1
|
Myran DT, Friesen E, Talarico R, Gaudreault A, Taljaard M, Hobin E, Smith BT, Schwartz N, Giesbrecht N, Crépault JF, Tanuseputro P, Manuel DG. The association between alcohol retail access and health care visits attributable to alcohol for individuals with and without a history of alcohol-related health-care use. Addiction 2024. [PMID: 38804474 DOI: 10.1111/add.16566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 04/22/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND AND AIMS Alcohol retail access is associated with alcohol use and related harms. This study measured whether this association differs for people with and without heavy and disordered patterns of alcohol use. DESIGN The study used a repeated cross-sectional analysis of health administrative databases. SETTING, PARTICIPANTS/CASES All residents of Ontario, Canada aged 10-105 years with universal health coverage (n = 10 677 604 in 2013) were included in the analysis. MEASUREMENTS Quarterly rates of emergency department (ED) and outpatient visits attributable to alcohol in 464 geographic regions between 2013 and 2019 were measured. Quarterly off-premises alcohol retail access scores were calculated (average drive to the closest seven stores) for each geographic region. Mixed-effect linear regression models adjusted for area-level socio-demographic covariates were used to examine associations between deciles of alcohol retail access and health-care visits attributable to alcohol. Stratified analyses were run for individuals with and without prior alcohol-attributable health-care use in the past 2 years. FINDINGS We included 437 707 ED visits and 505 271 outpatient visits attributable to alcohol. After adjustment, rates of ED visits were 39% higher [rate ratio (RR) = 1.39, 95% confidence interval (CI) = 1.20-1.61] and rates of outpatient visits were 49% higher (RR = 1.49, 95% CI = 1.26-1.75) in the highest versus lowest decile of alcohol access. There was a positive association between alcohol access and outpatient visits attributable to alcohol for individuals without prior health-care attributable to alcohol (RR = 1.65, 95% CI = 1.39-1.95 for the highest to lowest decile of alcohol access) but not for individuals with prior health-care attributable to alcohol (RR = 1.08, 95% CI = 0.90-1.30). There was a positive association between alcohol access and ED visits attributable to alcohol for individuals with and without prior health-care for alcohol for ED visits. CONCLUSION In Ontario, Canada, greater alcohol retail access appears to be associated with higher rates of emergency department (ED) and outpatient health-care visits attributable to alcohol. Individuals without prior health-care for alcohol may be more susceptible to greater alcohol retail access for outpatient but not ED visits attributable to alcohol.
Collapse
Affiliation(s)
- Daniel T Myran
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- ICES uOttawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Erik Friesen
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Robert Talarico
- ICES uOttawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Adrienne Gaudreault
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Monica Taljaard
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Erin Hobin
- Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Brendan T Smith
- Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Naomi Schwartz
- Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, Ontario, Canada
| | - Norman Giesbrecht
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Jean-François Crépault
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Peter Tanuseputro
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- ICES uOttawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Douglas G Manuel
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- ICES uOttawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| |
Collapse
|
2
|
Harrison LD, Dumicho AY, Eddeen AB, Tanuseputro P, Kendall CE, Fiedorowicz JG, Rosic T, Fernando SM, McNaughton CD, Corace K, Kurdyak P, Beckerleg W, Webber C, Gardner W, Sood M, Myran DT. Mortality in adolescents and young adults following a first presentation to the emergency department for alcohol. Acad Emerg Med 2024; 31:220-229. [PMID: 38097531 DOI: 10.1111/acem.14843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 11/09/2023] [Accepted: 11/26/2023] [Indexed: 02/27/2024]
Abstract
BACKGROUND AND METHODS We conducted a population-based, retrospective cohort study of first-time emergency department (ED) visits in adolescents and young adults (AYA) due to alcohol and compared mortality to AYA with nonalcohol ED visits between 2009 and 2015 using standardized all-cause mortality ratios (age, sex, income, and rurality). We described the cause of death for AYA and examined the association between clinical factors and mortality rates in the alcohol cohort using proportional hazard models. RESULTS A total of 71,776 AYA had a first-time ED visit due to alcohol (56.1% male, mean age 20.7 years) between 2009 and 2015, representing 3.3% of the 2,166,838 AYA with an ED visit in this time period. At 1 year, there were 2396 deaths, 248 (10.3%) following an ED visit related to alcohol. First-time alcohol ED visits were associated with a threefold higher risk in mortality at 1 year (0.35% vs. 0.10%, adjusted hazard ratio [aHR] 3.07, 95% confidence interval [CI] 2.69-3.51). Mortality was associated with age 25-29 years (aHR 3.88, 95% CI 2.56-5.86), being male (aHR 1.98, 95% CI 1.49-2.62), having a history of mental health or substance use (aHR 3.22, 95% CI 1.64-6.32), cause of visit being withdrawal/dependence (aHR 2.81, 95% CI 1.96-4.02), and having recurrent ED visits (aHR 1.97, 95% CI 1.27-3.05). Trauma (42.7%), followed by poisonings from drugs other than opioids (38.3%), and alcohol (28.6%) were the most common contributing causes of death. CONCLUSION Incident ED visits due to alcohol in AYA are associated with a high risk of 1-year mortality, especially in young adults, those with concurrent mental health or substance use disorders, and those with a more severe initial presentation. These findings may help inform the need and urgency for follow-up care in this population.
Collapse
Affiliation(s)
- Lyndsay D Harrison
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Asnake Y Dumicho
- ICES uOttawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Anan Bader Eddeen
- ICES uOttawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Peter Tanuseputro
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
- ICES uOttawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ontario, Canada
- Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
- Department of Primary Care, University of Ottawa, Ottawa, Ontario, Canada
| | - Claire E Kendall
- Bruyère Research Institute, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ontario, Canada
- Lamont Primary Health Care Research Centre, Riverside Campus Family Health Team, Ottawa, Ontario, Canada
| | - Jess G Fiedorowicz
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada
| | - Tea Rosic
- Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Shannon M Fernando
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Critical Care, Lakeridge Health Corporation, Oshawa, Ontario, Canada
| | - Candace D McNaughton
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Toronto, Ontario, Canada
- ICES Central, Toronto, Ontario, Canada
| | - Kim Corace
- Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada
| | - Paul Kurdyak
- ICES Central, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Weiwei Beckerleg
- ICES uOttawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Colleen Webber
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
- ICES uOttawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - William Gardner
- ICES uOttawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- CHEO Research Institute, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Manish Sood
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- ICES uOttawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Daniel Thomas Myran
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
- ICES uOttawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ontario, Canada
| |
Collapse
|
3
|
Friesen EL, Mataruga A, Bolton J, Kurdyak P. Characterizing the clinical subgroups of individuals who present to the emergency department for alcohol-related harms in Ontario, Canada: A latent class analysis. Psychiatry Res 2024; 333:115726. [PMID: 38224632 DOI: 10.1016/j.psychres.2024.115726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 12/15/2023] [Accepted: 01/06/2024] [Indexed: 01/17/2024]
Abstract
Alcohol-related emergency department (ED) visits are common and associated with adverse clinical outcomes, including premature mortality. This population-based retrospective cohort study identified clinically distinct subgroups of individuals who experience alcohol-related ED visits and characterized differences in the risk of adverse outcomes between them. 73,658 individuals who experienced an alcohol-related ED visit in Ontario, Canada between 2017 and 2018 were identified. Latent class analysis (LCA) revealed five clinically distinct subgroups within the overall cohort. These subgroups followed a severity gradient from low-frequency service use for acute intoxication to high-frequency service use for alcohol use disorder (AUD) and related comorbidities. Relative to those presenting for acute intoxication, those presenting for AUD and comorbidities had a much higher risk of hospital admission (adjusted odds ratio [aOR]: 8.26, 95 % confidence interval [CI]: 7.81-8.75) and post-discharge mortality (adjusted hazard ratio [aHR]: 3.07, 95 % CI: 2.81-3.37). There was a subgroup of individuals with a history of high frequency alcohol-related health service use who were at the highest risk of experiencing another alcohol-related ED visit after the index event (aHR: 4.76, 95 % CI: 4.55-4.99). Individuals who experience alcohol-related ED visits are not a homogenous population, but a constellation of subgroups with different clinical characteristics and risk of adverse outcomes.
Collapse
Affiliation(s)
- Erik Loewen Friesen
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada.
| | | | - James Bolton
- Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada; Department of Psychiatry, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Paul Kurdyak
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada
| |
Collapse
|
4
|
Ruegenberg A, Schmiedhofer M, Kreutzberg A, Henschke C, Möckel M, Slagman A. [Black box: Attenders with psychosocial needs in the emergency department]. Med Klin Intensivmed Notfmed 2024; 119:10-17. [PMID: 36635440 PMCID: PMC10803686 DOI: 10.1007/s00063-022-00981-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: 08/10/2022] [Revised: 08/10/2022] [Accepted: 12/01/2022] [Indexed: 01/14/2023]
Abstract
OBJECTIVES The aims are (a) assessment of the prevalence of psychosocial emergencies in the emergency department (ED), (b) determination of the proportion of cases not coded as diagnosis (unreported cases), and (c) characterization of identified patients. METHODS In a retrospective study, psychosocial emergencies in one week were identified from routine documentation of the central ED of the Charité - Universitätsmedizin Berlin, Charité Campus Mitte (CCM). After exclusion of planned admitted cases, 862 patients were included in the study. The identified psychosocial emergencies were descriptively analyzed with regard to their sociodemographic and clinical characteristics and compared with other emergencies. RESULTS The prevalence of psychosocial emergencies in the reported period was 11.9% (n = 103). A large proportion of psychosocial emergencies were not coded (35.9%) or not fully coded (20.4%) as an ICD diagnosis (unreported cases). There was a statistically relevant difference in gender distribution with a significantly higher proportion of males among psychosocial emergencies (70.9%) compared to other emergencies (50.7%; p < 0.0001). The two most common treatment causes among psychosocial emergencies were substance abuse (66.0%) and homelessness (20.4%). CONCLUSIONS This study shows a relevant proportion of psychosocial emergencies among all treatments in ED routine data and a high proportion of cases not captured in the coded diagnoses. EDs thus represent an important point of contact for vulnerable patient groups but standardized screening and identification are still lacking.
Collapse
Affiliation(s)
- Alina Ruegenberg
- Notfallmedizinische Versorgungsforschung, Notfall- und Akutmedizin, Campus Virchow Klinikum (CVK), und Charité Campus Mitte (CCM), Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - Martina Schmiedhofer
- Notfallmedizinische Versorgungsforschung, Notfall- und Akutmedizin, Campus Virchow Klinikum (CVK), und Charité Campus Mitte (CCM), Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - Anika Kreutzberg
- Fachgebiet für Management im Gesundheitswesen, Gesundheitsökonomisches Zentrum Berlin, Technische Universität Berlin, Berlin, Deutschland
| | - Cornelia Henschke
- Fachgebiet für Management im Gesundheitswesen, Gesundheitsökonomisches Zentrum Berlin, Technische Universität Berlin, Berlin, Deutschland
| | - Martin Möckel
- Notfallmedizinische Versorgungsforschung, Notfall- und Akutmedizin, Campus Virchow Klinikum (CVK), und Charité Campus Mitte (CCM), Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - Anna Slagman
- Notfallmedizinische Versorgungsforschung, Notfall- und Akutmedizin, Campus Virchow Klinikum (CVK), und Charité Campus Mitte (CCM), Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
| |
Collapse
|
5
|
Friesen EL, Mataruga A, Nickel N, Kurdyak P, Bolton JM. Outcomes in Clinical Subgroups of Patients With Alcohol-Related Hospitalizations. JAMA Netw Open 2024; 7:e2353971. [PMID: 38294814 PMCID: PMC10831574 DOI: 10.1001/jamanetworkopen.2023.53971] [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] [Received: 08/17/2023] [Accepted: 12/08/2023] [Indexed: 02/01/2024] Open
Abstract
Importance Alcohol-related hospitalizations are common and associated with significant cost to the health care system. We have a limited understanding of the characteristics of individuals who experience alcohol-related hospitalizations, which limits our capacity to prioritize those at the highest risk of postdischarge harm. Objective To identify and characterize the clinical subgroups of individuals who are hospitalized for alcohol-related harms. Design, Setting, and Participants This cohort study used latent class analysis (LCA) to identify clinical subgroups of individuals experiencing alcohol-related hospitalizations in 2 provinces in Canada. All individuals between ages 10 and 105 years who were hospitalized for an alcohol-related harm between January 2017 and December 2018 (ie, the index hospitalization) were eligible. Data were analyzed between June 2023 and August 2023. Exposures The exposure of interest was the clinical subgroup that an individual belonged to. These subgroups were identified using an LCA based on (1) the characteristics of the index hospitalization and (2) the history of alcohol-related health service use. Main Outcomes and Measures In-hospital mortality, alcohol-related hospital readmission, and all-cause mortality in the year following discharge from the index hospitalization. The association between subgroup membership and the risk of in-hospital and postdischarge outcomes was evaluated using multivariable regression. Results A total of 34 043 individuals were included in analysis, 4753 from Manitoba (median [IQR] age, 49 [40-58] years; 1786 female [37.6%]) and 29 290 from Ontario (median [IQR] age, 57 [45-67] years; 8527 female [29.1%]). Seven subgroups were identified following a gradient from low-frequency service use for acute intoxication to high-frequency service use for severe alcohol use disorder and liver disease. In Ontario, there were 4431 individuals in the liver disease subgroup representing 15.5% of the cohort who were at the highest risk of 1-year mortality (1382 [31.2%]) relative to the acute intoxication subgroup (42 [4.0%]) (adjusted hazard ratio [aHR], 3.83; 95% CI, 2.80-5.24). There was also a small subgroup (10.6%) of individuals with high-frequency alcohol-related health service use who had a much higher hazard of readmission following the index hospitalization (1-year readmission: 703 of 1526 [46.1%] vs 104 of 1058 [9.8%] in the acute intoxication subgroup; aHR, 5.09; 95% CI, 4.11-6.31). Conclusions and Relevance In this population-based cohort study of individuals experiencing alcohol-related hospitalizations, we identified several small, clinically distinct subgroups that were at a disproportionately high risk of readmission and mortality. These groups could merit prioritization in strategies aimed at reducing the risk of adverse outcomes following alcohol-related hospitalizations.
Collapse
Affiliation(s)
- Erik L. Friesen
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Mental Health and Addictions Research Program, ICES Central, Toronto, Ontario, Canada
- Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada
| | - Andrea Mataruga
- Mental Health and Addictions Research Program, ICES Central, Toronto, Ontario, Canada
| | - Nathan Nickel
- Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada
- Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Paul Kurdyak
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Mental Health and Addictions Research Program, ICES Central, Toronto, Ontario, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - James M. Bolton
- Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada
- Department of Psychiatry, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| |
Collapse
|
6
|
Lee YK, Trevisan L, S Fuehrlein B. Longitudinal Outcomes of the top 20 Utilizers of VA Connecticut's Psychiatric Emergency Services Between 2010 and 2020. Community Ment Health J 2023; 59:1532-1536. [PMID: 37243739 DOI: 10.1007/s10597-023-01140-y] [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: 10/11/2022] [Accepted: 05/16/2023] [Indexed: 05/29/2023]
Abstract
Frequent utilizers of emergency services represent a clinically important cohort with potentially unmet health care needs despite demanding a high volume of costly services. However, not much is known about their longitudinal course. This study identified the top 20 utilizers of VA Connecticut's psychiatric emergency services and conducted a chart review of their longitudinal outcomes during an 11-year period between 2010 and 2020, including their visit diagnoses, medical and psychiatric comorbidities, and types and frequency of other medical services and supports received. At the index visit, 19 of the 20 patients had substance use disorder and 14 patients had at least one non-substance psychiatric diagnosis. Despite all patients receiving primary care and other services, such as residential treatments, outpatient therapy, and social work consults, 11 of the 12 patients remaining alive and residing in the state continued to utilize psychiatric emergency services in 2020, revealing a pattern of persistent use.
Collapse
Affiliation(s)
- Yu Kyung Lee
- Yale School of Medicine, Yale University School of Medicine, New Haven, USA.
| | - Louis Trevisan
- Yale School of Medicine, Yale University School of Medicine, New Haven, USA
- Department of Psychiatry, Creighton University, Omaha, USA
| | - Brian S Fuehrlein
- Yale School of Medicine, Yale University School of Medicine, New Haven, USA
- Department of Psychiatry, Yale University, New Haven, USA
| |
Collapse
|
7
|
Kurdyak P, Lebenbaum M, Patrikar A, Rivera L, Lu H, Scales DC, Guttmann A. SARS-CoV-2 vaccination prevalence by mental health diagnosis: a population-based cross-sectional study in Ontario, Canada. CMAJ Open 2023; 11:E1066-E1074. [PMID: 37989512 PMCID: PMC10681672 DOI: 10.9778/cmajo.20220210] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Since the onset of the COVID-19 pandemic, there has been concern about the impact of SARS-CoV-2 infection among individuals with mental illnesses. We analyzed the SARS-CoV-2 vaccination status of Ontarians with and without a history of mental illness. METHODS We conducted a population-based cross-sectional study of all community-dwelling Ontario residents aged 19 years and older as of Sept. 17, 2021. We used health administrative data to categorize Ontario residents with a mental disorder (anxiety, mood, substance use, psychotic or other disorder) within the previous 5 years. Vaccine receipt as of Sept. 17, 2021, was compared between individuals with and without a history of mental illness. RESULTS Our sample included 11 900 868 adult Ontario residents. The proportion of individuals not fully vaccinated (2 doses) was higher among those with substance use disorders (37.7%) or psychotic disorders (32.6%) than among those with no mental disorders (22.9%), whereas there were similar proportions among those with anxiety disorders (23.5%), mood disorders (21.5%) and other disorders (22.1%). After adjustment for age, sex, neighbourhood income and homelessness, individuals with psychotic disorders (adjusted prevalence ratio 1.19, 95% confidence interval [CI] 1.18-1.20) and substance use disorders (adjusted prevalence ratio 1.35, 95% CI 1.34-1.35) were more likely to be partially vaccinated or unvaccinated relative to individuals with no mental disorders. INTERPRETATION Our study found that psychotic disorders and substance use disorders were associated with an increased prevalence of being less than fully vaccinated. Efforts to ensure such individuals have access to vaccinations, while challenging, are critical to ensuring the ongoing risks of death and other adverse consequences of SARS-CoV-2 infection are mitigated in this high-risk population.
Collapse
Affiliation(s)
- Paul Kurdyak
- ICES Central (Kurdyak, Lebenbaum, Patrikar, Lu, Scales, Guttmann); Centre for Addiction and Mental Health (Kurdyak); Institute of Health Policy Management and Evaluation (Kurdyak, Lebenbaum, Scales), and Departments of Psychiatry (Rivera) and Paediatrics (Guttmann), and Edwin S.H. Leong Centre for Healthy Children (Guttmann), University of Toronto, Toronto, Ont.
| | - Michael Lebenbaum
- ICES Central (Kurdyak, Lebenbaum, Patrikar, Lu, Scales, Guttmann); Centre for Addiction and Mental Health (Kurdyak); Institute of Health Policy Management and Evaluation (Kurdyak, Lebenbaum, Scales), and Departments of Psychiatry (Rivera) and Paediatrics (Guttmann), and Edwin S.H. Leong Centre for Healthy Children (Guttmann), University of Toronto, Toronto, Ont
| | - Aditi Patrikar
- ICES Central (Kurdyak, Lebenbaum, Patrikar, Lu, Scales, Guttmann); Centre for Addiction and Mental Health (Kurdyak); Institute of Health Policy Management and Evaluation (Kurdyak, Lebenbaum, Scales), and Departments of Psychiatry (Rivera) and Paediatrics (Guttmann), and Edwin S.H. Leong Centre for Healthy Children (Guttmann), University of Toronto, Toronto, Ont
| | - Laura Rivera
- ICES Central (Kurdyak, Lebenbaum, Patrikar, Lu, Scales, Guttmann); Centre for Addiction and Mental Health (Kurdyak); Institute of Health Policy Management and Evaluation (Kurdyak, Lebenbaum, Scales), and Departments of Psychiatry (Rivera) and Paediatrics (Guttmann), and Edwin S.H. Leong Centre for Healthy Children (Guttmann), University of Toronto, Toronto, Ont
| | - Hong Lu
- ICES Central (Kurdyak, Lebenbaum, Patrikar, Lu, Scales, Guttmann); Centre for Addiction and Mental Health (Kurdyak); Institute of Health Policy Management and Evaluation (Kurdyak, Lebenbaum, Scales), and Departments of Psychiatry (Rivera) and Paediatrics (Guttmann), and Edwin S.H. Leong Centre for Healthy Children (Guttmann), University of Toronto, Toronto, Ont
| | - Damon C Scales
- ICES Central (Kurdyak, Lebenbaum, Patrikar, Lu, Scales, Guttmann); Centre for Addiction and Mental Health (Kurdyak); Institute of Health Policy Management and Evaluation (Kurdyak, Lebenbaum, Scales), and Departments of Psychiatry (Rivera) and Paediatrics (Guttmann), and Edwin S.H. Leong Centre for Healthy Children (Guttmann), University of Toronto, Toronto, Ont
| | - Astrid Guttmann
- ICES Central (Kurdyak, Lebenbaum, Patrikar, Lu, Scales, Guttmann); Centre for Addiction and Mental Health (Kurdyak); Institute of Health Policy Management and Evaluation (Kurdyak, Lebenbaum, Scales), and Departments of Psychiatry (Rivera) and Paediatrics (Guttmann), and Edwin S.H. Leong Centre for Healthy Children (Guttmann), University of Toronto, Toronto, Ont
| |
Collapse
|
8
|
Terechin O, Johansen PM, Rosen AR, Morgan M, Fraenkel L. Mortality Rate Among Patients with Alcohol Use Disorder with Two or More Readmissions to the Hospital. J Community Hosp Intern Med Perspect 2023; 13:90-93. [PMID: 37868665 PMCID: PMC10589033 DOI: 10.55729/2000-9666.1235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 06/01/2023] [Accepted: 06/19/2023] [Indexed: 10/24/2023] Open
Abstract
Background Alcohol use disorder is associated with high morbidity and mortality rates, leading to a significant burden worldwide. Increased hazardous alcohol consumption has been reported during the COVID-19 pandemic raising concerns for greater impact of this already prevalent serious medical condition. Methods We conducted chart reviews and described demographic and clinical data for patients with two or more hospital readmissions from June 2020 to July 2021 and followed survival status through June 2022. Results We found a high mortality rate of 10.3%. Most patients had psychiatric conditions listed in the chart (n = 70, 80%). Only 34% (n = 24) of living patients and 6% (n = 1) of deceased patients were under psychiatric care. Rates of the utilization of medications for alcohol use disorder were low (n = 23, 26%). Interpretation We found high mortality rates in patients with two or more hospital readmissions with low rates of utilization of medications for alcohol use disorder and psychiatric care, thus identifying areas of potential improvement.
Collapse
|
9
|
Strayer RJ, Friedman BW, Haroz R, Ketcham E, Klein L, LaPietra AM, Motov S, Repanshek Z, Taylor S, Weiner SG, Nelson LS. Emergency Department Management of Patients With Alcohol Intoxication, Alcohol Withdrawal, and Alcohol Use Disorder: A White Paper Prepared for the American Academy of Emergency Medicine. J Emerg Med 2023; 64:517-540. [PMID: 36997435 DOI: 10.1016/j.jemermed.2023.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 01/06/2023] [Indexed: 03/30/2023]
Affiliation(s)
- Reuben J Strayer
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, New York.
| | - Benjamin W Friedman
- Department of Emergency Medicine, Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Rachel Haroz
- Cooper Medical School of Rowan University, Cooper University Healthcare, Camden, New Jersey
| | - Eric Ketcham
- Department of Emergency Medicine, Department of Behavioral Health, Addiction Medicine, Presbyterian Healthcare System, Santa Fe & Española, New Mexico
| | - Lauren Klein
- Department of Emergency Medicine, Good Samaritan Hospital, West Islip, New York
| | - Alexis M LaPietra
- Department of Emergency Medicine, Saint Joseph's Regional Medical Center, Paterson, New Jersey
| | - Sergey Motov
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, New York
| | - Zachary Repanshek
- Department of Emergency Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Scott Taylor
- Department of Emergency Medicine, Royal Melbourne Hospital, Melbourne, Australia
| | - Scott G Weiner
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Lewis S Nelson
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, New Jersey
| |
Collapse
|
10
|
Goldman-Mellor S, Kaplan MS, Qin P. Mortality Risk Following Nonfatal Injuries With Alcohol Use Disorder Involvement: A One-Year Follow-Up of Emergency Department Patients Using Linked Administrative Data. J Stud Alcohol Drugs 2022; 83:879-887. [PMID: 36484585 PMCID: PMC9756401 DOI: 10.15288/jsad.21-00444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 03/21/2022] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE Patient presentations to the emergency department (ED) for alcohol-involved injury represent a growing public health burden, but their characteristics and sequelae remain understudied. This study examined mortality rates among ED patients presenting with alcohol-involved injuries and assessed how mortality varied by injury intent and other characteristics. METHOD This retrospective cohort study used statewide, longitudinally linked ED patient record and mortality data from California. Participants comprised all residents presenting to a licensed ED in 2009-2012 with a nonfatal injury that involved comorbid diagnosis of alcohol use disorder (AUD; n = 261,222; 59.3% male). Injury intent was defined using International Classification of Diseases, 9th Revision, Clinical Modification external cause-of-injury codes. Cox regression was used to investigate factors associated with 12-month all-cause mortality rates. Age-, sex-, and race/ethnicity-adjusted standardized mortality ratios (SMRs) were calculated using statewide mortality data. RESULTS Most ED injury visits involving an AUD diagnosis were coded as unintentional (75.9%). Following the index ED visit, all-cause mortality among AUD-involved injury patients was 5,205 per 100,000 person-years, five times higher than the demographically matched population (SMR = 5.3; 95% confidence interval [5.2, 5.4]). Adjusted Cox regression models indicated that patients whose index injury was unintentional, and whose AUD was for acute intoxication, had significantly higher mortality. Most deaths among unintentionally injured patients were from natural causes, whereas external-cause deaths were relatively more common in the other patient groups. CONCLUSIONS AUD-involved injury presentations to the ED in California are common and associated with high patient mortality burden, which varies by injury intent. Interventions are needed to reduce excess mortality in these patients.
Collapse
Affiliation(s)
- Sidra Goldman-Mellor
- Department of Public Health, School of Social Sciences, Humanities, and Arts, University of California, Merced, Merced, California
| | - Mark S. Kaplan
- Department of Social Welfare, Luskin School of Public Affairs, University of California, Los Angeles, Los Angeles, California
| | - Ping Qin
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| |
Collapse
|
11
|
Friesen EL, Myran D, Yu W, Rosella L, Selby P, Kurdyak P. Rural-urban disparities in post-discharge outcomes following alcohol-related hospitalizations in Ontario, Canada: A retrospective cohort study. Drug Alcohol Depend 2022; 238:109568. [PMID: 35850027 DOI: 10.1016/j.drugalcdep.2022.109568] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 07/07/2022] [Accepted: 07/08/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Limited access to mental health and addiction (MHA) services in rural areas may increase the risk of recurrent alcohol-related harm among rural, relative to urban, residents. This study evaluated (1) rural-urban differences in clinical trajectories following alcohol-related hospitalizations and (2) whether limited access to MHA services mediates an increased risk of adverse post-discharge outcomes in rural areas. METHODS This was a population-based retrospective cohort study of individuals in Ontario, Canada, who experienced an alcohol-related hospitalization between 2016 and 2018. The primary exposure was rurality. The outcomes of interest were outpatient MHA care, alcohol-related emergency department visits, alcohol-related hospitalizations, and all-cause mortality within one-year of discharge from the index alcohol-related hospitalization. Data were collected using provincial health administrative databases. The associations between rurality and the time to each outcome were assessed using multivariable time-to-event regression. Mediation analyses were conducted using a counterfactual approach. RESULTS 46,657 individuals were included. 11.5% of the cohort died within one year of discharge from the index alcohol-related hospitalization. Relative to urban residents, rural residents were less likely to receive MHA outpatient care (adjusted hazard ratio (aHR): 0.80, 95% confidence interval (CI): 0.75-0.86) and more likely to die (aHR: 1.19, 95% CI: 1.06-1.34) in the year following discharge. The lower likelihood of post-discharge MHA-related care among rural residents mediated 31% (95% CI: 13-46%) of the increased risk of mortality. CONCLUSIONS A lack of follow-up MHA care mediates an increased risk of short-term mortality following alcohol-related hospitalizations in rural, relative to urban, communities.
Collapse
Affiliation(s)
- Erik Loewen Friesen
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada; ICES, Toronto, ON, Canada.
| | - Daniel Myran
- ICES, Toronto, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
| | | | - Laura Rosella
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; ICES, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Peter Selby
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Paul Kurdyak
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada; ICES, Toronto, ON, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
12
|
Goh P, Md Amir Ali LAB, Ou Yong D, Ong G, Quek J, Banu H, Wu JT, Mak CCM, Mao DR. Why Are Some Male Alcohol Misuse Disorder Patients High Utilisers of Emergency Health Services? An Asian Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10795. [PMID: 36078521 PMCID: PMC9518548 DOI: 10.3390/ijerph191710795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/25/2022] [Accepted: 08/25/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Certain alcohol misuse patients heavily utilise the Emergency Department (ED) and Emergency Medical Services (EMS) and may present with intoxication or long-term sequelae of alcohol misuse. Our study explored reasons for repeated ED/EMS utilisation and sought to understand perpetuating and protective factors for drinking. METHODS Face-to-face semi-structured qualitative interviews were conducted. Participants were recruited from an ED in Singapore. Interviews were audio-recorded, transcribed verbatim and underwent manual thematic analysis. Emergent themes were independently reviewed for agreement. Data from medical records, interview transcripts, and field notes were triangulated for analysis. RESULTS All participants were male (n = 20) with an average age of 55.6 years (SD = 8.86). Most were unemployed (75%), did not have tertiary education (75%), were divorced (55%), and had pre-existing psychiatric conditions (60%) and chronic cardiovascular conditions (75%). Reasons for utilisation included a perceived need due to symptoms, although sometimes it was bystanders who called the ambulance. ED/EMS was preferred due to the perceived higher quality and speed of care. Persistent drinking was attributed to social and environmental factors, and as a coping mechanism for stressors. Rehabilitation programs and meaningful activities reduced drinking tendencies. CONCLUSION ED/EMS provide sought-after services for alcohol misuse patients, resulting in high utilisation. Social and medical intervention could improve drinking behaviours and decrease overall ED/EMS utilisation.
Collapse
Affiliation(s)
- Pamela Goh
- Home Team Behavioural Sciences Centre, Ministry of Home Affairs, Singapore 698928, Singapore
| | | | - Donovan Ou Yong
- Emergency Department, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - Gabriel Ong
- Home Team Behavioural Sciences Centre, Ministry of Home Affairs, Singapore 698928, Singapore
| | - Jane Quek
- Home Team Behavioural Sciences Centre, Ministry of Home Affairs, Singapore 698928, Singapore
| | - Halitha Banu
- Home Team Behavioural Sciences Centre, Ministry of Home Affairs, Singapore 698928, Singapore
| | - Jun Tian Wu
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117456, Singapore
| | - Charles Chia Meng Mak
- National Addictions Management Service, Institute of Mental Health, Singapore 539747, Singapore
| | - Desmond Renhao Mao
- Acute & Emergency Care Department, Khoo Teck Puat Hospital, Singapore 768828, Singapore
| |
Collapse
|
13
|
Moe J, Wang YE, Schull MJ, Dong K, McGregor MJ, Hohl CM, Holroyd BR, McGrail KM. Characterizing people with frequent emergency department visits and substance use: a retrospective cohort study of linked administrative data in Ontario, Alberta, and B.C., Canada. BMC Emerg Med 2022; 22:127. [PMID: 35836121 PMCID: PMC9281237 DOI: 10.1186/s12873-022-00673-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 06/15/2022] [Indexed: 11/22/2022] Open
Abstract
Background Substance use is common among people who visit emergency departments (EDs) frequently. We aimed to characterize subgroups within this cohort to better understand care needs/gaps, and generalizability of characteristics in three Canadian provinces. Methods This was a retrospective cohort study (April 1st, 2013 to March 31st, 2016) of ED patients in Ontario, Alberta, and British Columbia (B.C.) We included patients ≥ 18 years with substance use-related healthcare contact during the study period and frequent ED visits, defined as those in the top 10% of ED utilization when all patients were ordered by annual ED visit number. We used linked administrative databases including ED visits and hospitalizations (all provinces); mental heath-related hospitalizations (Ontario and Alberta); and prescriptions, physician services, and mortality (B.C.). We compared to cohorts of people with (1) frequent ED visits and no substance use, and (2) non-frequent ED visits and substance use. We employed cluster analysis to identify subgroups with distinct visit patterns and clinical characteristics during index year, April 1st, 2014 to March 31st, 2015. Results In 2014/15, we identified 19,604, 7,706, and 9,404 people with frequent ED visits and substance use in Ontario, Alberta, and B.C (median 37–43 years; 60.9–63.0% male), whose ED visits and hospitalizations were higher than comparison groups. In all provinces, cluster analyses identified subgroups with “extreme” and “moderate” frequent visits (median 13–19 versus 4–6 visits/year). “Extreme” versus “moderate” subgroups had more hospitalizations, mental health-related ED visits, general practitioner visits but less continuity with one provider, more commonly left against medical advice, and had higher 365-day mortality in B.C. (9.3% versus 6.6%; versus 10.4% among people with frequent ED visits and no substance use, and 4.3% among people with non-frequent ED visits and substance use). The most common ED diagnosis was acute alcohol intoxication in all subgroups. Conclusions Subgroups of people with “extreme” (13–19 visits/year) and “moderate” (4–6 visits/year) frequent ED visits and substance use had similar utilization patterns and characteristics in Ontario, Alberta, and B.C., and the “extreme” subgroup had high mortality. Our findings suggest a need for improved evidence-based substance use disorder management, and strengthened continuity with primary and mental healthcare. Supplementary Information The online version contains supplementary material available at 10.1186/s12873-022-00673-x.
Collapse
Affiliation(s)
- Jessica Moe
- Department of Emergency Medicine, University of British Columbia, Diamond Health Care Centre, 11th Floor - 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada. .,Department of Emergency Medicine, Vancouver General Hospital, 920 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada. .,BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada.
| | - Yueqiao Elle Wang
- Department of Emergency Medicine, University of British Columbia, Diamond Health Care Centre, 11th Floor - 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
| | - Michael J Schull
- Institute for Clinical Evaluative Sciences, G1 06, 075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.,Department of Medicine, University of Toronto, 27 King's College Circle, Toronto, ON, M5S 1A1, Canada
| | - Kathryn Dong
- Department of Emergency Medicine, University of Alberta, 790 University Terrace Building, 8303 - 112 Street, Edmonton, AB, T6G 2T4, Canada
| | - Margaret J McGregor
- Department of Family Practice, University of British Columbia, 3rd Floor David Strangway Building, 5950 University Boulevard, Vancouver, BC, V6T 1Z3, Canada
| | - Corinne M Hohl
- Department of Emergency Medicine, University of British Columbia, Diamond Health Care Centre, 11th Floor - 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.,Department of Emergency Medicine, Vancouver General Hospital, 920 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada
| | - Brian R Holroyd
- Department of Emergency Medicine, University of Alberta, 790 University Terrace Building, 8303 - 112 Street, Edmonton, AB, T6G 2T4, Canada.,Emergency Strategic Clinical Network, Alberta Health Services, 14th Floor, North Tower, 10030 - 107 Street NW, Edmonton, AB, T5J 3E4, Canada
| | - Kimberlyn M McGrail
- School of Population and Public Health and Centre for Health Services and Policy Research, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T1Z3, Canada
| |
Collapse
|
14
|
Goldman-Mellor S, Olfson M, Schoenbaum M. Acute injury mortality and all-cause mortality following emergency department presentation for alcohol use disorder. Drug Alcohol Depend 2022; 236:109472. [PMID: 35490593 PMCID: PMC10492647 DOI: 10.1016/j.drugalcdep.2022.109472] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/11/2022] [Accepted: 04/15/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Alcohol-related morbidity and mortality have increased substantially in the U.S. Understanding the population health implications of these concerning trends, including by identifying clinical subgroups of alcohol users at increased risk for potentially preventable acute causes of mortality, is of critical importance. METHODS This retrospective cohort study used statewide, all-payer, longitudinally-linked ED patient record and mortality data from California. Participants comprised all residents presenting to a licensed ED at least once in 2009-2011 with a diagnosis of alcohol use disorder (AUD). Participants were followed for one year after index ED visit to assess acute injury (unintentional poisoning, suicide, homicide, motor vehicle crash, and fall- or fire-related injury) and all-cause mortality rates per 100,000 person-years. Age-, sex-, race/ethnicity-adjusted standardized mortality rates (SMRs) for acute injury causes of death were determined using statewide mortality data. RESULTS Among 437,855 patients with index non-fatal ED visits for AUD, the 12-month acute injury mortality rate was 608.6 per 100,000 (SMR=8.0; 95% CI=7.7, 8.3), and all-cause mortality was 5700.7 per 100,000 (SMR=6.5; 95% CI=6.4, 6.6). Unintentional poisoning accounted for 46.5%, and suicide for 19.7%, of acute-injury deaths. Acute injury deaths comprised 71.7% of all-cause mortality among patients aged 10-24 years, but much lower proportions among older patients. Female AUD patients had lower rates for all mortality outcomes. CONCLUSIONS Emergency department patients with a recognized AUD comprise a population at persistently elevated risk for mortality. Age-related AUD patient differences in common causes of death, including drug overdose and suicide, can inform the structure of future clinical interventions.
Collapse
Affiliation(s)
- Sidra Goldman-Mellor
- University of California, Merced, Merced, CA 95343, USA; School of Social Sciences, Humanities, and Arts, Merced, CA 95343, USA; Department of Public Health, Merced, Merced, CA 95343, USA.
| | - Mark Olfson
- Departments of Psychiatry and Epidemiology, Columbia University Irving Medical Center, New York, NY, USA.
| | - Michael Schoenbaum
- Division of Services and Intervention Research, National Institute of Mental Health, Bethesda, MD, USA.
| |
Collapse
|
15
|
Myran D, Hsu A, Kunkel E, Rhodes E, Imsirovic H, Tanuseputro P. Socioeconomic and Geographic Disparities in Emergency Department Visits due to Alcohol in Ontario: A Retrospective Population-level Study from 2003 to 2017. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2022; 67:534-543. [PMID: 34254563 PMCID: PMC9234901 DOI: 10.1177/07067437211027321] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE While the overall health system burden of alcohol is large and increasing in Canada, little is known about how this burden differs by sociodemographic factors. The objectives of this study were to assess sociodemographic patterns and temporal trends in emergency department (ED) visits due to alcohol to identify emerging and at-risk subgroups. METHODS We conducted a retrospective population-level cohort study of all individuals aged 10 to 105 living in Ontario, Canada. We identified ED visits due to alcohol between 2003 and 2017 using defined International Classification of Diseases, 10th edition, codes from a pre-existing indicator. We calculated annual age- and sex-standardized, and age- and sex-specific rates of ED visits and compared overall patterns and changes over time between urban and rural settings and income quintiles. RESULTS There were 829,662 ED visits due to alcohol over 15 years. Rates of ED visits due to alcohol were greater for individual living in the lowest- compared to the highest-income quintile neighbourhoods, and disparities (rate ratio lowest to highest quintile) increased with age from 1.22 (95% CI, 1.19 to 1.25) in 15- to 18-year-olds to 4.17 (95% CI, 4.07 to 4.28) in 55- to 59-year-olds. Rates of ED visits due to alcohol were significantly greater in rural settings (56.0 per 10,000 individuals, 95% CI, 55.7 to 56.4) compared to urban settings (44.8 per 10,000 individuals, 95% CI, 44.7 to 44.9), particularly for young adults. Increases in rates of visits between 2003 and 2017 were greater in rural versus urban settings (82 vs. 68% increase in age- and sex-standardized rates) and varied across sociodemographic subgroups with the largest annual increases in rates of visits in young (15 to 29) low-income women (6.9%, 95%CI, 6.7 to 7.3) and the smallest increase in older (45 to 59) high-income men (2.7, 95%CI, 2.4 to 3.0). CONCLUSION Alcohol harms display unique patterns with the highest burden in rural and lower-income populations. Rural-urban and income-based disparities differ by age and sex and have increased over time, which offers an imperative and opportunity for further interventions by clinicians and policy makers.
Collapse
Affiliation(s)
- Daniel Myran
- 10055The Ottawa Hospital Research Institute, Ontario, Canada.,Department of Family Medicine, University of Ottawa, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | - Amy Hsu
- 10055The Ottawa Hospital Research Institute, Ontario, Canada.,Department of Family Medicine, University of Ottawa, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | | | - Emily Rhodes
- 10055The Ottawa Hospital Research Institute, Ontario, Canada
| | | | - Peter Tanuseputro
- Department of Family Medicine, University of Ottawa, Ontario, Canada.,Bruyère Research Institute, Ottawa, Ontario, Canada.,Department of Medicine, University of Ottawa, Ontario, Canada
| |
Collapse
|
16
|
Association of obstructive sleep apnea and opioids use on adverse health outcomes: A population study of health administrative data. PLoS One 2022; 17:e0269112. [PMID: 35763495 PMCID: PMC9239451 DOI: 10.1371/journal.pone.0269112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 05/13/2022] [Indexed: 11/19/2022] Open
Abstract
Rationale
Despite the high prevalence of obstructive sleep apnea (OSA) and concurrent use of opioid therapy, no large-scale population studies have investigated whether opioid use and pre-existing OSA may interact synergistically to increase the risk of adverse health consequences. To address this knowledge gap, we conducted a retrospective cohort study using provincial health administrative data to evaluate whether the combined presence of opioid use and OSA increases the risk of adverse health consequences, such as mortality, hospitalizations, and emergency department (ED) visits; and if it does, whether this co-occurrence has synergistic clinical relevance.
Methods
We included all adults who underwent a diagnostic sleep study in Ontario, Canada, between 2013 and 2016. Individuals were considered exposed to opioids if they filled a prescription that overlapped with the date of their sleep study (Opioid+). Individuals with at least a 50% probability of having a diagnosis of moderate to severe OSA (OSA+) were identified using a previously externally validated case-ascertainment model. The primary outcome was all-cause mortality; secondary outcomes were all-cause or ischemic heart disease hospitalizations, all-cause ED visits, and motor vehicle collisions (MVC) requiring hospital or ED visit. We used multivariable Cox regression models to compare hazards between four mutually exclusive groups: (1) Opioid+ OSA+; (2) Opioid+ OSA-; (3) Opioid- OSA+, and (4) OSA- Opioid- (reference for comparison). Relative excess risks due to interaction (RERI) were calculated to test for additive interaction.
Results
Of 300,663 adults who underwent a sleep study, 15,713 (5.2%) were considered as Opioid+ and 128,351 (42.7%) as OSA+. Over a median of two years, 6,223 (2.1%) died from any cause. Regardless of OSA status, opioid use at the date of the sleep study was associated with an increased hazard for all-cause mortality with the greatest hazard associated with Opioid+ OSA- (adjusted hazard ratio [aHR]: 1.75, 95% CI 1.57–1.94), but not Opioid+ OSA+ (aHR: 1.14, 95% CI 1.02–1.27) as hypothesized. Regardless of OSA status, opioid use at the date of the sleep study was associated with an increased hazard for all secondary outcomes. Opioid+ OSA+ was associated with the greatest hazards of all-cause hospitalizations (aHR 1.55, 95% CI 1.49–1.61) and MVC (aHR of 1.39; 95% CI 1.09–1.77); however, no statistically significant synergistic effects were observed.
Conclusions
Adults referred for sleep disorder assessment who used opioids had a significantly increased hazard of adverse health outcomes than those who did not, regardless of whether they had a high probability of moderate to severe OSA. The use of opioids and OSA was associated with the greatest hazard of all-cause hospitalizations and MVC requiring hospital or ED visit. The interaction of opioids and OSA did not confer a synergistic risk for poor outcomes.
Collapse
|
17
|
Liu Z, Mao DRH, Fook-Chong S, Mak CCM, Tan XXE, Wu JT, Tan KB, Ong MEH, Siddiqui FJ. Nationwide Alcohol-related visits In Singapore's Emergency departments (NAISE): A retrospective population-level study from 2007 to 2016. Drug Alcohol Rev 2022; 41:1236-1244. [PMID: 35437844 DOI: 10.1111/dar.13472] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 03/09/2022] [Accepted: 03/14/2022] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Excessive alcohol consumption is associated with increased morbidity and mortality, and its societal impact is substantial. The Nationwide Alcohol-related visits In Singapore Emergency departments study aims to characterise trends in ED visits involving acute and chronic alcohol consumption between 2007 and 2016. METHODS Data from the Singapore Ministry of Health, comprising all ED visits in Singapore from 2007 to 2016, were used. The data were aggregated by year and analysed for changes in prevalence and rates of ED visits for acute and chronic alcohol consumption, broken down by age, gender and ethnicity. RESULTS Over the study period, the number of ED visits involving alcohol consumption increased 98.3%, from 2236 in 2007 to 4433 in 2016. During the same period, the rate per 100 000 population increased 62.4% from 48.7 to 79.1, and total ED-related costs rose by 140%, from 528 680 to 1 269 638 SGD. The increase in alcohol-related visits rates and costs was higher than non-alcohol-related visits rates and costs, which increased by 12.1% and 115% respectively. While trends in acute and chronic alcohol-related ED visits stayed stable amongst women, they rose substantially in men. Older men aged 50-69 show the highest rates and rate of increase for both acute and chronic alcohol-related ED visits. DISCUSSION AND CONCLUSIONS Alcohol-related visits contributed disproportionately to the increasing number of ED visits in Singapore between 2007 and 2016. Older men form the demographic with the highest rates and increase in rates of alcohol-related ED visits and form a potential group for targeted intervention.
Collapse
Affiliation(s)
- Zhenghong Liu
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
| | | | - Stephanie Fook-Chong
- Prehospital and Emergency Research Centre, Duke-NUS Medical School, Singapore, Singapore
| | - Charles Chia Meng Mak
- National Addictions Management Service, Institute of Mental Health, Singapore, Singapore
| | - Xi Xiang Esther Tan
- Department of Emergency Medicine, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Jun Tian Wu
- Health Services Research Centre, SingHealth, Singapore, Singapore.,Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Kelvin B Tan
- Future Systems Office, Infocomms, Technology and Data Group, Ministry of Health, Singapore, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.,Centre for Regulatory Excellence, Duke-NUS Medical School, Singapore, Singapore
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore.,Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Fahad J Siddiqui
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| |
Collapse
|
18
|
Xie EC, Chan K, Khangura JK, Koh JJK, Orkin AM, Sheikh H, Hayman K, Gupta S, Kumar T, Hulme J, Mrochuk M, Dong K. CAEP position statement on improving emergency care for persons experiencing homelessness: executive summary. CAN J EMERG MED 2022; 24:369-375. [PMID: 35389188 PMCID: PMC8988109 DOI: 10.1007/s43678-022-00303-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 03/18/2022] [Indexed: 11/13/2022]
Affiliation(s)
- Edward C Xie
- Department of Family & Community Medicine, Division of Emergency Medicine, University Health Network, Toronto General Hospital Research Institute, University of Toronto, Toronto, ON, Canada. .,Emergency Department, RFE Building, Toronto General Hospital, Toronto, ON, Canada.
| | - Kathryn Chan
- Division of Emergency Medicine, McMaster University, Hamilton, ON, Canada
| | - Jaspreet K Khangura
- Department of Emergency Medicine, Royal Alexandra Hospital, University of Alberta, Edmonton, AB, Canada.,Department of Emergency Medicine, University of Alberta, Edmonton, AB, Canada
| | - Justin Jek-Kahn Koh
- Department of Emergency Medicine, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Aaron M Orkin
- Department of Family and Community Medicine, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Department of Emergency Medicine, St Joseph's Health Centre, Unity Health Toronto, Inner City Health Associates, Toronto, ON, Canada
| | - Hasan Sheikh
- Division of Emergency Medicine, University Health Network, Toronto, ON, Canada.,Department of Family & Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Kate Hayman
- Division of Emergency Medicine, University Health Network, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sahil Gupta
- Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Thara Kumar
- Department of Emergency Medicine, University of Alberta, Edmonton, AB, Canada.,Medical Officer of Health, Central Zone, Alberta, Canada.,Department of Emergency Medicine, University of Calgary, Calgary, AB, Canada
| | - Jennifer Hulme
- Department of Family and Community Medicine, University Health Network, Toronto General Hospital Research Institute, University of Toronto, Toronto, ON, Canada.,Toronto General Hospital, 200 Elizabeth Street, R. Fraser Elliott Building, Ground Floor, Room 480, Toronto, ON, M5G 2C4, Canada
| | - May Mrochuk
- Department of Emergency Medicine, Royal Alexandra Hospital, University of Alberta, Edmonton, AB, Canada
| | - Kathryn Dong
- Department of Emergency Medicine, University of Alberta, Edmonton, AB, Canada.,B804 Women's Centre, Royal Alexandra Hospital, 10240 Kingsway Avenue, Edmonton, AB, T5H 3V9, Canada
| |
Collapse
|
19
|
Myran DT, Rhodes E, Imsirovic H, Fernando SM, Sood MM, Tanuseputro P. Assessment of Age and Sex Differences in Risk of 1-Year Mortality After Emergency Department Visits Caused by Alcohol Use. JAMA Netw Open 2022; 5:e225499. [PMID: 35377429 PMCID: PMC8980906 DOI: 10.1001/jamanetworkopen.2022.5499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
This cross-sectional study assesses age and sex differences in risk of 1-year mortality in patients with emergency department visits due to alcohol compared with the general population in Ontario, Canada.
Collapse
Affiliation(s)
- Daniel T. Myran
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Emily Rhodes
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Shannon M. Fernando
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Manish M. Sood
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Peter Tanuseputro
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| |
Collapse
|
20
|
Leong C, Bolton JM, Ekuma O, Prior HJ, Singal D, Nepon J, Konrad G, Paillé M, Finlayson G, Nickel N. Association of alcohol use disorder on alcohol-related cancers, diabetes, ischemic heart disease and death: a population-based, matched cohort study. Addiction 2022; 117:368-381. [PMID: 34286922 DOI: 10.1111/add.15646] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 12/04/2020] [Accepted: 07/07/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS High-risk alcohol consumption is associated with compromised health. This study aimed to compare the incidence of alcohol-related cancers, diabetes, ischemic heart disease (IHD) and mortality between those with and without an indication of alcohol use disorder (AUD). DESIGN Retrospective, population-based, matched cohort study using data from the Manitoba Population Research Data Repository. Rates were modeled using generalized linear models with either negative binomial distribution or Poisson distribution and a log offset of person-years to account for each person's time to follow-up. SETTING Manitoba, Canada. PARTICIPANTS Individuals aged ≥ 12 years with a first indication of AUD (index date) between 1 April 1990 and 31 March 2015 were matched to five controls based on age, sex and geographical region at index. This study included 53 410 individuals with AUD and 264 857 matched controls. MEASUREMENTS Adjusted rate ratios (aRR) and 95% confidence intervals (CI) were determined for each outcome from 5 years prior to and 20 years after AUD detection. FINDINGS Alcohol-related cancers (aRR = 4.85, 95% CI = 3.88-6.07 and aRR = 1.85, 95% CI = 1.35-2.53 for men and women, respectively), diabetes (aRR = 1.74, 95% CI = 1.50-2.02 and aRR = 2.43, 95% CI = 2.20-2.68) and IHD (aRR = 3.59, 95% CI = 3.31-3.90 and aRR = 2.92, 95% CI = 2.50-3.41) peaked in the 1 year prior to index for those with AUD compared with matched controls. All-cause mortality (aRR = 3.31, 95% CI = 3.09-3.55 and aRR =3.61, 95% CI = 3.21-4.04) was highest in the year of index and remained higher among cases compared with controls throughout the 20-year follow-up. CONCLUSION People with alcohol use disorder appear to have higher rates of adverse health outcomes in the year before alcohol use disorder recognition, and death at the time of alcohol use disorder recognition, compared with matched controls.
Collapse
Affiliation(s)
- Christine Leong
- College of Pharmacy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - James M Bolton
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada.,Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada.,Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Okechukwu Ekuma
- Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada
| | - Heather J Prior
- Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada
| | - Deepa Singal
- Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada
| | - Josh Nepon
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Geoffrey Konrad
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Michael Paillé
- Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada
| | - Greg Finlayson
- Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada
| | - Nathan Nickel
- Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada.,Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| |
Collapse
|
21
|
Moe J, Wang EY, McGregor MJ, Schull MJ, Dong K, Holroyd BR, Hohl CM, Grafstein E, O'Sullivan F, Trimble J, McGrail KM. Subgroups of people who make frequent emergency department visits in Ontario and Alberta: a retrospective cohort study. CMAJ Open 2022; 10:E232-E246. [PMID: 35292481 PMCID: PMC8929427 DOI: 10.9778/cmajo.20210132] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The population that visits emergency departments frequently is heterogeneous and at high risk for mortality. This study aimed to characterize these patients in Ontario and Alberta, compare them with controls who do not visit emergency departments frequently, and identify subgroups. METHODS This was a retrospective cohort study that captured patients in Ontario or Alberta from fiscal years 2011/12 to 2015/16 in the Dynamic Cohort from the Canadian Institute for Health Information, which defined people with frequent visits to the emergency department in the top 10% of annual visits and randomly selected controls from the bottom 90%. We included patients 18 years of age or older and linked to emergency department, hospitalization, continuing care, home care and mental health-related hospitalization data. We characterized people who made frequent visits to the emergency department over time, compared them with controls and identified subgroups using cluster analysis. We examined emergency department visit acuity using the Canadian Triage and Acuity Scale. RESULTS The number of patients who made frequent visits to the emergency department ranged from 435 334 to 477 647 each year in Ontario (≥ 4 visits per year), and from 98 840 to 105 047 in Alberta (≥ 5 visits per year). The acuity of these visits increased over time. Those who made frequent visits to the emergency department were older and used more health care services than controls. We identified 4 subgroups of those who made frequent visits: "short duration" (frequent, regularly spaced visits), "older patients" (median ages 69 and 64 years in Ontario and Alberta, respectively; more comorbidities; and more admissions), "young mental health" (median ages 45 and 40 years in Ontario and Alberta, respectively; and common mental health-related and alcohol-related visits) and "injury" (increased prevalence of injury-related visits). INTERPRETATION From 2011/12 to 2015/16, people who visited emergency departments frequently had increasing visit acuity, had higher health care use than controls, and comprised distinct subgroups. Emergency departments should codevelop interventions with the identified subgroups to address patient needs.
Collapse
Affiliation(s)
- Jessica Moe
- Department of Emergency Medicine (Moe, Wang, Hohl, Grafstein, O'Sullivan), and of Family Practice (McGregor), University of British Columbia; Department of Emergency Medicine (Moe, Hohl), Vancouver General Hospital; Department of Emergency Medicine, University of British Columbia, Vancouver, BC; ICES (Schull); Department of Medicine (Schull), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Dong, Holroyd), University of Alberta; Emergency Strategic Clinical Network (Holroyd), Alberta Health Services, Edmonton, Alta.; Patients for Patient Safety Canada (Trimble), Ottawa, Ont.; School of Population and Public Health and Centre for Health Services and Policy Research (McGrail), University of British Columbia, Vancouver, BC
| | - Elle Yuequiao Wang
- Department of Emergency Medicine (Moe, Wang, Hohl, Grafstein, O'Sullivan), and of Family Practice (McGregor), University of British Columbia; Department of Emergency Medicine (Moe, Hohl), Vancouver General Hospital; Department of Emergency Medicine, University of British Columbia, Vancouver, BC; ICES (Schull); Department of Medicine (Schull), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Dong, Holroyd), University of Alberta; Emergency Strategic Clinical Network (Holroyd), Alberta Health Services, Edmonton, Alta.; Patients for Patient Safety Canada (Trimble), Ottawa, Ont.; School of Population and Public Health and Centre for Health Services and Policy Research (McGrail), University of British Columbia, Vancouver, BC
| | - Margaret J McGregor
- Department of Emergency Medicine (Moe, Wang, Hohl, Grafstein, O'Sullivan), and of Family Practice (McGregor), University of British Columbia; Department of Emergency Medicine (Moe, Hohl), Vancouver General Hospital; Department of Emergency Medicine, University of British Columbia, Vancouver, BC; ICES (Schull); Department of Medicine (Schull), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Dong, Holroyd), University of Alberta; Emergency Strategic Clinical Network (Holroyd), Alberta Health Services, Edmonton, Alta.; Patients for Patient Safety Canada (Trimble), Ottawa, Ont.; School of Population and Public Health and Centre for Health Services and Policy Research (McGrail), University of British Columbia, Vancouver, BC
| | - Michael J Schull
- Department of Emergency Medicine (Moe, Wang, Hohl, Grafstein, O'Sullivan), and of Family Practice (McGregor), University of British Columbia; Department of Emergency Medicine (Moe, Hohl), Vancouver General Hospital; Department of Emergency Medicine, University of British Columbia, Vancouver, BC; ICES (Schull); Department of Medicine (Schull), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Dong, Holroyd), University of Alberta; Emergency Strategic Clinical Network (Holroyd), Alberta Health Services, Edmonton, Alta.; Patients for Patient Safety Canada (Trimble), Ottawa, Ont.; School of Population and Public Health and Centre for Health Services and Policy Research (McGrail), University of British Columbia, Vancouver, BC
| | - Kathryn Dong
- Department of Emergency Medicine (Moe, Wang, Hohl, Grafstein, O'Sullivan), and of Family Practice (McGregor), University of British Columbia; Department of Emergency Medicine (Moe, Hohl), Vancouver General Hospital; Department of Emergency Medicine, University of British Columbia, Vancouver, BC; ICES (Schull); Department of Medicine (Schull), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Dong, Holroyd), University of Alberta; Emergency Strategic Clinical Network (Holroyd), Alberta Health Services, Edmonton, Alta.; Patients for Patient Safety Canada (Trimble), Ottawa, Ont.; School of Population and Public Health and Centre for Health Services and Policy Research (McGrail), University of British Columbia, Vancouver, BC
| | - Brian R Holroyd
- Department of Emergency Medicine (Moe, Wang, Hohl, Grafstein, O'Sullivan), and of Family Practice (McGregor), University of British Columbia; Department of Emergency Medicine (Moe, Hohl), Vancouver General Hospital; Department of Emergency Medicine, University of British Columbia, Vancouver, BC; ICES (Schull); Department of Medicine (Schull), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Dong, Holroyd), University of Alberta; Emergency Strategic Clinical Network (Holroyd), Alberta Health Services, Edmonton, Alta.; Patients for Patient Safety Canada (Trimble), Ottawa, Ont.; School of Population and Public Health and Centre for Health Services and Policy Research (McGrail), University of British Columbia, Vancouver, BC
| | - Corinne M Hohl
- Department of Emergency Medicine (Moe, Wang, Hohl, Grafstein, O'Sullivan), and of Family Practice (McGregor), University of British Columbia; Department of Emergency Medicine (Moe, Hohl), Vancouver General Hospital; Department of Emergency Medicine, University of British Columbia, Vancouver, BC; ICES (Schull); Department of Medicine (Schull), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Dong, Holroyd), University of Alberta; Emergency Strategic Clinical Network (Holroyd), Alberta Health Services, Edmonton, Alta.; Patients for Patient Safety Canada (Trimble), Ottawa, Ont.; School of Population and Public Health and Centre for Health Services and Policy Research (McGrail), University of British Columbia, Vancouver, BC
| | - Eric Grafstein
- Department of Emergency Medicine (Moe, Wang, Hohl, Grafstein, O'Sullivan), and of Family Practice (McGregor), University of British Columbia; Department of Emergency Medicine (Moe, Hohl), Vancouver General Hospital; Department of Emergency Medicine, University of British Columbia, Vancouver, BC; ICES (Schull); Department of Medicine (Schull), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Dong, Holroyd), University of Alberta; Emergency Strategic Clinical Network (Holroyd), Alberta Health Services, Edmonton, Alta.; Patients for Patient Safety Canada (Trimble), Ottawa, Ont.; School of Population and Public Health and Centre for Health Services and Policy Research (McGrail), University of British Columbia, Vancouver, BC
| | - Fiona O'Sullivan
- Department of Emergency Medicine (Moe, Wang, Hohl, Grafstein, O'Sullivan), and of Family Practice (McGregor), University of British Columbia; Department of Emergency Medicine (Moe, Hohl), Vancouver General Hospital; Department of Emergency Medicine, University of British Columbia, Vancouver, BC; ICES (Schull); Department of Medicine (Schull), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Dong, Holroyd), University of Alberta; Emergency Strategic Clinical Network (Holroyd), Alberta Health Services, Edmonton, Alta.; Patients for Patient Safety Canada (Trimble), Ottawa, Ont.; School of Population and Public Health and Centre for Health Services and Policy Research (McGrail), University of British Columbia, Vancouver, BC
| | - Johanna Trimble
- Department of Emergency Medicine (Moe, Wang, Hohl, Grafstein, O'Sullivan), and of Family Practice (McGregor), University of British Columbia; Department of Emergency Medicine (Moe, Hohl), Vancouver General Hospital; Department of Emergency Medicine, University of British Columbia, Vancouver, BC; ICES (Schull); Department of Medicine (Schull), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Dong, Holroyd), University of Alberta; Emergency Strategic Clinical Network (Holroyd), Alberta Health Services, Edmonton, Alta.; Patients for Patient Safety Canada (Trimble), Ottawa, Ont.; School of Population and Public Health and Centre for Health Services and Policy Research (McGrail), University of British Columbia, Vancouver, BC
| | - Kimberlyn M McGrail
- Department of Emergency Medicine (Moe, Wang, Hohl, Grafstein, O'Sullivan), and of Family Practice (McGregor), University of British Columbia; Department of Emergency Medicine (Moe, Hohl), Vancouver General Hospital; Department of Emergency Medicine, University of British Columbia, Vancouver, BC; ICES (Schull); Department of Medicine (Schull), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Dong, Holroyd), University of Alberta; Emergency Strategic Clinical Network (Holroyd), Alberta Health Services, Edmonton, Alta.; Patients for Patient Safety Canada (Trimble), Ottawa, Ont.; School of Population and Public Health and Centre for Health Services and Policy Research (McGrail), University of British Columbia, Vancouver, BC
| |
Collapse
|
22
|
Profiles of high emergency department users with mental disorders. Am J Emerg Med 2022; 54:131-141. [DOI: 10.1016/j.ajem.2022.01.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 11/20/2022] Open
|
23
|
Moe J, Wang EY, McGregor MJ, Schull MJ, Dong K, Holroyd BR, Hohl CM, Grafstein E, O'Sullivan F, Trimble J, McGrail KM. People who make frequent emergency department visits based on persistence of frequent use in Ontario and Alberta: a retrospective cohort study. CMAJ Open 2022; 10:E220-E231. [PMID: 35292480 PMCID: PMC8929439 DOI: 10.9778/cmajo.20210131] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The factors that underlie persistent frequent visits to the emergency department are poorly understood. This study aimed to characterize people who visit emergency departments frequently in Ontario and Alberta, by number of years of frequent use. METHODS This was a retrospective cohort study aimed at capturing information about patients visiting emergency departments in Ontario and Alberta, Canada, from Apr. 1, 2011, to Mar. 31, 2016. We identified people 18 years or older with frequent emergency department use (top 10% of emergency department use) in fiscal year 2015/16, using the Dynamic Cohort from the Canadian Institute of Health Information. We then organized them into subgroups based on the number of years (1 to 5) in which they met the threshold for frequent use over the study period. We characterized subgroups using linked emergency department, hospitalization and mental health-related hospitalization data. RESULTS We identified 252 737 people in Ontario and 63 238 people in Alberta who made frequent visits to the emergency department. In Ontario and Alberta, 44.3% and 44.7%, respectively, met the threshold for frequent use in only 1 year and made 37.9% and 38.5% of visits; 6.8% and 8.2% met the threshold for frequent use over 5 years and made 11.9% and 13.2% of visits. Many characteristics followed gradients based on persistence of frequent use: as years of frequent visits increased (1 to 5 years), people had more comorbidities, homelessness, rural residence, annual emergency department visits, alcohol- and substance use-related presentations, mental health hospitalizations and instances of leaving hospital against medical advice. INTERPRETATION Higher levels of comorbidities, mental health issues, substance use and rural residence were seen with increasing years of frequent emergency department use. Interventions upstream and in the emergency department must address unmet needs, including services for substance use and social supports.
Collapse
Affiliation(s)
- Jessica Moe
- Department of Emergency Medicine (Moe, Wang, Hohl, O'Sullivan), University of British Columbia; Department of Emergency Medicine (Moe, Hohl), Vancouver General Hospital; Department of Family Practice (McGregor), Department of Emergency Medicine (Grafstein), University of British Columbia, Vancouver, BC; ICES Central (Schull); Department of Medicine (Schull), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Dong, Holroyd), University of Alberta; Emergency Strategic Clinical Network (Holroyd), Alberta Health Services, Edmonton, Alta.; Vancouver Coastal Health (Grafstein), Vancouver, BC; Providence Health Care (Grafstein), Vancouver, BC; Patients for Patient Safety Canada (Trimble), Ottawa, Ont.; School of Population and Public Health and Centre for Health Services and Policy Research (McGrail), University of British Columbia, Vancouver, BC
| | - Elle Yuequiao Wang
- Department of Emergency Medicine (Moe, Wang, Hohl, O'Sullivan), University of British Columbia; Department of Emergency Medicine (Moe, Hohl), Vancouver General Hospital; Department of Family Practice (McGregor), Department of Emergency Medicine (Grafstein), University of British Columbia, Vancouver, BC; ICES Central (Schull); Department of Medicine (Schull), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Dong, Holroyd), University of Alberta; Emergency Strategic Clinical Network (Holroyd), Alberta Health Services, Edmonton, Alta.; Vancouver Coastal Health (Grafstein), Vancouver, BC; Providence Health Care (Grafstein), Vancouver, BC; Patients for Patient Safety Canada (Trimble), Ottawa, Ont.; School of Population and Public Health and Centre for Health Services and Policy Research (McGrail), University of British Columbia, Vancouver, BC
| | - Margaret J McGregor
- Department of Emergency Medicine (Moe, Wang, Hohl, O'Sullivan), University of British Columbia; Department of Emergency Medicine (Moe, Hohl), Vancouver General Hospital; Department of Family Practice (McGregor), Department of Emergency Medicine (Grafstein), University of British Columbia, Vancouver, BC; ICES Central (Schull); Department of Medicine (Schull), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Dong, Holroyd), University of Alberta; Emergency Strategic Clinical Network (Holroyd), Alberta Health Services, Edmonton, Alta.; Vancouver Coastal Health (Grafstein), Vancouver, BC; Providence Health Care (Grafstein), Vancouver, BC; Patients for Patient Safety Canada (Trimble), Ottawa, Ont.; School of Population and Public Health and Centre for Health Services and Policy Research (McGrail), University of British Columbia, Vancouver, BC
| | - Michael J Schull
- Department of Emergency Medicine (Moe, Wang, Hohl, O'Sullivan), University of British Columbia; Department of Emergency Medicine (Moe, Hohl), Vancouver General Hospital; Department of Family Practice (McGregor), Department of Emergency Medicine (Grafstein), University of British Columbia, Vancouver, BC; ICES Central (Schull); Department of Medicine (Schull), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Dong, Holroyd), University of Alberta; Emergency Strategic Clinical Network (Holroyd), Alberta Health Services, Edmonton, Alta.; Vancouver Coastal Health (Grafstein), Vancouver, BC; Providence Health Care (Grafstein), Vancouver, BC; Patients for Patient Safety Canada (Trimble), Ottawa, Ont.; School of Population and Public Health and Centre for Health Services and Policy Research (McGrail), University of British Columbia, Vancouver, BC
| | - Kathryn Dong
- Department of Emergency Medicine (Moe, Wang, Hohl, O'Sullivan), University of British Columbia; Department of Emergency Medicine (Moe, Hohl), Vancouver General Hospital; Department of Family Practice (McGregor), Department of Emergency Medicine (Grafstein), University of British Columbia, Vancouver, BC; ICES Central (Schull); Department of Medicine (Schull), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Dong, Holroyd), University of Alberta; Emergency Strategic Clinical Network (Holroyd), Alberta Health Services, Edmonton, Alta.; Vancouver Coastal Health (Grafstein), Vancouver, BC; Providence Health Care (Grafstein), Vancouver, BC; Patients for Patient Safety Canada (Trimble), Ottawa, Ont.; School of Population and Public Health and Centre for Health Services and Policy Research (McGrail), University of British Columbia, Vancouver, BC
| | - Brian R Holroyd
- Department of Emergency Medicine (Moe, Wang, Hohl, O'Sullivan), University of British Columbia; Department of Emergency Medicine (Moe, Hohl), Vancouver General Hospital; Department of Family Practice (McGregor), Department of Emergency Medicine (Grafstein), University of British Columbia, Vancouver, BC; ICES Central (Schull); Department of Medicine (Schull), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Dong, Holroyd), University of Alberta; Emergency Strategic Clinical Network (Holroyd), Alberta Health Services, Edmonton, Alta.; Vancouver Coastal Health (Grafstein), Vancouver, BC; Providence Health Care (Grafstein), Vancouver, BC; Patients for Patient Safety Canada (Trimble), Ottawa, Ont.; School of Population and Public Health and Centre for Health Services and Policy Research (McGrail), University of British Columbia, Vancouver, BC
| | - Corinne M Hohl
- Department of Emergency Medicine (Moe, Wang, Hohl, O'Sullivan), University of British Columbia; Department of Emergency Medicine (Moe, Hohl), Vancouver General Hospital; Department of Family Practice (McGregor), Department of Emergency Medicine (Grafstein), University of British Columbia, Vancouver, BC; ICES Central (Schull); Department of Medicine (Schull), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Dong, Holroyd), University of Alberta; Emergency Strategic Clinical Network (Holroyd), Alberta Health Services, Edmonton, Alta.; Vancouver Coastal Health (Grafstein), Vancouver, BC; Providence Health Care (Grafstein), Vancouver, BC; Patients for Patient Safety Canada (Trimble), Ottawa, Ont.; School of Population and Public Health and Centre for Health Services and Policy Research (McGrail), University of British Columbia, Vancouver, BC
| | - Eric Grafstein
- Department of Emergency Medicine (Moe, Wang, Hohl, O'Sullivan), University of British Columbia; Department of Emergency Medicine (Moe, Hohl), Vancouver General Hospital; Department of Family Practice (McGregor), Department of Emergency Medicine (Grafstein), University of British Columbia, Vancouver, BC; ICES Central (Schull); Department of Medicine (Schull), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Dong, Holroyd), University of Alberta; Emergency Strategic Clinical Network (Holroyd), Alberta Health Services, Edmonton, Alta.; Vancouver Coastal Health (Grafstein), Vancouver, BC; Providence Health Care (Grafstein), Vancouver, BC; Patients for Patient Safety Canada (Trimble), Ottawa, Ont.; School of Population and Public Health and Centre for Health Services and Policy Research (McGrail), University of British Columbia, Vancouver, BC
| | - Fiona O'Sullivan
- Department of Emergency Medicine (Moe, Wang, Hohl, O'Sullivan), University of British Columbia; Department of Emergency Medicine (Moe, Hohl), Vancouver General Hospital; Department of Family Practice (McGregor), Department of Emergency Medicine (Grafstein), University of British Columbia, Vancouver, BC; ICES Central (Schull); Department of Medicine (Schull), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Dong, Holroyd), University of Alberta; Emergency Strategic Clinical Network (Holroyd), Alberta Health Services, Edmonton, Alta.; Vancouver Coastal Health (Grafstein), Vancouver, BC; Providence Health Care (Grafstein), Vancouver, BC; Patients for Patient Safety Canada (Trimble), Ottawa, Ont.; School of Population and Public Health and Centre for Health Services and Policy Research (McGrail), University of British Columbia, Vancouver, BC
| | - Johanna Trimble
- Department of Emergency Medicine (Moe, Wang, Hohl, O'Sullivan), University of British Columbia; Department of Emergency Medicine (Moe, Hohl), Vancouver General Hospital; Department of Family Practice (McGregor), Department of Emergency Medicine (Grafstein), University of British Columbia, Vancouver, BC; ICES Central (Schull); Department of Medicine (Schull), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Dong, Holroyd), University of Alberta; Emergency Strategic Clinical Network (Holroyd), Alberta Health Services, Edmonton, Alta.; Vancouver Coastal Health (Grafstein), Vancouver, BC; Providence Health Care (Grafstein), Vancouver, BC; Patients for Patient Safety Canada (Trimble), Ottawa, Ont.; School of Population and Public Health and Centre for Health Services and Policy Research (McGrail), University of British Columbia, Vancouver, BC
| | - Kimberlyn M McGrail
- Department of Emergency Medicine (Moe, Wang, Hohl, O'Sullivan), University of British Columbia; Department of Emergency Medicine (Moe, Hohl), Vancouver General Hospital; Department of Family Practice (McGregor), Department of Emergency Medicine (Grafstein), University of British Columbia, Vancouver, BC; ICES Central (Schull); Department of Medicine (Schull), University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Dong, Holroyd), University of Alberta; Emergency Strategic Clinical Network (Holroyd), Alberta Health Services, Edmonton, Alta.; Vancouver Coastal Health (Grafstein), Vancouver, BC; Providence Health Care (Grafstein), Vancouver, BC; Patients for Patient Safety Canada (Trimble), Ottawa, Ont.; School of Population and Public Health and Centre for Health Services and Policy Research (McGrail), University of British Columbia, Vancouver, BC
| |
Collapse
|
24
|
Koh JJK, Malczewska M, Doyle MM, Moe J. Prevention of alcohol withdrawal seizure recurrence and treatment of other alcohol withdrawal symptoms in the emergency department: a rapid review. BMC Emerg Med 2021; 21:131. [PMID: 34742248 PMCID: PMC8572067 DOI: 10.1186/s12873-021-00524-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 10/22/2021] [Indexed: 11/10/2022] Open
Abstract
Background Patients who experience harms from alcohol and other substance use often seek care in the emergency department (ED). ED visits related to alcohol withdrawal have increased across the world during the COVID-19 pandemic. ED clinicians are responsible for risk-stratifying patients under time and resource constraints and must reliably identify those who are safe for outpatient management versus those who require more intensive levels of care. Published guidelines for alcohol withdrawal are largely limited to the primary care and outpatient settings, and do not provide specific guidance for ED use. The purpose of this review was to synthesize published evidence on the treatment of alcohol withdrawal syndrome in the ED. Methods We conducted a rapid review by searching MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials (1980 to 2020). We searched for grey literature on Google and hand-searched the conference abstracts of relevant addiction medicine and emergency medicine professional associations (2015 to 2020). We included interventional and observational studies that reported outcomes of clinical interventions aimed at treating alcohol withdrawal syndrome in adults in the ED. Results We identified 13 studies that met inclusion criteria for our review (7 randomized controlled trials and 6 observational studies). Most studies were at high/serious risk of bias. We divided studies based on intervention and summarized evidence narratively. Benzodiazepines decrease alcohol withdrawal seizure recurrence and treat other alcohol withdrawal symptoms, but no clear evidence supports the use of one benzodiazepine over another. It is unclear if symptom-triggered benzodiazepine protocols are effective for use in the ED. More evidence is needed to determine if phenobarbital, with or without benzodiazepines, can be used safely and effectively to treat alcohol withdrawal in the ED. Phenytoin does not have evidence of effectiveness at preventing withdrawal seizures in the ED. Conclusions Few studies have evaluated the safety and efficacy of pharmacotherapies for alcohol withdrawal specifically in the ED setting. Benzodiazepines are the most evidence-based treatment for alcohol withdrawal in the ED. Pharmacotherapies that have demonstrated benefit for treatment of alcohol withdrawal in other inpatient and outpatient settings should be evaluated in the ED setting before routine use.
Collapse
Affiliation(s)
- Justin Jek-Kahn Koh
- Addiction Medicine Fellowship Program, British Columbia Centre for Substance Use, Vancouver, BC, Canada. .,Royal College Emergency Medicine Residency Program, Department of Emergency Medicine, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada.
| | | | - Mary M Doyle
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Jessica Moe
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada.,Department of Emergency Medicine, Vancouver General Hospital, Vancouver, BC, Canada.,British Columbia Centre for Disease Control, Vancouver, BC, Canada
| |
Collapse
|
25
|
Konrad G, Leong C, Bolton JM, Prior HJ, Paillé MT, Nepon J, Singal D, Ekuma O, Enns JE, Nickel NC. Use of pharmacotherapy for alcohol use disorder in Manitoba, Canada: A whole-population cohort study. PLoS One 2021; 16:e0257025. [PMID: 34478448 PMCID: PMC8415582 DOI: 10.1371/journal.pone.0257025] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 08/22/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Update the evidence on use of pharmacotherapy for alcohol use disorder in a Canadian population. METHODS Using whole-population administrative data from Manitoba, Canada, we identified all residents age 12+ who were first diagnosed with alcohol use disorder between April 1, 1996 and March 31, 2015, and compared characteristics of those who filled a prescription for naltrexone, acamprosate or disulfiram at least once during that period to those who did not fill a prescription for an alcohol use disorder medication. RESULTS Only 1.3% of individuals with alcohol use disorder received pharmacotherapy (62.3% of prescriptions were for naltrexone, 39.4% for acamprosate, 7.5% for disulfiram). Most prescriptions came from family physicians in urban alcohol use disorder (53.6%) and psychiatrists (22.3%). Individuals were more likely to fill a prescription for alcohol use disorder medication if they lived in an urban vs rural environment (OR 2.25; 95% CI 1.83-2.77) or had a mood/anxiety disorder diagnosis vs no diagnosis (OR 2.40, 95% CI 1.98-2.90) in the five years before being diagnosed with alcohol use disorder. CONCLUSION Despite established evidence for the effectiveness of pharmacotherapy for alcohol use disorder, these medications continue to be profoundly underutilized in Canada.
Collapse
Affiliation(s)
- Geoffrey Konrad
- Department of Psychiatry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Christine Leong
- Department of Psychiatry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - James M. Bolton
- Department of Psychiatry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Heather J. Prior
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Michael T. Paillé
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Josh Nepon
- Department of Psychiatry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Deepa Singal
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Okechukwu Ekuma
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Jennifer E. Enns
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Nathan C. Nickel
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- Dept. of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| |
Collapse
|
26
|
Rojo-Mira J, Pineda-Álvarez M, Zapata-Ospina JP. Efficacy and Safety of Anticonvulsants for the Inpatient Treatment of Alcohol Withdrawal Syndrome: A Systematic Review and Meta-analysis. Alcohol Alcohol 2021; 57:155-164. [PMID: 34396386 DOI: 10.1093/alcalc/agab057] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/25/2021] [Accepted: 07/25/2021] [Indexed: 11/12/2022] Open
Abstract
AIM To examine the efficacy and safety of antiepileptic drugs (AED) for the inpatient treatment of patients with moderate to severe alcohol withdrawal syndrome (AWS). METHODS We searched in databases and gray literature to include randomized controlled clinical trials in adults that compare the use of AED versus placebo or any other medication. Studies that did not specify severity or were performed on an outpatient basis were excluded. The outcomes were improvement of symptoms, delirium tremens, seizures and adverse events. Two researchers independently selected the references, extracted the data and assessed the risk of bias. A qualitative synthesis was made and, when the heterogeneity was mild or moderate, a meta-analysis was performed. The quality of the evidence obtained was evaluated with the Grading of Recommendations Assessment, Development and Evaluation tool. RESULTS In total, 26 studies with 1709 patients were included. No benefit is described in withdrawal syndrome severity measured by scales or in the development of delirium tremens. The only possible meta-analysis showed that there are no differences in the incidence of seizures (risk ratio [RR] = 1.0; confidence interval (CI) 95% 0.76-1.33), even when compared with placebo (RR = 0.95; CI95% 0.57-1.57). There were also no differences in adverse events, although a higher proportion of some mild cases were described with the use of carbamazepine and valproic acid. CONCLUSIONS The routine use of AED is not suggested in the treatment of patients with moderate or severe AWS unless indicated for comorbidity (weak recommendation against using moderate quality of evidence).
Collapse
Affiliation(s)
- Jenny Rojo-Mira
- Department of Pharmacology and Toxicology, School of Medicine, Universidad de Antioquia, Medellín, Colombia
| | | | - Juan P Zapata-Ospina
- Institute of Medical Research, Grupo Académico de Epidemiología Clínica (GRAEPIC), School of Medicine, Universidad de Antioquia, Medellín, Colombia
| |
Collapse
|