Interventions to Reduce Hospital and Emergency Department Utilization Among People With Alcohol and Substance Use Disorders: A Scoping Review

Emergency care utilization in persons with substance related diagnoses

Background

Substance use is a significant contributor to emergency department (ED) visits. Little is known about ED utilization patterns of individuals with substance related diagnosis (SRD). We used electronic health records (EHR) from a large healthcare system in California to examine ED healthcare utilization and socio-demographic characteristics of individuals with SRDs.

Methods

We used EHR data on all adult patients in our health system from April 2012 through September 2019 to conduct adjusted logistic regression models to determine socio-demographic correlates of SRDs (e.g., use, misuse, dependence) and associations between having an SRD and receiving emergency care.

Results

Among the sample (n = 342,651), the majority were female (55.08 %), Non-Hispanic White (58.10 %), with mean age of 48.26 (SD = 18.10), and there were 18,015 (5.26 %) individuals with an SRD. Patients with an alcohol-related diagnosis had the highest odds of visiting the ED (aOR = 3.75), followed by those with opioid (aOR = 3.57) and stimulant-related diagnoses (aOR = 3.48). Individuals with an SRD were more likely to identify as male, Black/African American, Hispanic/Latinx, have no health insurance, and have a serious mental illness. In the adjusted model, those with an SRD were significantly more likely to have ever received emergency care (aOR 3.72 [95 % CI 3.62-3.84]) than those without an SRD.

Discussion

Our study found an association between having an SRD and utilizing emergency health services. Demographic characteristics suggest disparities exist for those with SRDs around gender, race/ethnicity, insurance status, and mental health. These data can help with screening and targeted responses to prevent or provide emergency care.

Latent class analysis of emergency department patients engaged in telehealth peer recovery support services and associations of identified classes with post-discharge outcomes

BACKGROUND

People with substance use disorders (SUDs) frequently use emergency department (ED) services. Despite evidence demonstrating that post-discharge SUD treatment linkage effectively reduces the number of ED re-presentations, relatively few hospitals have implemented interventions to identify and connect patients with SUDs to appropriate care. ED-based peer recovery support specialist (PRSS) interventions have emerged as a promising approach for hospitals, but more research is needed to understand the extent to which these interventions meet the needs of patients who present to the ED for different reasons and with various underlying concerns.

METHOD

A retrospective cohort analysis used data from a telehealth PRSS program in 15 EDs within one Indiana hospital system. The study included 2950 ED patients who engaged with telehealth PRSS services between September 2018 and September 2021. Latent class analysis identified patterns of patient characteristics associated with post-discharge PRSS engagement and ED re-presentations. Covariate predictors and distal outcomes were assessed to examine the associations between class membership, demographic factors, and patient outcomes.

RESULTS

The study team selected a six-class model as the best fit for the data. Class 1, representing patients with opioid use disorder and mental health diagnoses who presented to the ED for an opioid overdose, was used as the reference class for all other statistical tests. Multinomial logistic regression analysis demonstrated significant associations between covariate predictors, outcomes, and class membership. Regression results also demonstrate PRSSs had greater success contacting patients with prior year ED use and patients with a successful post-discharge PRSS contact were less likely to re-present to the ED.

CONCLUSION

Results highlight the heterogeneity of patients with SUDs and emphasize the need for tailored interventions to address patient-specific needs more effectively. They also provide support for the perceived utility of PRSS engagement for ED patients.