illicit opioids: A systematic review and meta-analysis. JOURNAL OF SUBSTANCE USE 2021. [DOI: 10.1080/14659891.2021.1978112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Bahram Armoon
- Research Center, Douglas Mental Health University Institute, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, Qc, Canada
| | - Azadeh Bayani
- Student Research Committee, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mark D. Griffiths
- International Gaming Research Unit, Psychology Department, Nottingham Trent University, Nottingham, UK
| | - Amir-Hossein Bayat
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
| | - Rasool Mohammadi
- Department of Biostatistics and Epidemiology, School of Public Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Ladan Fattah Moghaddam
- Department of Nursing, Faculty of Nursing and Midwifery, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Elahe Ahounbar
- Substance Abuse and Dependence Research Center, The University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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