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Heidari O, Winiker A, Dangerfield DT, Wenzel J, Rodney T, Mehta S, Genberg B. Understanding healthcare engagement for people who inject drugs. Res Nurs Health 2024; 47:242-250. [PMID: 37982368 PMCID: PMC10961200 DOI: 10.1002/nur.22355] [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: 06/01/2023] [Revised: 09/28/2023] [Accepted: 11/03/2023] [Indexed: 11/21/2023]
Abstract
People who inject drugs (PWID) are at an increased risk of multimorbid mental health and chronic diseases, which are frequently underdiagnosed and under-treated due to systemic barriers and ongoing substance use. Healthcare engagement is essential to address these conditions and prevent excess morbidity and mortality. The goal of this study was to understand how PWID engage in care for their chronic health conditions and substance use treatment given the known historic and pervasive barriers. We conducted 24 semistructured qualitative interviews informed by the Behavioral Model for Vulnerable Populations between July-September 2019. Participants were sampled across a range of comorbidities, including co-occurring mental health disorders. Thematic analysis was conducted to explore experiences of healthcare engagement for multimorbid chronic diseases, mental health, and treatment for substance use disorder. Mean age for participants was 58 years; 63% reported male sex and 83% reported Black race. Interviews yielded themes regarding healthcare access and wraparound services, positive patient-provider relationships, service integration for substance use treatment and mental health, healthcare needs alignment, medication of opioid use disorder stigma, and acceptance of healthcare. Taken together, participants described how these themes enabled healthcare engagement. Engagement in care is crucial to support health and recovery. Clinical implications include the importance of strengthening patient-provider relationships, encouraging integration of medical and mental health services, and counseling on substance use treatment options in a non- stigmatizing manner. Additionally, policy to reimburse wrap-around support for substance use recovery can improve care engagement and outcomes related to chronic diseases, mental health, and substance use among PWID. No Patient or Public Contribution: While we acknowledge and thank ALIVE participants for their time for data collection and sharing their perspectives, no ALIVE participants, other people who use drugs, and service users were involved in data collection, analysis or interpretation of data, or in preparation of the manuscript.
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Affiliation(s)
- Omeid Heidari
- Department of Child, Family, and Population Health Nursing, School of Nursing, University of Washington, Seattle, Washington, USA
| | - Abigail Winiker
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Derek T Dangerfield
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA
| | - Jennifer Wenzel
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
- Sidney Kimmel Comprehensive Cancer Center, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Tamar Rodney
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | - Shruti Mehta
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Becky Genberg
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
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2
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Morgan B, Lancaster R, Boyagoda B, Ananda R, Attwood LO, Jacka D, Woolley I. The burden of skin and soft tissue, bone and joint infections in an Australian cohort of people who inject drugs. BMC Infect Dis 2024; 24:299. [PMID: 38454356 PMCID: PMC10918955 DOI: 10.1186/s12879-024-09143-0] [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: 07/03/2023] [Accepted: 02/15/2024] [Indexed: 03/09/2024] Open
Abstract
INTRODUCTION There are currently limited data regarding the clinical and economic significance of skin and soft tissue infections (SSTI) and bone and joint infections in Australian people who inject drugs (PWID). METHODS Retrospective cohort study in adult PWID admitted to Monash Health, a large heath care network with six hospitals in Victoria, Australia. Inpatients were identified using administrative datasets and International Classification of Disease (ICD-10) coding for specific infection-related conditions. Cost analysis was based on mean ward, intensive care and hospital-in-the-home (HITH) lengths of stay. Spinal infections and endocarditis were excluded as part of previous studies. RESULTS A total of 185 PWID (61 female, 124 male, median age 37) meeting the study criteria were admitted to Monash Health between January 2010 and January 2021. Admitting diagnoses included 78 skin abscesses, 80 cellulitis, 17 septic arthritis, 4 osteomyelitis, 3 thrombophlebitis and 1 each of necrotising fasciitis, vasculitis and myositis. Pain (87.5%) and swelling (75.1%) were the most common presenting complaints. Opioids (67.4%) and methamphetamine (37.5%) were the most common primary drugs injected. Almost half (46.5%) of patients had concurrent active hepatitis C (HCV) infection on admission. Hepatitis B (HBV) and Human Immunodeficiency Virus (HIV) were uncommon. The most significant causative organism was methicillin-susceptible Staphylococcus aureus (24.9%). In 40.0% (74/185) no organism was identified. Patients required a median acute hospital stay of 5 days (2-51 days). There were 15 patients admitted to the intensive care unit (ICU) with median duration 2 days. PICC line insertion for antibiotics was required in 16.8% of patients, while 51.4% required surgical intervention. Median duration of both oral and IV antibiotic therapy was 11 days. Almost half (48.6%) of patients were enrolled in an opioid maintenance program on discharge. Average estimated expenditure was AUD $16, 528 per admission. CONCLUSION Skin and soft tissue and joint infections are a major cause of morbidity for PWID. Admission to hospital provides opportunistic involvement of addiction specialty services.
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Affiliation(s)
- B Morgan
- Department of Medicine, Monash Health, Clayton, Australia.
| | - R Lancaster
- Addiction Medicine Unit, Monash Health, Clayton, Australia
| | - B Boyagoda
- Central Clinical School, Monash University, Clayton, Australia
| | - R Ananda
- Department of Medicine, Monash Health, Clayton, Australia
| | - L O Attwood
- Central Clinical School, Monash University, Clayton, Australia
- Department of Infectious Diseases, Alfred Health, Clayton, Australia
- Monash Infectious Diseases, Monash Health, Clayton, Australia
| | - D Jacka
- Addiction Medicine Unit, Monash Health, Clayton, Australia
| | - I Woolley
- Central Clinical School, Monash University, Clayton, Australia.
- Department of Infectious Diseases, Alfred Health, Clayton, Australia.
- Monash Infectious Diseases, Monash Health, Clayton, Australia.
- School of Clinical Sciences, Monash University, Clayton, Australia.
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Curtis SJ, Colledge-Frisby S, Stewardson AJ, Doyle JS, Higgs P, Maher L, Hickman M, Stoové MA, Dietze PM. Prevalence and incidence of emergency department presentations and hospital separations with injecting-related infections in a longitudinal cohort of people who inject drugs. Epidemiol Infect 2023; 151:e192. [PMID: 37953739 PMCID: PMC10728979 DOI: 10.1017/s0950268823001784] [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: 06/16/2023] [Revised: 10/05/2023] [Accepted: 10/26/2023] [Indexed: 11/14/2023] Open
Abstract
People who inject drugs are at risk of acute bacterial and fungal injecting-related infections. There is evidence that incidence of hospitalizations for injecting-related infections are increasing in several countries, but little is known at an individual level. We aimed to examine injecting-related infections in a linked longitudinal cohort of people who inject drugs in Melbourne, Australia. A retrospective descriptive analysis was conducted to estimate the prevalence and incidence of injecting-related infections using administrative emergency department and hospital separation datasets linked to the SuperMIX cohort, from 2008 to 2018. Over the study period, 33% (95%CI: 31-36%) of participants presented to emergency department with any injecting-related infections and 27% (95%CI: 25-30%) were admitted to hospital. Of 1,044 emergency department presentations and 740 hospital separations, skin and soft tissue infections were most common, 88% and 76%, respectively. From 2008 to 2018, there was a substantial increase in emergency department presentations and hospital separations with any injecting-related infections, 48 to 135 per 1,000 person-years, and 18 to 102 per 1,000 person-years, respectively. The results emphasize that injecting-related infections are increasing, and that new models of care are needed to help prevent and facilitate early detection of superficial infection to avoid potentially life-threatening severe infections.
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Affiliation(s)
- Stephanie J. Curtis
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
- Department of Infectious Diseases, the Alfred Hospital and Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Samantha Colledge-Frisby
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
- National Drug Research Institute, Curtin University, Melbourne, VIC, Australia
| | - Andrew J. Stewardson
- Department of Infectious Diseases, the Alfred Hospital and Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Joseph S. Doyle
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
- Department of Infectious Diseases, the Alfred Hospital and Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Peter Higgs
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
- Department of Public Health, La Trobe University, Bundoora, VIC, Australia
| | - Lisa Maher
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
- The Kirby Institute, Faculty of Medicine, UNSW, Wallace Wurth Building, Kensington, NSW, Australia
| | - Matthew Hickman
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Mark A. Stoové
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
- The Kirby Institute, Faculty of Medicine, UNSW, Wallace Wurth Building, Kensington, NSW, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Paul M. Dietze
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
- National Drug Research Institute, Curtin University, Melbourne, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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Muacevic A, Adler JR. Rates and Patterns of Australian Emergency Department Presentations of People Who Use Stimulants: A Systematic Literature Review. Cureus 2022; 14:e30429. [PMID: 36407224 PMCID: PMC9671087 DOI: 10.7759/cureus.30429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2022] [Indexed: 01/25/2023] Open
Abstract
The use of illicit stimulants continues to pose a significant challenge to different health sectors. In Australia, four particular stimulants, namely amphetamines and their derivatives, methamphetamine, ecstasy or 3,4-methylenedioxy-methamphetamine (MDMA), and cocaine cause a significant challenge to EDs as managing patients who use stimulants can be labor and resource intensive. While Australian data are available for stimulant-related ambulance attendances and hospitalizations, little is known about ED presentations of people who use stimulants. The aim of this paper is to systematically review the available literature related to the rates and patterns of ED presentations of people who use stimulants in Australia. A search was conducted on EBSCOhost, CINAHL Complete, and PubMed databases, as well as Google Scholar. Search terms consisted of combinations of the following terms: 1) stimulant AND ED AND Australia; 2) stimulants AND emergency presentations OR accident and emergency AND Australia, 3) amphetamine OR methamphetamine OR ecstasy OR cocaine AND ED AND Australia. Articles that met the inclusion criteria were included in the review and subjected to a quality appraisal. Data were extracted from the selected papers, including patient demographics, presentation rates, type of stimulant, reasons for presentations, police or ambulance service involvement, comorbidities, mental health issues, triage codes, admissions, and separations. The results of the review are reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Studies were eligible if they were English-language peer-reviewed articles published between January 2011 and December 2021 and if they included data on Australian ED presentations of people who use non-prescription illicit stimulants. Studies were excluded if they did not include stimulant-related ED presentations or focused on ED presentations related to prescription stimulants, including Ritalin and Adderall, non-stimulant drugs, or caffeine for attention deficit disorder (ADD) or attention-deficit hyperactivity disorder (ADHD). The selected articles were appraised for quality, rigor, and risk of bias by two authors. The studies were assessed using the Newcastle Ottawa Scale (NOS) for cross-sectional, cohort, and case-control studies depending on the methodology identified in the study. A total of 19 articles were included in this study. Males represented 53 to 85% of ED presentations of people who use stimulants with an age range of 0 to 65 and are more likely to be transported by police or ambulance. People who use stimulants presented to EDs with varying psychological and behavioral concerns such as psychosis, self-harm, suicidal ideations, hallucinations, agitations, and aggressiveness, as well as medical conditions, including heart palpitations, nausea and vomiting, and significant physical injuries.
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5
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Prevalence and factors associated with hospitalisation for bacterial skin infections among people who inject drugs: The ETHOS Engage Study. Drug Alcohol Depend 2022; 237:109543. [PMID: 35772249 DOI: 10.1016/j.drugalcdep.2022.109543] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 06/15/2022] [Accepted: 06/17/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Injecting-related skin and soft tissue infections (SSTIs) are a preventable cause of inpatient hospitalisation among people who inject drugs (PWID). This study aimed to determine the prevalence of hospitalisation for SSTIs among PWID, and identify similarities and differences in factors associated with hospitalisation for SSTIs versus non-bacterial harms related to injecting drug use. METHODS We performed cross-sectional analyses of baseline data from an observational cohort study of PWID attending drug treatment clinics and needle and syringe programs in Australia. Logistic regression models were used to identify factors associated with self-reported hospitalisation for (1) SSTIs (abscess and/or cellulitis), and (2) non-bacterial harms related to injecting drug use (e.g., non-fatal overdose; hereafter referred to as non-bacterial harms), both together and separately. RESULTS 1851 participants who injected drugs in the previous six months were enrolled (67% male; 85% injected in the past month; 42% receiving opioid agonist treatment [OAT]). In the previous year, 40% (n = 737) had been hospitalised for drug-related causes: 20% (n = 377) and 29% (n = 528) of participants were admitted to hospital for an SSTI and non-bacterial harm, respectively. Participants who were female (adjusted odds ratio [aOR]: 1.53, 95% CI: 1.19-1.97) or homeless (aOR: 1.59, 95% CI: 1.16-2.19) were more likely to be hospitalised for an SSTI, but not a non-bacterial harm. Both types of hospitalisation were more likely among people recently released from prison. CONCLUSIONS Hospitalisation for SSTIs is common among PWID. Community-based interventions to prevent SSTIs and subsequent hospitalisation among PWID will require targeting of at-risk groups, including women, people experiencing homelessness, and incarcerated people upon prison release.
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Examining Relational Dimensions of Service Encounters for Disadvantaged People Who Use Drugs. J Addict Nurs 2022; 33:159-167. [DOI: 10.1097/jan.0000000000000479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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7
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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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8
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Attwood LO, Spelman D. Group A streptococcal bacteraemia at a tertiary hospital in Melbourne: concern of an under-reported risk group in Australia. Intern Med J 2021; 51:565-570. [PMID: 32092233 DOI: 10.1111/imj.14807] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 02/05/2020] [Accepted: 02/09/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Invasive group A streptococcal (iGAS) infections are increasing worldwide with at-risk groups being children, pregnant women and the elderly. In 2017, there was a rise in iGAS cases in Victoria, prompting a Chief Health Officer advisory. AIMS To describe the characteristics of patients with GAS bacteraemia admitted to a tertiary hospital. To compare at-risk groups in our population with those identified in the Victorian Government health alert. METHODS Retrospective review of patients with GAS bacteraemia admitted between June 2014 and December 2017 at a tertiary hospital in Melbourne, Victoria. RESULTS Forty-three cases of GAS bacteraemia occurred. Average age was 52 years (range 15-88 years) with 63% male. Average length of stay was 14 days (range 0-72 days) and all-cause mortality occurred in two (5%) cases. Twelve (28%) patients presented with shock, 11 (26%) required intensive care unit admission and 13 (30%) surgical intervention. A history of intravenous drug use was documented in 18 (42%) cases and was commonly complicated by bone or joint involvement or thrombosis. Typing of GAS samples identified 22 different emm-types. CONCLUSION GAS bacteraemia resulted in significant morbidity and prolonged hospitalisation. In contrast to the at-risk groups identified in the Victorian Government health advisory, the commonest risk group in this series were people who inject drugs and most commonly middle-aged men. Invasive GAS should be considered if a person who injects drugs presents with acute severe sepsis.
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Affiliation(s)
- Lucy O Attwood
- Department of Infectious Diseases, Alfred Health, Melbourne, Victoria, Australia
| | - Denis Spelman
- Department of Infectious Diseases, Alfred Health, Melbourne, Victoria, Australia
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9
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Di Rico R, Nambiar D, Gabbe B, Stoové M, Dietze P. Patient-specific record linkage between emergency department and hospital admission data for a cohort of people who inject drugs: methodological considerations for frequent presenters. BMC Med Res Methodol 2020; 20:283. [PMID: 33246414 PMCID: PMC7694355 DOI: 10.1186/s12874-020-01163-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 11/16/2020] [Indexed: 11/11/2022] Open
Abstract
Background People who inject drugs (PWID) have been identified as frequent users of emergency department (ED) and hospital inpatient services. The specific challenges of record linkage in cohorts with numerous administrative health records occurring in close proximity are not well understood. Here, we present a method for patient-specific record linkage of ED and hospital admission data for a cohort of PWID. Methods Data from 688 PWID were linked to two state-wide administrative health databases identifying all ED visits and hospital admissions for the cohort between January 2008 and June 2013. We linked patient-specific ED and hospital admissions data, using administrative date-time timestamps and pre-specified linkage criteria, to identify hospital admissions stemming from ED presentations for a given individual. The ability of standalone databases to identify linked ED visits or hospital admissions was examined. Results There were 3459 ED visits and 1877 hospital admissions identified during the study period. Thirty-four percent of ED visits were linked to hospital admissions. Most links had hospital admission timestamps in-between or identical to their ED visit timestamps (n = 1035, 87%). Allowing 24-h between ED visits and hospital admissions captured more linked records, but increased manual inspection requirements. In linked records (n = 1190), the ED ‘departure status’ variable correctly reflected subsequent hospital admission in only 68% of cases. The hospital ‘admission type’ variable was non-specific in identifying if a preceding ED visit had occurred. Conclusions Linking ED visits with subsequent hospital admissions in PWID requires access to date and time variables for accurate temporal sorting, especially for same-day presentations. Selecting time-windows to capture linked records requires discretion. Researchers risk under-ascertainment of hospital admissions if using ED data alone.
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Affiliation(s)
- Rehana Di Rico
- Program for Behaviours and Health Risks, Burnet Institute, 85 Commercial Road, Melbourne, Victoria, 3004, Australia. .,Epworth Monash Rehabilitation Medicine Unit, Epworth HealthCare, 32 Erin Street, Richmond, Victoria, 3121, Australia.
| | - Dhanya Nambiar
- Population Health Research, Turning Point/ Central Clinical School, Monash University, 110 Church Street, Richmond, Victoria, 3121, Australia
| | - Belinda Gabbe
- Department of Epidemiology and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria, 3004, Australia.,Health Data Research UK, Swansea University Medical School, Swansea University, Swansea, UK
| | - Mark Stoové
- Program for Behaviours and Health Risks, Burnet Institute, 85 Commercial Road, Melbourne, Victoria, 3004, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria, 3004, Australia
| | - Paul Dietze
- Program for Behaviours and Health Risks, Burnet Institute, 85 Commercial Road, Melbourne, Victoria, 3004, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria, 3004, Australia
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10
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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: 84] [Impact Index Per Article: 21.0] [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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11
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Lubman DI, Matthews S, Heilbronn C, Killian JJ, Ogeil RP, Lloyd B, Witt K, Crossin R, Smith K, Bosley E, Carney R, Wilson A, Eastham M, Keene T, Shipp C, Scott D. The National Ambulance Surveillance System: A novel method for monitoring acute alcohol, illicit and pharmaceutical drug related-harms using coded Australian ambulance clinical records. PLoS One 2020; 15:e0228316. [PMID: 32004349 PMCID: PMC6994147 DOI: 10.1371/journal.pone.0228316] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 01/13/2020] [Indexed: 11/29/2022] Open
Abstract
Although harmful consumption of alcohol and other drugs (both illicit and pharmaceutical) significantly contribute to global burden of disease, not all harms are captured within existing morbidity data sources. Indeed, harms occurring in the community may be missed or under-reported. This paper describes the National Ambulance Surveillance System, a unique Australian system for monitoring and mapping acute harms related to alcohol and other drug consumption. Data are sourced from paramedic electronic patient care records provided by ambulance services from across Australia. Coding occurs in a purpose-built system, by a team of specialised research assistants. Alcohol, and specific illicit and pharmaceutical drugs, rather than broad drug classes, are manually coded and the dataset is reviewed and cleaned prior to analysis. The National Ambulance Surveillance System is an ongoing, dynamic surveillance system of alcohol and other drug-related harms across Australia. The data includes more than 140 output variables per attendance, including individual substances, demographics, temporal, geospatial, and clinical data (e.g., Glasgow Coma Scale score, naloxone provision and response, outcome of attendance). The National Ambulance Surveillance System is an internationally unique population-level surveillance system of acute harms arising from alcohol and other drug consumption. Dissemination of National Ambulance Surveillance System data has been used to inform and evaluate policy approaches and potential points of intervention, as well as guide workforce development needs and clinical practice at the local and national level. This methodology could be replicated in other countries.
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Affiliation(s)
- Dan I. Lubman
- Turning Point, Eastern Health, Richmond, Victoria, Australia
- Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia
- Monash Addiction Research Centre, Monash University, Frankston, Victoria, Australia
| | - Sharon Matthews
- Turning Point, Eastern Health, Richmond, Victoria, Australia
- Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia
| | - Cherie Heilbronn
- Turning Point, Eastern Health, Richmond, Victoria, Australia
- Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia
| | - Jessica J. Killian
- Turning Point, Eastern Health, Richmond, Victoria, Australia
- Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia
| | - Rowan P. Ogeil
- Turning Point, Eastern Health, Richmond, Victoria, Australia
- Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia
- Monash Addiction Research Centre, Monash University, Frankston, Victoria, Australia
| | - Belinda Lloyd
- Turning Point, Eastern Health, Richmond, Victoria, Australia
- Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia
| | - Katrina Witt
- Turning Point, Eastern Health, Richmond, Victoria, Australia
- Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia
- Monash Addiction Research Centre, Monash University, Frankston, Victoria, Australia
| | - Rose Crossin
- Turning Point, Eastern Health, Richmond, Victoria, Australia
- Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia
- Monash Addiction Research Centre, Monash University, Frankston, Victoria, Australia
| | - Karen Smith
- Ambulance Victoria, Doncaster, Victoria, Australia
- Department of Community Emergency Health and Paramedic Practice, Monash University, Frankston, Victoria, Australia
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Emma Bosley
- Queensland Ambulance Service, Brisbane, Queensland, Australia
| | - Rosemary Carney
- New South Wales Ambulance, Rozelle, New South Wales, Australia
| | - Alex Wilson
- Ambulance Tasmania, Hobart, Tasmania, Australia
| | - Matthew Eastham
- St John Ambulance Australia (NT) Incorporated, Casuarina, Northern Territory, Australia
| | - Toby Keene
- Australian Capital Territory Ambulance Service, Fairbairn, Australian Capital Territory, Australia
| | - Carol Shipp
- Australian Capital Territory Ambulance Service, Fairbairn, Australian Capital Territory, Australia
| | - Debbie Scott
- Turning Point, Eastern Health, Richmond, Victoria, Australia
- Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia
- Monash Addiction Research Centre, Monash University, Frankston, Victoria, Australia
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12
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Ranin J, Salemovic D, Brmbolic B, Marinkovic J, Boricic I, Pesic PI, Zerjav S, Stanojevic M, Jevtovic D. Comparison of Demographic, Epidemiological, Immunological, and Clinical Characteristics of Patients with HIV Mono-infection Versus Patients Co-infected with HCV or/and HBV: A Serbian Cohort Study. Curr HIV Res 2019; 16:222-230. [PMID: 30014804 DOI: 10.2174/1570162x16666180717115614] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 07/08/2018] [Accepted: 07/10/2018] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The study aimed to correlate the status of hepatitis C (HCV) and hepatitis B virus (HBV) co-infection in patients with human immunodeficiency virus (HIV) infection with clinical and demographic data prior to starting highly active antiretroviral therapy (HAART) and assess the impact of HCV and HBV co-infection on the natural history of HIV infection. PATIENTS AND METHODS The study involved a total of 836 treatment-naive patients with available serological status for HBV and HCV at the point of therapy initiation. Patients were stratified into four groups: HIV mono-infection, HIV/HCV, HIV/HBV, and HIV/HCV/HBV co-infection. Demographic, epidemiological, immunological and clinical characteristics were analyzed in order to assess the possible impact of HCV and HBV co-infection on HIV - related immunodeficiency and progression to AIDS. RESULTS The prevalence of HCV and HBV co-infection in our cohort was 25.7% and 6.3%, respectively. Triple HIV/HCV/HBV infection was recorded in 1.7% of the patients. In comparison with those co-infected with HCV, patients with HIV mono-infection had lower levels of serum liver enzymes activity and higher CD4 cell counts, and were less likely to have CD4 cell counts below100 cells/µL and clinical AIDS, with OR 0.556 and 0.561, respectively. No difference in the development of advanced immunodeficiency and/or AIDS was recorded between patients with HIV monoinfection and those co-infected with HBV, or both HCV/HBV. CONCLUSION HIV/HCV co-infection was found to be more prevalent than HIV/HBV co-infection in a Serbian cohort. Co-infection with HCV was related to more profound immunodeficiency prior to therapy initiation, reflecting a possible unfavorable impact of HCV on the natural history of HIV infection.
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Affiliation(s)
- J Ranin
- University of Belgrade Faculty of Medicine, University Hospital for Infectious and Tropical Diseases, Clinical Centre of Serbia, Belgrade, Serbia
| | - D Salemovic
- University of Belgrade Faculty of Medicine, University Hospital for Infectious and Tropical Diseases, Clinical Centre of Serbia, Belgrade, Serbia
| | - B Brmbolic
- University of Belgrade Faculty of Medicine, University Hospital for Infectious and Tropical Diseases, Clinical Centre of Serbia, Belgrade, Serbia
| | - J Marinkovic
- University of Belgrade Faculty of Medicine, Institute for Medical Statistics, Belgrade, Serbia
| | - I Boricic
- University of Belgrade Faculty of Medicine, Institute for Pathohystology, Belgrade, Serbia
| | - Pavlovic I Pesic
- Virology Laboratory, Microbiology Department, Clinical Center Serbia, Belgrade, Serbia
| | - S Zerjav
- Virology Laboratory, Microbiology Department, Clinical Center Serbia, Belgrade, Serbia
| | - M Stanojevic
- University of Belgrade Faculty of Medicine, Institute of Microbiology and Immunology, Belgrade, Serbia
| | - D Jevtovic
- University of Belgrade Faculty of Medicine, University Hospital for Infectious and Tropical Diseases, Clinical Centre of Serbia, Belgrade, Serbia
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13
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Stewart AC, Cossar R, Dietze P, Armstrong G, Curtis M, Kinner SA, Ogloff JRP, Kirwan A, Stoové M. Lifetime prevalence and correlates of self-harm and suicide attempts among male prisoners with histories of injecting drug use. HEALTH & JUSTICE 2018; 6:19. [PMID: 30324532 PMCID: PMC6755595 DOI: 10.1186/s40352-018-0077-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 10/01/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Histories of self-harm and suicide attempts are common among people in prison in Australia, and substance dependence is an established risk factor for these lifetime experiences. We describe the prevalence of self-reported history of non-suicidal self-injury (NSSI) and suicide attempts in a cohort of men with recent histories of injecting drug use (IDU) imprisoned in Victoria, Australia. Baseline interviews from the Prison and Transition Health (PATH) prospective cohort study were conducted in the weeks prior to release from prison among 400 incarcerated men who reported regular IDU in the six months prior to incarceration. RESULTS Participants completed a researcher-administered structured questionnaire that collected information on sociodemographics, substance use patterns, and physical and mental health indicators. More than one third (37%) reported a history of NSSI and almost half of participants (47%) reported a history of suicide attempts. In multivariable Poisson regression models, a history of NSSI was associated with: being aged 30-39 years; moving accommodation three or more times in the year prior to current sentence; self-reporting a history of mental illness diagnosis; current poor psychiatric well-being; and self-reporting three or more previous drug overdoses. History of suicide attempts was significantly associated with: self-reporting a history of mental illness diagnosis; current poor psychiatric well-being; and self-reporting a history of 1-2 and > 3 drug overdoses. CONCLUSION We observed a disconcertingly high lifetime prevalence of non-suicidal self-injury and suicide attempts among incarcerated males with a history of recent regular injecting drug use. Significant associations with indicators of mental illness and drug related harms support the need to prioritise in-prison screening and early intervention to reduce the risk of future harms for this population.
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Affiliation(s)
- Ashleigh C. Stewart
- Behaviours and Health Risks, Burnet Institute, Melbourne, VIC Australia
- School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC Australia
| | - Reece Cossar
- 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 Preventative Medicine, Monash University, Melbourne, VIC Australia
| | - Gregory Armstrong
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC Australia
| | - Michael Curtis
- Behaviours and Health Risks, Burnet Institute, Melbourne, VIC Australia
| | - Stuart A. Kinner
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC Australia
- Centre for Adolescent Health, Murdoch Children’s Research Institute, The Royal Children’s Hospital Melbourne, Parkville, VIC Australia
- Griffith Criminology Institute, Griffith University, Mt Gravatt, QLD Australia
- Mater Research Institute-UQ, The University of Queensland, QLD, Brisbane, Australia
| | - James R. P. Ogloff
- Centre for Forensic Behavioural Science, Swinburne University of Technology and Forensicare, 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 Preventative Medicine, Monash University, Melbourne, VIC Australia
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