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Oliveras C, Bruguera P, Cordero Torres I, Millán Hernández A, Pons MT, Guzmán Cortez PR, Gómez-Ramiro M, Vázquez Vallejo M, Salgado E, Asenjo Romero M, Vieta E, Gual A, López-Pelayo H, Balcells-Oliveró M. Another Round: Influence of Alcohol-Related Conditions and Other Drug Use-Related Disorders in Emergency Department Frequent Use - A Single-Site Matched Case-Control Study in Spain. Eur Addict Res 2024:1-13. [PMID: 39068928 DOI: 10.1159/000538987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 04/11/2024] [Indexed: 07/30/2024]
Abstract
INTRODUCTION Patients who make 5 or more visits per year to hospital emergency departments (EDs) are usually considered ED frequent users (FUs). This study aims to better characterize the influence of alcohol and other drug use-related disorders in this phenomenon in a European Mediterranean country with public, universal, tax-financed healthcare system. METHODS Matched case-control study. Cases were adults between 18 and 65 years old who consulted 5 or more times the ED of a tertiary hospital in Spain between December 2018 and November 2019. Each case was assigned a control of the same age and gender, who appeared to the ED on the same day, but who made 4 visits or less to the service during the study period. The electronic record of the first ED visit during this period was used to extract the variables of interest: emergency care received, clinical and social characteristics. Predictors of frequent ED use were identified with conditional logistic regression. RESULTS 609 case-control pairs (total n = 1,218) were selected. History of alcohol-related conditions (adjusted odds ratio [AOR] = 1.82 [95% CI: 1.26-2.64] p = 0.001) and also other drug use-related disorders (AOR = 1.50 [95% CI: 1.11-2.03] p = 0.009) significantly increased the probability of frequent use of emergency services. DISCUSSION/CONCLUSION Alcohol-related conditions and other drug use-related disorders must be evaluated in all ED FUs. Specific action protocols to concurrently address repeated attendance and addictions in the emergency room could be a good tool to reduce frequent ED use.
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Affiliation(s)
- Clara Oliveras
- Addictions Unit, Psychiatry and Psychology Service, ICN, Hospital Clinic Barcelona, Barcelona, Spain
- Department of Psychiatry and Clinical Psychology, Hospital Clínic de Barcelona, Barcelona, Spain
- Health and Addictions Research Group, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Universitat de Barcelona, Red de Investigación en Atención Primaria de Adicciones, RIAPAd (RICORS), Barcelona, Spain
| | - Pol Bruguera
- Addictions Unit, Psychiatry and Psychology Service, ICN, Hospital Clinic Barcelona, Barcelona, Spain
- Department of Psychiatry and Clinical Psychology, Hospital Clínic de Barcelona, Barcelona, Spain
- Health and Addictions Research Group, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Universitat de Barcelona, Red de Investigación en Atención Primaria de Adicciones, RIAPAd (RICORS), Barcelona, Spain
| | | | - Andrea Millán Hernández
- Health and Addictions Research Group, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Universitat de Barcelona, Red de Investigación en Atención Primaria de Adicciones, RIAPAd (RICORS), Barcelona, Spain
| | - Maria Teresa Pons
- Addictions Unit, Psychiatry and Psychology Service, ICN, Hospital Clinic Barcelona, Barcelona, Spain
- Department of Psychiatry and Clinical Psychology, Hospital Clínic de Barcelona, Barcelona, Spain
- Health and Addictions Research Group, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Universitat de Barcelona, Red de Investigación en Atención Primaria de Adicciones, RIAPAd (RICORS), Barcelona, Spain
| | - Pablo Rodrigo Guzmán Cortez
- Addictions Unit, Psychiatry and Psychology Service, ICN, Hospital Clinic Barcelona, Barcelona, Spain
- Department of Psychiatry and Clinical Psychology, Hospital Clínic de Barcelona, Barcelona, Spain
- Health and Addictions Research Group, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Universitat de Barcelona, Red de Investigación en Atención Primaria de Adicciones, RIAPAd (RICORS), Barcelona, Spain
| | - Marta Gómez-Ramiro
- Department of Psychiatry and Clinical Psychology, Hospital Clínic de Barcelona, Barcelona, Spain
- Hospital Clínic de Barcelona, Emergency Department, Barcelona, Spain
- Centro de Investigación en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Barcelona Clínic Schizophrenia Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, Barcelona, Spain
- Psychiatry Service, Complejo Hospitalario Universitario de Vigo, SERGAS, Spain, Translational Neuroscience Research Group, Galicia Sur Health Research Institute (IISGS), Barcelona, Spain
| | - Mireia Vázquez Vallejo
- Department of Psychiatry and Clinical Psychology, Hospital Clínic de Barcelona, Barcelona, Spain
- Hospital Clínic de Barcelona, Emergency Department, Barcelona, Spain
| | - Emilio Salgado
- Hospital Clínic de Barcelona, Emergency Department, Barcelona, Spain
- Clinical Toxicology Unit, Hospital Clínic de Barcelona, Barcelona, Spain
| | | | - Eduard Vieta
- Department of Psychiatry and Clinical Psychology, Hospital Clínic de Barcelona, Barcelona, Spain
- Centro de Investigación en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - Antoni Gual
- Addictions Unit, Psychiatry and Psychology Service, ICN, Hospital Clinic Barcelona, Barcelona, Spain
- Department of Psychiatry and Clinical Psychology, Hospital Clínic de Barcelona, Barcelona, Spain
- Health and Addictions Research Group, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Universitat de Barcelona, Red de Investigación en Atención Primaria de Adicciones, RIAPAd (RICORS), Barcelona, Spain
| | - Hugo López-Pelayo
- Addictions Unit, Psychiatry and Psychology Service, ICN, Hospital Clinic Barcelona, Barcelona, Spain
- Department of Psychiatry and Clinical Psychology, Hospital Clínic de Barcelona, Barcelona, Spain
- Health and Addictions Research Group, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Universitat de Barcelona, Red de Investigación en Atención Primaria de Adicciones, RIAPAd (RICORS), Barcelona, Spain
| | - Mercè Balcells-Oliveró
- Addictions Unit, Psychiatry and Psychology Service, ICN, Hospital Clinic Barcelona, Barcelona, Spain
- Department of Psychiatry and Clinical Psychology, Hospital Clínic de Barcelona, Barcelona, Spain
- Health and Addictions Research Group, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Universitat de Barcelona, Red de Investigación en Atención Primaria de Adicciones, RIAPAd (RICORS), Barcelona, Spain
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Fleury MJ, Cao Z, Grenier G. Emergency Department Use among Patients with Mental Health Problems: Profiles, Correlates, and Outcomes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:864. [PMID: 39063441 PMCID: PMC11276606 DOI: 10.3390/ijerph21070864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Revised: 06/28/2024] [Accepted: 06/29/2024] [Indexed: 07/28/2024]
Abstract
Patients with mental health (MH) problems are known to use emergency departments (EDs) frequently. This study identified profiles of ED users and associated these profiles with patient characteristics and outpatient service use, and with subsequent adverse outcomes. A 5-year cohort of 11,682 ED users was investigated (2012-2017), using Quebec (Canada) administrative databases. ED user profiles were identified through latent class analysis, and multinomial logistic regression used to associate patients' characteristics and their outpatient service use. Cox regressions were conducted to assess adverse outcomes 12 months after the last ED use. Four ED user profiles were identified: "Patients mostly using EDs for accessing MH services" (Profile 1, incident MDs); "Repeat ED users" (Profile 2); "High ED users" (Profile 3); "Very high and recurrent high ED users" (Profile 4). Profile 4 and 3 patients exhibited the highest ED use along with severe conditions yet received the most outpatient care. The risk of hospitalization and death was higher in these profiles. Their frequent ED use and adverse outcomes might stem from unmet needs and suboptimal care. Assertive community treatments and intensive case management could be recommended for Profiles 4 and 3, and more extensive team-based GP care for Profiles 2 and 1.
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Affiliation(s)
- Marie-Josée Fleury
- Department of Psychiatry, McGill University, 1033, Pine Avenue West, Montreal, QC H3A 1A1, Canada
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, 6875 LaSalle Blvd., Montreal, QC H4H 1R3, Canada; (Z.C.); (G.G.)
| | - Zhirong Cao
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, 6875 LaSalle Blvd., Montreal, QC H4H 1R3, Canada; (Z.C.); (G.G.)
| | - Guy Grenier
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, 6875 LaSalle Blvd., Montreal, QC H4H 1R3, Canada; (Z.C.); (G.G.)
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Tatangelo M, Landry R, Beaulieu D, Watson C, Knowlan S, Anawati A, Bodson A, Aubin N, Marsh DC, Leary T, Morin KA. Association of hospital-based substance use supports on emergency department revisits: a retrospective cohort study in Sudbury, Canada from 2018 to 2022. Harm Reduct J 2024; 21:71. [PMID: 38549074 PMCID: PMC10976798 DOI: 10.1186/s12954-024-00985-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 03/09/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND This study compares emergency department (ED) revisits for patients receiving hospital-based substance-use support compared to those who did not receive specialized addiction services at Health Sciences North in Sudbury, Ontario, Canada. METHODS The study is a retrospective observational study using administrative data from all patients presenting with substance use disorder (SUD) at Health Sciences North from January 1, 2018, and August 31, 2022 with ICD-10 codes from the Discharge Abstract Database (DAD) and the National Ambulatory Care Database (NACRS). There were two interventions under study: addiction medicine consult services (AMCS group), and specialized addiction medicine unit (AMU group). The AMCS is a consult service offered for patients in the ED and those who are admitted to the hospital. The AMU is a specialized inpatient medical unit designed to offer addiction support to stabilize patients that operates under a harm-reduction philosophy. The primary outcome was all cause ED revisit within 30 days of the index ED or hospital visit. The secondary outcome was all observed ED revisits in the study period. Kaplan-Meier curves were used to measure the proportion of 30-day revisits by exposure group. Odds ratios and Hazard Ratios were calculated using logistic regression models with random effects and Cox-proportional hazard model respectively. RESULTS A total of 5,367 patients with 10,871 ED index visits, and 2,127 revisits between 2018 and 2022 are included in the study. 45% (2,340/5,367) of patient were not admitted to hospital. 30-day revisits were less likely among the intervention group: Addiction Medicine Consult Services (AMCS) in the ED significantly reduced the odds of revisits (OR 0.53, 95% CI 0.39-0.71, p < 0.01) and first revisits (OR 0.42, 95% CI 0.33-0.53, p < 0.01). The AMU group was associated with lower revisits odds (OR 0.80, 95% CI 0.66-0.98, p = 0.03). For every additional year of age, the odds of revisits slightly decreased (OR 0.99, 95% CI 0.98-1.00, p = 0.01) and males were found to have an increased risk compared to females (OR 1.50, 95% CI 1.35-1.67, p < 0.01). INTERPRETATION We observe statistically significant differences in ED revisits for patients receiving hospital-based substance-use support at Health Sciences North. Hospital-based substance-use supports could be applied to other hospitals to reduce 30-day revisits.
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Affiliation(s)
- Mark Tatangelo
- Health Science North, Sudbury, ON, Canada
- ICES North, Sudbury, ON, Canada
| | | | | | | | | | - Alex Anawati
- Health Science North, Sudbury, ON, Canada
- Dr. Gilles Arcand Centre for Health Equity, Sudbury, ON, Canada
| | | | - Natalie Aubin
- Health Science North, Sudbury, ON, Canada
- Laurentian University, Sudbury, ON, Canada
| | - David C Marsh
- Health Science North, Sudbury, ON, Canada
- ICES North, Sudbury, ON, Canada
- Dr. Gilles Arcand Centre for Health Equity, Sudbury, ON, Canada
- Northern Ontario School of Medicine University, Sudbury, ON, Canada
- Laurentian University, Sudbury, ON, Canada
| | - Tara Leary
- Health Science North, Sudbury, ON, Canada
- Northern Ontario School of Medicine University, Sudbury, ON, Canada
| | - Kristen A Morin
- Health Science North, Sudbury, ON, Canada.
- ICES North, Sudbury, ON, Canada.
- Dr. Gilles Arcand Centre for Health Equity, Sudbury, ON, Canada.
- Northern Ontario School of Medicine University, Sudbury, ON, Canada.
- Laurentian University, Sudbury, ON, Canada.
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Rajab D, Fujioka JK, Walker M, Bartels SA, MacKenzie M, Purkey E. Emergency department care experiences among people who use substances: a qualitative study. Int J Equity Health 2023; 22:248. [PMID: 38049838 PMCID: PMC10696685 DOI: 10.1186/s12939-023-02050-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 11/02/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND People who use substances (PWUS) encounter significant barriers to accessing care for their complex health needs. As a result, emergency departments (EDs) often become the first point of healthcare access for many PWUS and are a crucial setting for the study of health inequities. This study aimed to understand the ED healthcare experiences of PWUS with the intent of informing ways of improving the delivery of equitable care. METHODS This qualitative study was part of a larger cross-sectional, mixed-methods study that examined ED experiences among diverse underserved and equity-deserving groups (EDGs) within Kingston, Ontario, Canada. Participants shared and self-interpreted a story about a memorable ED or UCC visit within the preceding 24 months. Data from participants who self-identified as having substance use experiences was analyzed through inductive thematic analysis. RESULTS Of the 1973 unique participants who completed the survey, 246 participants self-identified as PWUS and were included in the analysis. Most participants were < 45 years of age (61%), male (53%), and white/European (57%). 45% identified as a person with a disability and 39% frequently struggled to make ends meet. Themes were determined at the patient, provider, and system levels. PATIENT history of substance use and experience of intersectionality negatively influenced participants' anticipation and perception of care. Provider: negative experiences were linked to assumption making, feelings of stigma and discrimination, and negative perceptions of provider care. Whereas positive experiences were linked to positive perceptions of provider care. System: timeliness of care and the perception of inadequate mental health resources negatively impacted participants' care experience. Overall, these themes shaped participants' trust of ED staff, their desire to seek care, and their perception of the care quality received. CONCLUSIONS PWUS face significant challenges when seeking care in the ED. Given that EDs are a main site of healthcare utilization, there is an urgent need to better support staff in the ED to improve care experiences among PWUS. Based on the findings, three recommendations are proposed: (1) Integration of an equity-oriented approach into the ED, (2) Widespread training on substance use, and (3) Investment in expert resources and services to support PWUS.
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Affiliation(s)
- Dana Rajab
- Department of Medicine, Queen's University, Kingston, ON, Canada.
| | - Jamie K Fujioka
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Melanie Walker
- Department of Medicine, Queen's University, Kingston, ON, Canada
- Department of Emergency Medicine, Queen's University, Kingston, ON, Canada
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
| | - Susan A Bartels
- Department of Emergency Medicine, Queen's University, Kingston, ON, Canada
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
| | - Meredith MacKenzie
- Department of Family Medicine, Queen's University, Kingston, ON, Canada
- Street Health Centre, Kingston Community Health Centres, Kingston, ON, Canada
| | - Eva Purkey
- Department of Family Medicine, Queen's University, Kingston, ON, Canada
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
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5
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Scheuermeyer FX, Lane D, Grunau B, Grafstein E, Miles I, Kestler A, Barbic D, Barbic S, Slvjic I, Duley S, Yu A, Chiu I, Innes G. Risk factors associated with 1-week revisit among emergency department patients with alcohol withdrawal. CAN J EMERG MED 2023; 25:150-156. [PMID: 36645614 DOI: 10.1007/s43678-022-00414-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 11/11/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND Approximately one-quarter of emergency department (ED) visits for alcohol withdrawal result in unscheduled 1-week ED return visits, but it is unclear what patient and clinical factors may impact this outcome METHODS: From January 1, 2015, to December 31, 2018, at three urban EDs in Vancouver, Canada, we studied patients who were discharged with a primary or secondary diagnosis of alcohol withdrawal. We performed a structured chart review to ascertain patient characteristics, ED treatments, and the outcome of an ED return within 1 week of discharge. We used univariable and multivariable Bayesian binomial regression to identify characteristics associated with being in the upper quartile of 1-week ED revisits. RESULTS We collected 935 ED visits among 593 unique patients. Median age was 45 years (interquartile range 34 to 55 years) and 71% were male. The risk of a 1-week ED revisit was 15.0% (IQR 12.3; 19.5%). After adjustment, factors independently associated with a high risk for return included any prior ED visit within 30 days, no fixed address, initial blood alcohol level > 45 mmol/L, and initial Clinical Institute Withdrawal Assessment-alcohol revised score > 23. These factors explained 41% of the overall variance in revisits. CONCLUSION Among discharged ED patients with alcohol withdrawal, we describe high-risk patient characteristics associated with 1-week ED revisits, and these findings may assist clinicians to facilitate appropriate discharge planning with access to integrated follow-up support.
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Affiliation(s)
- Frank X Scheuermeyer
- Department of Emergency Medicine, St Paul's Hospital and The University of British Columbia, Vancouver, BC, Canada. .,Centre for Health Evaluation and Outcomes Sciences, St Paul's Hospital, Vancouver, BC, Canada. .,Department of Family Medicine, University of British Columbia, Vancouver, BC, Canada.
| | - Daniel Lane
- Faculty of Medicine, University of Calgary, Calgary, AB, Canada
| | - Brian Grunau
- Department of Emergency Medicine, St Paul's Hospital and The University of British Columbia, Vancouver, BC, Canada.,Centre for Health Evaluation and Outcomes Sciences, St Paul's Hospital, Vancouver, BC, Canada
| | - Eric Grafstein
- Department of Emergency Medicine, St Paul's Hospital and The University of British Columbia, Vancouver, BC, Canada.,Centre for Health Evaluation and Outcomes Sciences, St Paul's Hospital, Vancouver, BC, Canada
| | - Isabelle Miles
- Department of Emergency Medicine, St Paul's Hospital and The University of British Columbia, Vancouver, BC, Canada.,British Columbia Center for Substance Use, Vancouver, BC, Canada
| | - Andrew Kestler
- Department of Emergency Medicine, St Paul's Hospital and The University of British Columbia, Vancouver, BC, Canada.,Centre for Health Evaluation and Outcomes Sciences, St Paul's Hospital, Vancouver, BC, Canada.,British Columbia Center for Substance Use, Vancouver, BC, Canada
| | - David Barbic
- Department of Emergency Medicine, St Paul's Hospital and The University of British Columbia, Vancouver, BC, Canada.,Centre for Health Evaluation and Outcomes Sciences, St Paul's Hospital, Vancouver, BC, Canada
| | - Skye Barbic
- Centre for Health Evaluation and Outcomes Sciences, St Paul's Hospital, Vancouver, BC, Canada.,Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Igor Slvjic
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Shayla Duley
- Department of Family Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Alec Yu
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Ivan Chiu
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Grant Innes
- Department of Emergency Medicine, Rockyview Hospital and The University of Calgary, Calgary, AB, Canada
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