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Singh NM, Daniel K, Balasanova AA. Impact of hospital-administered extended-release naltrexone on readmission rates for patients with alcohol use disorder. Intern Med J 2024. [PMID: 38984396 DOI: 10.1111/imj.16467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 06/10/2024] [Indexed: 07/11/2024]
Abstract
BACKGROUND AND AIMS Alcohol use disorder (AUD) is a persistent public health concern, contributing significantly to mortality and morbidity. This study aims to evaluate the impact of in-hospital extended-release naltrexone (XR-NTX) administration on alcohol-related outcomes. METHODS This retrospective cohort study, conducted at an academic medical centre, included 141 adult patients with AUD who received XR-NTX between December 2020 and June 2021. Primary and secondary outcomes were assessed 90 days before and after XR-NTX administration to identify number of alcohol-related hospitalisations, emergency department (ED) visits and average length of hospital stay. Subgroup analyses assessed outcomes in high hospital utilisers and marginally housed or unhoused populations. RESULTS There was a significant decrease in ED visits and length of hospital stay post XR-NTX and no significant difference in the number of rehospitalisations. Subgroup analysis showed significant reduction in hospital readmissions and ED visits among high hospital utilisers. Our sample was a predominantly middle-aged, male and white patient population. CONCLUSIONS In-hospital initiation of XR-NTX for AUD was associated with a significant decrease in ED visits and length of hospital stay. While no significant impact on the number of hospitalisations was observed overall, there was a substantial reduction in hospital readmissions and ED visits among high utilisers. Our findings suggest the potential benefits of in-hospital XR-NTX, emphasising the need for further research to establish causal relationships, assess cost-effectiveness and explore effectiveness across diverse patient populations. Effective in-hospital interventions, such as XR-NTX, hold promise for improving patient outcomes and reducing the healthcare burden associated with AUD.
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Affiliation(s)
- Nathaniel M Singh
- College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Kristin Daniel
- Division of Pharmaceutical and Nutrition Care, Nebraska Medicine, Nebraska Medical Center, Omaha, Nebraska, USA
| | - Alёna A Balasanova
- Department of Psychiatry, University of Nebraska Medical Center, Omaha, Nebraska, USA
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Aryan M, Qian S, Chen Z, Louissaint J, Qian X, Rosenblatt R, Verna E, Brown R, Wong R, Clark V, Zhang W. Patients with early-stage alcohol-associated liver disease are at increased risk of hospital readmission and death. Eur J Gastroenterol Hepatol 2024; 36:318-325. [PMID: 38179871 DOI: 10.1097/meg.0000000000002701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
BACKGROUND AND AIMS Patients with alcohol use disorder (AUD) can develop alcohol-associated fatty liver disease (AFLD). However, the impact of AFLD on outcomes remains unclear. We studied the impact of AFLD on readmission, 30-day mortality, and overall mortality in patients admitted with AUD. METHODS Hospitalized patients with AUD between 2011 and 2019 at a tertiary medical center were retrospectively evaluated. Our population included patients with AUD with AFLD: AST and ALT elevation and serum bilirubin <3 mg/dl. Patients with AUD without evidence of liver disease served as control and were labeled as no ALD. Patients with alcohol-associated cirrhosis (AC) and alcohol-associated hepatitis (AH) were included for comparison. Kaplan-Meier survival analysis and multivariable regression for predictors of mortality and survival were performed. RESULTS There were 7522 patients of which 32.44% were female with mean age of 51.86 ± 14.41 years. Patient distribution included no ALD (n = 3775), AFLD (n = 2192), AC (n = 1017) and AH (n = 538) groups. Compared to no ALD group, AFLD group was associated with significantly higher 30-day mortality [4.43% vs. 1.56%, hazard ratio (HR): 2.84; P < 0.001], overall mortality [15.97% vs. 12.69%, HR 1.40, P < 0.001], and 30-day readmission [21.85% vs. 18.49%, odds ratio: 1.21; P < 0.01]. CONCLUSION We demonstrated that AFLD is not a benign entity and poses significant mortality risk. Our results suggest that AFLD may be under-recognized and highlight the need for focused management and close follow-up after discharge.
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Affiliation(s)
- Mahmoud Aryan
- Division of Gastroenterology and Hepatology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama
| | - Steve Qian
- Division of Gastroenterology and Hepatology, University of Florida College of Medicine
| | - Zhiguo Chen
- Department of Biostatistics, University of Florida, Gainesville, Florida
| | - Jeremy Louissaint
- Center for Liver Disease and Liver Transplantation, Columbia University Vagelos College of Physicians and Surgeons
| | - Xia Qian
- Division of Gastroenterology and Hepatology, University of Florida College of Medicine
| | - Russell Rosenblatt
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, New York
| | - Elizabeth Verna
- Center for Liver Disease and Liver Transplantation, Columbia University Vagelos College of Physicians and Surgeons
| | - Robert Brown
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, New York
| | - Robert Wong
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine and Veterans Affairs Palo Alto Healthcare System, Palo Alto, California
| | - Virginia Clark
- Division of Gastroenterology and Hepatology, University of Florida College of Medicine
| | - Wei Zhang
- Division of Gastroenterology and Hepatology, University of Florida College of Medicine
- Liver Center, Gastrointestinal Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Lai JH, Han S, Park C, Avanceña AL. Association Between Alcohol Use Disorder and Hospital Readmission Rates and Outcomes in Cancer Survivors: A Population Cohort Study. J Natl Compr Canc Netw 2024; 22:e237076. [PMID: 38394782 PMCID: PMC11188046 DOI: 10.6004/jnccn.2023.7076] [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: 07/05/2023] [Accepted: 08/29/2023] [Indexed: 02/25/2024]
Abstract
BACKGROUND Alcohol use disorder (AUD) is the most common substance use disorder and is characterized by heavy alcohol use and the inability to control drinking. This study sought to compare the rate, timing, length, and total costs of hospital readmissions among cancer survivors with and without AUD. METHODS We used the Nationwide Readmissions Database in 2017 and 2018 in this cohort study. Cancer survivors with an AUD diagnosis during their index hospitalization were included in the exposure group. Propensity score matching was used to identify cancer survivors without AUD for the control group. The primary outcome was all-cause readmission, and secondary outcomes included days to, length of, and total cost of readmission. Outcomes were measured after 90 and 180 days of follow-up. Logistic regression was used to measure the likelihood of readmission, and negative binomial regression and gamma regression were used for the other outcomes. RESULTS Of 485,962 cancer survivors, 13,953 (2.9%) had co-occurring AUD. Cancer survivors with AUD had slightly higher odds of 90-day (odds ratio, 1.14; 95% CI, 1.06-1.22) and 180-day (odds ratio, 1.11; 95% CI, 1.05-1.18) readmission compared with those without AUD. Cancer survivors with AUD who were readmitted after 90 days also had higher readmission costs ($3,785 vs $3,376; P=.03). No differences in time to and length of readmission were observed between groups. The odds of readmission were higher among cancer survivors with AUD irrespective of age and type of cancer. Male, but not female, cancer survivors with AUD were more likely than those without AUD to be readmitted in both follow-up periods. CONCLUSIONS This population-based cohort study of cancer survivors in the United States found that AUD is associated with higher 90- and 180-day readmission rates and higher related health care costs after 90 days of follow-up. Hospitalized cancer survivors with AUD may benefit from addiction treatment and discharge planning that addresses their co-occurring AUD.
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Affiliation(s)
- Jyun-Heng Lai
- Health Outcomes Division, College of Pharmacy, The University of Texas at Austin, Austin, Texas
| | - Sola Han
- Health Outcomes Division, College of Pharmacy, The University of Texas at Austin, Austin, Texas
| | - Chanhyun Park
- Health Outcomes Division, College of Pharmacy, The University of Texas at Austin, Austin, Texas
| | - Anton L.V. Avanceña
- Health Outcomes Division, College of Pharmacy, The University of Texas at Austin, Austin, Texas
- Department of Internal Medicine, Dell Medical School, The University of Texas at Austin, Austin, Texas
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Fleury MJ, Cao Z, Grenier G, Huỳnh C. Profiles of quality of outpatient care use, associated sociodemographic and clinical characteristics, and adverse outcomes among patients with substance-related disorders. Subst Abuse Treat Prev Policy 2023; 18:5. [PMID: 36641441 PMCID: PMC9840840 DOI: 10.1186/s13011-022-00511-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 12/22/2022] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND This study identified patient profiles in terms of their quality of outpatient care use, associated sociodemographic and clinical characteristics, and adverse outcomes based on frequent emergency department (ED) use, hospitalization, and death from medical causes. METHODS A cohort of 18,215 patients with substance-related disorders (SRD) recruited in addiction treatment centers was investigated using Quebec (Canada) health administrative databases. A latent class analysis was produced, identifying three profiles of quality of outpatient care use, while multinomial and logistic regressions tested associations with patient characteristics and adverse outcomes, respectively. RESULTS Profile 1 patients (47% of the sample), labeled "Low outpatient service users", received low quality of care. They were mainly younger, materially and socially deprived men, some with a criminal history. They had more recent SRD, mainly polysubstance, and less mental disorders (MD) and chronic physical illnesses than other Profiles. Profile 2 patients (36%), labeled "Moderate outpatient service users", received high continuity and intensity of care by general practitioners (GP), while the diversity and regularity in their overall quality of outpatient service was moderate. Compared with Profile 1, they were older, less likely to be unemployed or to live in semi-urban areas, and most had common MD and chronic physical illnesses. Profile 3 patients (17%), labeled "High outpatient service users", received more intensive psychiatric care and higher quality of outpatient care than other Profiles. Most Profile 3 patients lived alone or were single parents, and fewer lived in rural areas or had a history of homelessness, versus Profile 1 patients. They were strongly affected by MD, mostly serious MD and personality disorders. Compared with Profile 1, Profile 3 had more frequent ED use and hospitalizations, followed by Profile 2. No differences in death rates emerged among the profiles. CONCLUSIONS Frequent ED use and hospitalization were strongly related to patient clinical and sociodemographic profiles, and the quality of outpatient services received to the severity of their conditions. Outreach strategies more responsive to patient needs may include motivational interventions and prevention of risky behaviors for Profile 1 patients, collaborative GP-psychiatrist care for Profile 2 patients, and GP care and intensive specialized treatment for Profile 3 patients.
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Affiliation(s)
- Marie-Josée Fleury
- Douglas Hospital Research Centre, 6875 LaSalle Blvd, Montreal, Quebec, H4H 1R3, Canada. .,Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, Quebec, H3A 1A1, Canada.
| | - Zhirong Cao
- grid.412078.80000 0001 2353 5268Douglas Hospital Research Centre, 6875 LaSalle Blvd, Montreal, Quebec H4H 1R3 Canada
| | - Guy Grenier
- grid.412078.80000 0001 2353 5268Douglas Hospital Research Centre, 6875 LaSalle Blvd, Montreal, Quebec H4H 1R3 Canada
| | - Christophe Huỳnh
- grid.459278.50000 0004 4910 4652Institut universitaire sur les dépendances, Centre intégré universitaire de santé et des services sociaux du Centre-Sud-de-l’Île-de-Montréal, 950 Louvain Est, Montreal, Quebec H2M 2E8 Canada
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Singh A, Aggarwal M, Garg R, Stevens T, Chahal P. Post-pancreatitis diabetes mellitus: insight on optimal management with nutrition and lifestyle approaches. Ann Med 2022; 54:1776-1786. [PMID: 35786076 PMCID: PMC9254994 DOI: 10.1080/07853890.2022.2090601] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Pancreatitis is the leading gastrointestinal cause of hospitalizations. There are multiple short- and long-term complications associated with pancreatitis. Post-pancreatitis diabetes mellitus (PPDM) is one of the less explored complications of pancreatitis. Nonetheless, it has attracted considerable attention during the last decade. PPDM is now the second most common cause of new-onset diabetes mellitus (DM) in adults after type II DM surpassing type 1 DM. However, there exists a knowledge gap amongst practitioners regarding diagnosis, complications, and management of PPDM. In this narrative, we aim to provide a brief review regarding risks, diagnosis and management of PPDM with a special focus on dietary and lifestyle management strategies.KEY MESSAGESPost-pancreatitis diabetes mellitus (PPDM) is now the second most common cause of new-onset diabetes mellitus (DM) in adults after type II DM surpassing type 1 DM.New-onset diabetes in patients with pancreatitis could also be an early marker of occult pancreatic malignancy.Management of PPDM is complex and requires a team-based approach including gastroenterologists, endocrinologists, primary care physicians, nutritionists, and behavioural health specialists.
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Affiliation(s)
- Amandeep Singh
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Manik Aggarwal
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Rajat Garg
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Tyler Stevens
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Prabhleen Chahal
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
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Chockalingam L, Burnham EL, Jolley SE. Medication prescribing for alcohol use disorders during alcohol-related encounters in a Colorado regional healthcare system. Alcohol Clin Exp Res 2022; 46:1094-1102. [PMID: 35723682 DOI: 10.1111/acer.14837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 04/04/2022] [Indexed: 11/28/2022]
Abstract
RATIONALE Investigations show that medications for alcohol use disorders (MAUD) reduce heavy drinking and relapses. However, only 1.6% of individuals with alcohol use disorders (AUD) receive MAUD across care settings. The epidemiology of MAUD prescribing in the acute care setting is incompletely described. We hypothesized that MAUD would be under prescribed in inpatient acute care hospital settings compared to the outpatient, emergency department (ED), and inpatient substance use treatment settings. METHODS We evaluated electronic health record (EHR) data from adult patients with an International Classification of Diseases, 10th revision (ICD-10) alcohol-related diagnosis in the University of Colorado Health (UCHealth) system between January 1, 2016 and 31 December, 2019. Data from patients with an ICD-10 diagnosis code for opioid use disorder and those receiving MAUD prior to their first alcohol-related episode were excluded. The primary outcome was prescribing of MAUD, defined by prescription of naltrexone, acamprosate, and/or disulfiram. We performed bivariate and multivariate analyses to identify independent predictors of MAUD prescribing at UCHealth. RESULTS We identified 48,421 unique patients with 136,205 alcohol-related encounters at UCHealth. Encounters occurred in the ED (42%), inpatient acute care (17%), inpatient substance use treatment (18%), or outpatient primary care (12%) settings. Only 2270 (5%) patients received MAUD across all settings. Female sex and addiction medicine consults positively predicted MAUD prescribing. In contrast, encounters outside inpatient substance use treatment, Hispanic ethnicity, and black or non-white race were negative predictors of MAUD prescribing. Compared to inpatient substance use treatment, inpatient acute care hospitalizations for AUD was associated with a 93% reduced odds of receiving MAUD. CONCLUSIONS AUD-related ED and inpatient acute care hospital encounters in our healthcare system were common. Nevertheless, prescriptions for MAUD were infrequent in this population, particularly in inpatient settings. Our findings suggest that the initiation of MAUD for patients with alcohol-related diagnoses in acute care settings deserves additional evaluation.
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Affiliation(s)
| | - Ellen L Burnham
- Department of Medicine, Pulmonary Sciences and Critical Care Medicine, University of Colorado, Aurora, Colorado, USA
| | - Sarah E Jolley
- Department of Medicine, Pulmonary Sciences and Critical Care Medicine, University of Colorado, Aurora, Colorado, USA
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Gabet M, Gentil L, Lesage A, Fleury MJ. Investigating characteristics of patients with mental disorders to predict out-patient physician follow-up within 30 days of emergency department discharge. BJPsych Open 2022; 8:e95. [PMID: 35579032 PMCID: PMC9169501 DOI: 10.1192/bjo.2022.64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Prompt follow-up at emergency department discharge is a key indicator of healthcare quality and patient recovery. To improve services, better knowledge of predictors for out-patient physician follow-up within 30 days after discharge is needed. AIMS We investigated clinical and sociodemographic characteristics and service use to predict patients with mental disorders with or without physician follow-up after emergency department use. METHOD This study used data extracted from clinical administrative databases for 9514 patients who attended an emergency department in Quebec (Canada) in 2014-2015 (index visit) for mental health reasons. Patient clinical and sociodemographic characteristics from 2012-2013 to 2014-2015, and service use 12 months before the index visit, were investigated as predictors for patients with or without prompt follow-up, using hierarchical logistic regression. RESULTS Two-thirds of patients did not receive prompt physician follow-up. Patients with level 1-2 illness acuity at emergency department triage (needing immediate or urgent care); those with adjustment or bipolar disorders, but without alcohol-related disorders (clinical characteristics); and patients with higher continuity of physician care, more psychosocial interventions in community healthcare centres and prior hospital admission (service use characteristics) were more likely to receive prompt out-patient follow-up. CONCLUSIONS Access to medical care was poor, considering the high needs of this population. The role of the emergency department as a gateway for accessing out-patient care may be strengthened by strategies like screening, brief intervention including motivational treatments, brief case management offered by emergency department staff, timely referral to services and better post-discharge planning. Collaborative care for patients attending emergency departments should also be improved.
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Affiliation(s)
- Morgane Gabet
- Department of Health Administration, School of Public Health, Université de Montréal, Canada; and Douglas Hospital Research Center, Canada
| | - Lia Gentil
- Douglas Hospital Research Center, Canada; and Department of Psychiatry, McGill University, Canada
| | - Alain Lesage
- Department of Psychiatry, Université de Montréal, Canada; and Centre de recherche Fernand-Séguin, Institut universitaire en santé mentale de Montréal, Canada
| | - Marie-Josée Fleury
- Department of Health Administration, School of Public Health, Université de Montréal, Canada; Douglas Hospital Research Center, Canada; and Department of Psychiatry, McGill University, Canada
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Fleury MJ, Grenier G, Cao Z, Huỳnh C, Chihade D. Predictors of Emergency Department Use for Suicidal Behaviors among Patients with Substance-Related Disorders. Arch Suicide Res 2022; 27:796-817. [PMID: 35499529 DOI: 10.1080/13811118.2022.2066591] [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: 11/02/2022]
Abstract
OBJECTIVE This study aimed to identify predictors of emergency department (ED) use for suicide ideation or suicide attempt compared with other reasons among 14,158 patients with substance-related disorders (SRD) in Quebec (Canada). METHODS Longitudinal data on clinical, sociodemographic, and service use variables for patients who used addiction treatment centers in 2012-13 were extracted from Quebec administrative databases. A multinomial logistic regression was produced, comparing predictors of suicide ideation or attempts to other reasons for ED use in 2015-16. RESULTS Patients using ED for both suicide ideation and attempt were more likely to have bipolar or personality disorders, problems related to the social environment, 4+ previous yearly outpatient consultations with their usual psychiatrist, high prior ED use, and dropout from SRD programs in addiction treatment centers in the previous 7 years, compared with those using ED for other reasons. Patients with alcohol- or drug-related disorders other than cannabis and living in the least materially deprived areas, urban territories, and university healthcare regions made more suicide attempts than those using ED for other reasons. Patients with common mental disorders, 1-3 previous yearly outpatient consultations with their usual psychiatrist, one previous treatment episode in addiction treatment centers, and those using at least one SRD program experienced more suicide ideation than patients using ED for other reasons. CONCLUSION Clinical variables most strongly predicted suicidal behaviors, whereas completion of SRD programs may help to reduce them. SRD services and outreach strategies should be reinforced, particularly for patients with complex issues living in more advantaged urban areas. HIGHLIGHTSOver 10% of ED visits were for suicidal behaviors among patients with SRD.ED use for suicidal behaviors was mainly associated with clinical variables.Addiction treatment centers may help reduce ED use for suicidal behaviors.
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Sims SA, Pereira G, Preen D, Fatovich D, O'Donnell M. Young people with prior health service contacts have increased risk of repeated alcohol-related harm hospitalisations. Drug Alcohol Rev 2022; 41:1226-1235. [PMID: 35385585 DOI: 10.1111/dar.13467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 03/03/2022] [Accepted: 03/10/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION After a first alcohol-related hospitalisation in youth, subsequent hospitalisations may demonstrate an increased risk of further alcohol-related hospitalisations, but there is no existing data on this. METHODS A retrospective longitudinal study between July 1992 and June 2017 using linked hospital administrative data identified 23 464 Western Australian young people [9009 (38.4%) females and 14 455 (61.6%) males], aged 12-24 years hospitalised for at least one alcohol-related harm (ARH) episode of care. Cox regression was used to estimate hazard ratios (HR) between risk factors and repeated alcohol-related hospitalisation after the first discharge for ARH. RESULTS Of those admitted for an alcohol-related hospitalisation (n = 23 464), 21% (n = 4996) were readmitted for ARH. This high-risk sub-group comprised 46% (n = 16 017) of the total alcohol-related admissions (n = 34 485). After the first discharge for ARH, 16% (804) of people who experienced an alcohol-related readmission were readmitted within 1 month, and 51.8% (2589) were readmitted within 12 months. At increased risk of readmission were Aboriginal people and those with prior health service contacts occurring before their first alcohol-related hospitalisation, including illicit drug hospitalisations, mental health contacts and, in a sub-analysis, emergency department presentations. DISCUSSION AND CONCLUSIONS The probability of a repeated ARH hospitalisation was highest in the first month after initial discharge. There is a high-risk sub-group of young people more likely to have a repeat ARH hospitalisation. This represents an opportunity to provide interventions to those most at risk of repeated ARH.
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Affiliation(s)
- Scott A Sims
- School of Population and Global Health, University of Western Australia, Perth, Australia.,Developmental Pathways and Social Policy, Telethon Kids Institute, Perth, Australia
| | - Gavin Pereira
- Curtin School of Population Health, Curtin University, Perth, Australia.,enAble Institute, Curtin University, Perth, Australia.,Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - David Preen
- School of Population and Global Health, University of Western Australia, Perth, Australia
| | - Daniel Fatovich
- Department of Emergency Medicine, Royal Perth Hospital, Perth, Australia.,Emergency Medicine, University of Western Australia, Perth, Australia
| | - Melissa O'Donnell
- School of Population and Global Health, University of Western Australia, Perth, Australia.,Developmental Pathways and Social Policy, Telethon Kids Institute, Perth, Australia.,Australian Centre for Child Protection, University of South Australia, Adelaide, Australia
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Manca F, Lewsey J. Hospital discharge location and socioeconomic deprivation as risk factors for alcohol dependence relapses: A cohort study. Drug Alcohol Depend 2021; 229:109148. [PMID: 34773887 DOI: 10.1016/j.drugalcdep.2021.109148] [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: 08/06/2021] [Revised: 10/18/2021] [Accepted: 10/18/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is evidence that social support can improve the ability of an individual with alcohol use disorder to manage relapses. However, the role of families and friends in this context is debated as family history and co-drinking are also risk factors for initiating alcohol drinking or maintaining addictive behaviours. AIM To quantitatively evaluate whether the hospital discharge location (in company or alone) after an alcohol dependence hospitalisation can influence the risk of relapses and whether this impact is modified by socioeconomic deprivation. METHODS A cohort of 1141 patients hospitalised for the first time for alcohol dependence in Scotland between 2010 and 2019 was derived from a routine healthcare database. Relapses were defined as recurrent alcohol-related hospitalisation. Survival analysis was undertaken to compare the risk of relapse for different discharge locations and socioeconomic deprivation groups. RESULTS On average, living in company of others was associated with a significant lower risk of relapses compared to living alone (HR: 0.84 95%CI: 0.71-0.99). This association differed across socioeconomic groups, being greater for those living in areas with the highest level of socioeconomic deprivation (HR: 0.76 95%CI: 0.57-1.01) and lower elsewhere. While this effect was not statistically significant (p = 0.056), its extent varied based on how we defined our cohort: it was not detectable when we expanded the cohort to all individuals with alcohol use disorders. CONCLUSION Home settings and the environment where individuals reside should be considered as significant psychosocial factors when clinicians design therapies and hospital discharge planning for patients with alcohol dependence.
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Affiliation(s)
- Francesco Manca
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, G12 8RZ Glasgow, UK.
| | - Jim Lewsey
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, G12 8RZ Glasgow, UK.
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Sinner GJ, Annabathula R, Viquez K, Alnabelsi TS, Leung SW. Infective endocarditis in pregnancy from 2009 to 2019: the consequences of injection drug use. Infect Dis (Lond) 2021; 53:633-639. [PMID: 33905273 DOI: 10.1080/23744235.2021.1912821] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Endocarditis during pregnancy carries a maternal mortality of up to 30%, but prior publications do not reflect the current opioid epidemic. CASE PRESENTATIONS We reviewed our institution's infective endocarditis registry from 2009 to 2019 and identified 19 females with endocarditis during pregnancy in order to compare our contemporary outcomes with historical reports. In our cohort, intravenous drug use was reported in all cases, and the most common pathogen was Staphylococcus (74%) followed by Serratia (13%). The tricuspid valve was involved in 18 (95%) patients, and contrary to prior reports, all but two patients were managed conservatively with antibiotics alone. Maternal and infant mortality (5% and 0%, respectively) were lower in our cohort compared to all previous reviews. CONCLUSION We conclude that the better outcomes seen in this report are likely due to the younger age of the patients and the more frequent right-sided valvular involvement. SUMMARY This review highlights contemporary outcomes in endocarditis during pregnancy. We review historical case reports in light of the opioid epidemic. We observed more Staphylococcus, more right-sided valvular involvement, and more conservative management as well as improved maternal and foetal mortality.
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Affiliation(s)
- Gregory J Sinner
- Gill Heart and Vascular Institute, Division of Cardiovascular Medicine, University of Kentucky, Lexington, KY, USA
| | | | - Karolina Viquez
- Department of Medicine, University of Kentucky, Lexington, KY, USA
| | - Talal S Alnabelsi
- Gill Heart and Vascular Institute, Division of Cardiovascular Medicine, University of Kentucky, Lexington, KY, USA
| | - Steve W Leung
- Gill Heart and Vascular Institute, Division of Cardiovascular Medicine, University of Kentucky, Lexington, KY, USA
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Gentil L, Grenier G, Vasiliadis HM, Huỳnh C, Fleury MJ. Predictors of Recurrent High Emergency Department Use among Patients with Mental Disorders. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094559. [PMID: 33923112 PMCID: PMC8123505 DOI: 10.3390/ijerph18094559] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/16/2021] [Accepted: 04/17/2021] [Indexed: 11/23/2022]
Abstract
Few studies have examined predictors of recurrent high ED use. This study assessed predictors of recurrent high ED use over two and three consecutive years, compared with high one-year ED use. This five-year longitudinal study is based on a cohort of 3121 patients who visited one of six Quebec (Canada) ED at least three times in 2014–2015. Multinomial logistic regression was performed. Clinical, sociodemographic and service use variables were identified based on data extracted from health administrative databases for 2012–2013 to 2014–2015. Of the 3121 high ED users, 15% (n = 468) were recurrent high ED users for a two-year period and 12% (n = 364) over three years. Patients with three consecutive years of high ED use had more personality disorders, anxiety disorders, alcohol or drug related disorders, chronic physical illnesses, suicidal behaviors and violence or social issues. More resided in areas with high social deprivation, consulted frequently with psychiatrists, had more interventions in local community health service centers, more prior hospitalizations and lower continuity of medical care. Three consecutive years of high ED use may be a benchmark for identifying high users needing better ambulatory care. As most have multiple and complex health problems, higher continuity and adequacy of medical care should be prioritized.
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Affiliation(s)
- Lia Gentil
- 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;
- Centre Intégré Universitaire de Santé et des Services Sociaux du Centre-Sud-de-l’Île-de-Montréal, Institut Universitaire sur les Dépendances, 950 Louvain Est, Montréal, QC H2M 2E8, Canada;
| | - Guy Grenier
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, 6875 LaSalle Blvd, Montreal, QC H4H 1R3, Canada;
| | - Helen-Maria Vasiliadis
- Département Des Sciences de la Santé Communautaire, Université de Sherbrooke, Longueuil, QC J4K 0A8, Canada;
- Centre de Recherche Charles-Le Moyne-Saguenay–Lac-Saint-Jean sur les Innovations en Santé (CR-CSIS), Campus de Longueuil-Université de Sherbrooke, 150 Place Charles-Lemoyne, Longueuil, QC J4K 0A8, Canada
| | - Christophe Huỳnh
- Centre Intégré Universitaire de Santé et des Services Sociaux du Centre-Sud-de-l’Île-de-Montréal, Institut Universitaire sur les Dépendances, 950 Louvain Est, Montréal, QC H2M 2E8, Canada;
| | - 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;
- Correspondence:
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Gentil L, Grenier G, Fleury MJ. Factors Related to 30-day Readmission following Hospitalization for Any Medical Reason among Patients with Mental Disorders: Facteurs liés à la réhospitalisation à 30 jours suivant une hospitalisation pour une raison médicale chez des patients souffrant de troubles mentaux. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2021; 66:43-55. [PMID: 33063531 PMCID: PMC7890589 DOI: 10.1177/0706743720963905] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This study evaluated the contributions of clinical, sociodemographic, and service use variables to the risk of early readmission, defined as readmission within 30 days of discharge following hospitalization for any medical reason (mental or physical illnesses), among patients with mental disorders in Quebec (Canada). METHODS In this longitudinal study, 2,954 hospitalized patients who had visited 1 of 6 Quebec emergency departments (ED) in 2014 to 2015 (index year) were identified through clinical administrative databanks. The first hospitalization was considered that may have occurred at any Quebec hospital. Data collected between 2012 and 2013 and 2013 and 2014 on clinical, sociodemographic, and service use variables were assessed as related to readmission/no readmission within 30 days of discharge using hierarchical binary logistic regression. RESULTS Patients with co-occurring substance-related disorders/chronic physical illnesses, serious mental disorders, or adjustment disorders (clinical variables); 4+ outpatient psychiatric consultations with the same psychiatrist; and patients hospitalized for any medical reason within 12 months prior to index hospitalization (service use variables) were more likely to be readmitted within 30 days of discharge. Patients who made 1 to 3 ED visits within 1 year prior to the index hospitalization, had their index hospitalization stay of 16 to 29 days, or consulted a physician for any medical reason within 30 days after discharge or prior to the readmission (service use variables) were less likely to be rehospitalized. CONCLUSIONS Early hospital readmission was more strongly associated with clinical variables, followed by service use variables, both playing a key role in preventing early readmission. Results suggest the importance of developing specific interventions for patients at high risk of readmission such as better discharge planning, integrated and collaborative care, and case management. Overall, better access to services and continuity of care before and after hospital discharge should be provided to prevent early hospital readmission.
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Affiliation(s)
- Lia Gentil
- Douglas Mental Health University Institute, Montréal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Guy Grenier
- Douglas Mental Health University Institute, Montréal, Quebec, Canada
| | - Marie-Josée Fleury
- Douglas Mental Health University Institute, Montréal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
- Marie-Josée Fleury, PhD, Douglas Mental Health University Institute, 6875 La Salle Blvd., Montreal, Quebec, Canada H4H 1R3.
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Akram F, Rosales M, Chaudhuri S, Mansouripour SM, Sharif U, Maqsood A, Wadhawan A, Mohyuddin F, Mukhtar F. Predictors of civil and forensic inpatient psychiatric readmissions at a Public Mental Health Hospital. Psychiatry Res 2020; 293:113447. [PMID: 32977046 DOI: 10.1016/j.psychres.2020.113447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 09/07/2020] [Indexed: 11/26/2022]
Abstract
Inpatient psychiatric readmissions are increasingly prevalent and associated with worse prognostic outcomes and high economic costs, regardless of the medicolegal ramifications that necessitate them. Unlike most general medical readmissions, psychiatric readmissions are commonly warranted for both medical and legal purposes. However, studies focusing on analyzing the predictors of inpatient psychiatric readmission and their relationship to civil versus forensic readmission are limited. The purpose of this study was to examine the predictors of psychiatric readmission among civil and forensic patients admitted to a psychiatric hospital. In this retrospective chart review, we extrapolated data from medical records of 741 patients admitted from 2012 to 2017 with follow up until 2019. Analyses involved chi-square tests for comparing the distribution of demographic and clinical variables between forensic and civil readmission, and Cox regression to determine predictors of time to first readmission. Our results show that race, diagnosis, restraint/seclusion, type of admission, and disposition are significantly associated with an increased risk of psychiatric readmission. This study has important implications for healthcare providers and policy makers in revising mental health policies and improving systems-based practices for the mental health system. Future efforts in improving community psychiatric services and enhancing inpatient therapeutic environment may reduce psychiatric readmissions.
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Affiliation(s)
- Faisal Akram
- Saint Elizabeths Hospital, DC Department of Behavioral Health, Washington, DC, United States; Mood and Anxiety Program, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Marianela Rosales
- Department of Psychiatry, Temple University, Philadelphia, PA, United States
| | - Sanjay Chaudhuri
- Department of Psychiatry, Penn State University, Hershey, PA, United States
| | - Seyed M Mansouripour
- Saint Elizabeths Hospital, DC Department of Behavioral Health, Washington, DC, United States
| | - Usman Sharif
- Department of Psychiatry, Berkshire Medical Center, Pittsfield, MA, United States
| | - Anum Maqsood
- Department of Internal Medicine, Howard University Hospital, Washington DC, United States
| | - Abhishek Wadhawan
- Saint Elizabeths Hospital, DC Department of Behavioral Health, Washington, DC, United States
| | - Farooq Mohyuddin
- Saint Elizabeths Hospital, DC Department of Behavioral Health, Washington, DC, United States
| | - Fahad Mukhtar
- Saint Elizabeths Hospital, DC Department of Behavioral Health, Washington, DC, United States.
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