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Fleury MJ, Imboua A, Grenier G. Barriers and Facilitators to High Emergency Department Use Among Patients with Mental Disorders: A Qualitative Investigation. Community Ment Health J 2024; 60:869-884. [PMID: 38383882 DOI: 10.1007/s10597-024-01239-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 01/17/2024] [Indexed: 02/23/2024]
Abstract
This qualitative study explored reasons for high emergency department (ED) use (3 + visits/year) among 299 patients with mental disorders (MD) recruited in four ED in Quebec, Canada. A conceptual framework including healthcare system and ED organizational features, patient profiles, and professional practice guided the content analysis. Results highlighted insufficient access to and inadequacy of outpatient care. While some patients were quite satisfied with ED care, most criticized the lack of referrals or follow-up care. Patient profiles justifying high ED use were strongly associated with health and social issues perceived as needing immediate care. The main barriers in professional practice involved lack of MD expertise among primary care clinicians, and insufficient follow-up by psychiatrists in response to patient needs. Collaboration with outpatient care may be prioritized to reduce high ED use and improve ED interventions by strengthening the discharge process, and increasing access to outpatient care.
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Affiliation(s)
- Marie-Josée Fleury
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC, H3A 1A1, Canada.
- Douglas Hospital Research Centre, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada.
| | - Armelle Imboua
- Douglas Hospital Research Centre, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada
| | - Guy Grenier
- Douglas Hospital Research Centre, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada
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2
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Wang PR, Anand A, Bena JF, Morrison S, Weleff J. Changes in Emergency Department Utilization in Vulnerable Populations After COVID-19 Shelter-in-Place Orders. Cureus 2024; 16:e60556. [PMID: 38887338 PMCID: PMC11182374 DOI: 10.7759/cureus.60556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2024] [Indexed: 06/20/2024] Open
Abstract
OBJECTIVES This study aims to compare emergency department (ED) utilization and admission rates for patients with a history of mental health (MH) disorders, substance use disorders (SUDs), and social determinants of health (SDOH) before and after implementing COVID-19 shelter-in-place (SIP) orders. METHODS This was a retrospective, multicenter study leveraging electronic medical record (EMR) data from 20 EDs across a large Midwest integrated healthcare system from 5/2/2019 to 12/31/2019 (pre-SIP) and from 5/2/2020 to 12/31/2020 (post-SIP). Diagnoses were documented in the patient's medical records. Poisson and logistic regression models were used to evaluate ED utilization and admission rate changes. RESULTS A total of 871,020 ED encounters from 487,028 unique patients were captured. Overall, 2,572 (0.53%) patients had a documented Z code for SDOH. Patients with previously diagnosed MH disorders or SUDs were more likely to seek ED care after the SIP orders were implemented (risk ratio (RR): 1.20, 95% confidence interval (CI): 1.18-1.22, p<0.001), as were patients with SDOH (RR: 2.37, 95% CI: 2.19-2.55, p<0.001). Patients with both previously diagnosed MH disorders or SUDs and a documented SDOH had even higher ED utilization (RR: 3.31, 95% CI: 2.83-3.88, p<0.001) than those with either condition alone. Patients with MH disorders and SUDs (OR: 0.89, 95% CI: 0.86-0.92, p<0.001) or SDOH (OR: 0.67, 95% CI: 0.54-0.83, p<0.001) were less likely to be admitted post-SIP orders, while patients with a history of diseases of physiologic systems were more likely to be admitted. CONCLUSION Vulnerable populations with a history of MH disorders, SUDs, and SDOH experienced increased ED utilization but a lower rate of hospital admissions after the implementation of SIP orders. The findings highlight the importance of addressing these needs to mitigate the impact of public health crises on these populations.
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Affiliation(s)
- Philip R Wang
- Department of Psychiatry, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, USA
| | - Akhil Anand
- Department of Psychiatry and Psychology, Neurological Institute, Cleveland Clinic, Cleveland, USA
| | - James F Bena
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, USA
| | - Shannon Morrison
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, USA
| | - Jeremy Weleff
- Department of Psychiatry, Yale School of Medicine, New Haven, USA
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Choudhury S, Choi SL, Lee Y, Manser SS. Examining the Role of Self-Harm in the Relationship between Emergency Department Service Utilization and Trauma-Induced Homelessness among Homeless Individuals in Texas. HEALTH & SOCIAL WORK 2024; 49:87-94. [PMID: 38478764 DOI: 10.1093/hsw/hlae002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 08/17/2023] [Accepted: 09/08/2023] [Indexed: 04/30/2024]
Abstract
Homelessness is a complex public health problem in the United States. Current or ongoing history of trauma among individuals adds to the complexity and challenges of homelessness. Our study assessed the moderating role of self-harm in the association between emergency department (ED) service utilization and trauma-induced homelessness (TIH) among adults in Texas. Homeless adults (N = 282) who completed their baseline Vulnerability Index Service Prioritization Decision Assistance Prescreen Tool survey between February 2021 and February 2022 at a Local Mental Health Authority in Texas were selected. The outcome variable, TIH, was assessed by current period of homelessness due to experiencing trauma or abuse. The main independent variable was ED utilization, while self-harm in the past year was assessed as the moderating variable. A multivariate logistic regression with a moderation analysis was conducted while adjusting for the covariates. Individuals who utilized ED services and engaged in self-harm and risky behaviors had greater odds of experiencing current period of TIH. Male respondents were less likely to experience TIH. Finally, engaging in self-harm significantly moderated the association between ED service use and TIH. This study may help inform efforts to develop tailored interventions and promote resilience-based approaches to improve health outcomes among individuals experiencing homelessness due to TIH.
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Affiliation(s)
- Sumaita Choudhury
- MPH, is a doctoral candidate and research associate, Texas Institute for Excellence in Mental Health, Steve Hicks School of Social Work, University of Texas at Austin, 1823 Red River Street, Austin, TX 78712, USA
| | - Sharon Lee Choi
- PhD, is a research associate, Texas Institute for Excellence in Mental Health, Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, USA
| | - Yehyang Lee
- MS, is a graduate research assistant, Texas Institute for Excellence in Mental Health, Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, USA
| | - Stacey Stevens Manser
- PhD, is a research scientist and associate director, Texas Institute for Excellence in Mental Health, Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, USA
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Helm AF, Andre MA, Shaffer PM, Bruzios KE, Marcus S, Harter J, Smelson D. Multicomponent Co-Occurring Disorders Treatment and Wraparound Services for Individuals Experiencing Chronic Homelessness. Community Ment Health J 2024:10.1007/s10597-024-01271-w. [PMID: 38625650 DOI: 10.1007/s10597-024-01271-w] [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: 08/21/2023] [Accepted: 03/19/2024] [Indexed: 04/17/2024]
Abstract
Individuals experiencing chronic homelessness have high rates of persistent co-occurring mental health and substance use disorders (COD), and they often have difficulty with service engagement and retention, resulting in symptom exacerbation and housing loss. This study pilot tested Maintaining Independence and Sobriety Through Systems Integration, Outreach and Networking (MISSION), a multicomponent wraparound treatment approach to improve COD symptoms and housing stability among individuals experiencing chronic homelessness and persistent COD. This open pilot study enrolled and assessed 109 individuals with a COD experiencing chronic homelessness and offered one year of MISSION. Statistically significant improvements were observed in behavioral health symptoms and functioning, days of illicit drug use, and housing stability. By treatment completion, 85% of participants were referred to social and behavioral supports. This pilot study demonstrates that MISSION helped to successfully engage participants in treatment, reduce substance use and mental health symptoms, and improve housing outcomes.
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Affiliation(s)
- Abigail F Helm
- Department of Medicine, Division of Health Systems Science, University of Massachusetts Chan Medical School, Worcester, MA, USA.
| | - Michael A Andre
- Department of Medicine, Division of Health Systems Science, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Paige M Shaffer
- Department of Medicine, Division of Health Systems Science, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Kathryn E Bruzios
- Department of Medicine, Division of Health Systems Science, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Sarah Marcus
- Department of Medicine, Division of Health Systems Science, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Jennifer Harter
- Department of Medicine, Division of Health Systems Science, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - David Smelson
- Department of Medicine, Division of Health Systems Science, University of Massachusetts Chan Medical School, Worcester, MA, USA
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Blinick R, Felsen A, Ye K, Lewis A, Kargoli F, Bellin E, Naji L, Haramati LB. Imaging Utilization and Cost of Substance Use in an Urban Academic Medical Center During the Contemporary Opioid Epidemic. Acad Radiol 2024:S1076-6332(24)00091-6. [PMID: 38582686 DOI: 10.1016/j.acra.2024.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 02/13/2024] [Accepted: 02/13/2024] [Indexed: 04/08/2024]
Abstract
RATIONALE AND OBJECTIVES To determine the recent impact of illicit substance use on imaging utilization and associated costs. METHODS Retrospective study from an inner city urban multi-site academic medical center. Institutional Review Board (IRB) approval was obtained with a waiver of informed consent. A substance use cohort comprised patients 12 years old presenting to the Emergency Department (ED) January 2017 to June 2019 with a positive urine toxicology and an ICD code associated with substance use. The comparison cohort was randomly selected from a group of ED patients who presented with no or negative urine toxicology and no documented substance use ICD code. Data extracted from the EMR included demographics, number and type of imaging studies, Charlson comorbidity index, and in-hospital mortality during the study period. RESULTS The substance use and comparison cohorts comprised 3191 and 3200 patients, respectively. The substance use cohort was older on average (mean age 45.67 ± 14.88 vs 43.91 ± 20.57 years), more often male (63% [2026/3191] vs. 39% [1255/3200]) and had a mean Charlson score 88% higher than the comparison cohort (3.33 vs 1.78). The majority of both cohorts were ethnic minorities (<10% white). The substance use cohort had significantly more imaging vs the comparison cohort, total 36,413 (mean 11.41 exams/patient) vs total 12,399 (mean 3.87 exams/patient), p < 0.0001, and was higher for all modalities except mammography. Average imaging costs per patient were nearly 300% higher for the substance use vs comparison cohort, ($1287.18 vs. $434.70). CONCLUSION Imaging utilization and associated costs were substantially higher for patients with a positive urine toxicology and substance use related ICD codes compared to the broader ED population in an underserved urban population.
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Affiliation(s)
- Rachel Blinick
- Montefiore Medical Center, Bronx, New York 10467, USA; Albert Einstein College of Medicine, Bronx, New York, 10461, USA.
| | - Amanda Felsen
- Albert Einstein College of Medicine, Bronx, New York, 10461, USA; Department of Radiology, Columbia University Medical Center, New York, New York, 10032, USA
| | - Kenny Ye
- Albert Einstein College of Medicine, Bronx, New York, 10461, USA
| | - Ariel Lewis
- Albert Einstein College of Medicine, Bronx, New York, 10461, USA; Department of Radiology, Jacobi Medical Center, Bronx, New York 10461, USA
| | - Faraj Kargoli
- Montefiore Medical Center, Bronx, New York 10467, USA
| | - Eran Bellin
- Montefiore Medical Center, Bronx, New York 10467, USA; Albert Einstein College of Medicine, Bronx, New York, 10461, USA
| | - Leen Naji
- Montefiore Medical Center, Bronx, New York 10467, USA; Albert Einstein College of Medicine, Bronx, New York, 10461, USA
| | - Linda B Haramati
- Montefiore Medical Center, Bronx, New York 10467, USA; Albert Einstein College of Medicine, Bronx, New York, 10461, USA; Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, USA
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Stanford D, Dinh MM, Eastwood JG, Korczak V, Seimon RV, Moore C, Liu H, Bein KJ. Clinical and longitudinal patterns of frequent presenters to emergency departments: A multi-centre data linkage analysis. Emerg Med Australas 2024; 36:277-282. [PMID: 38172087 DOI: 10.1111/1742-6723.14349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 09/21/2023] [Accepted: 11/04/2023] [Indexed: 01/05/2024]
Abstract
OBJECTIVE To describe clinical characteristics and longitudinal patterns of representation in a cohort of patients who frequently present to EDs for care. METHODS A retrospective data analysis linking routinely collected ED data across three hospitals. The study population consisted of patients who presented to any ED on 10 or more occasions in any continuous 365-day period from 1 July 2015 to 30 June 2021. Presenting complaints were divided into those with any mental health, drug and alcohol, or social presentations (MHDAS group) and those without (non-MHDAS group). Outcomes of interest were number of presentations as well as temporal and facility clustering of presentations. A per patient regression analysis was performed to identify independent risk factors for increased presentations. RESULTS Presentations by 1640 frequent ED presenters in the study constituted 4.6% of total ED presentations. MHDAS study group were younger, predominantly English speaking, twice as likely to be married, had lower hospital admission rates and almost three times as many of them did not wait for treatment. Statistically significant differences were also found between these groups regarding presentation clustering, facility entropy, each of the four categories of the number of ED presentations, and Index of Relative Socio-Economic Advantage and Disadvantage. CONCLUSION Representations associated with MHDAS have a different trajectory of representation episodes compared to non-MHDAS group. Escalating number of presentations and clustering are important predictors of future representation numbers. Those 'did not waits' who appear to be representing would be the highest risk of ongoing and persistent representations in the future and should be the target of early interventions to ensure they are accessing appropriate care before this happens.
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Affiliation(s)
- Dorota Stanford
- Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Michael M Dinh
- Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, New South Wales, Australia
- RPA Green Light Institute for Emergency Care, Sydney Local Health District, Sydney, New South Wales, Australia
| | - John G Eastwood
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Local Health District, Sydney, Australia
| | - Viola Korczak
- Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, New South Wales, Australia
- The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Radhika V Seimon
- RPA Green Light Institute for Emergency Care, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Corey Moore
- Public Health Unit, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Hueiming Liu
- Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| | - Kendall J Bein
- Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, New South Wales, Australia
- RPA Green Light Institute for Emergency Care, Sydney Local Health District, Sydney, New South Wales, Australia
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Shah H, Hawks L, Walker RJ, Egede LE. Substance Use Disorders, Mental Illness, and Health Care Utilization Among Adults With Recent Criminal Legal Involvement. Psychiatr Serv 2024; 75:221-227. [PMID: 37674397 DOI: 10.1176/appi.ps.20220491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
OBJECTIVE Individuals involved with the criminal legal system have higher rates of mental illness, addiction, and health care utilization. The authors examined whether substance use disorders and mental illness alone or in combination drive health care utilization among those with recent criminal legal involvement. METHODS This cross-sectional analysis used nationally representative data from U.S. adults with past-year criminal legal involvement (N=9,039) recorded in the National Survey on Drug Use and Health (2015-2019). Using adjusted negative binomial regression models, the authors estimated relative risks for health care utilization. Primary independent variable categories included neither substance use disorder nor mental illness, substance use disorder only, mental illness only, and both conditions. Health care utilization included emergency department (ED) visits and nights spent in inpatient care. RESULTS Relative to neither mental illness nor substance use disorder, mental illness alone was associated with significantly increased acute health care services use: for ED visits, incidence risk ratio (IRR)=1.43 (95% CI=1.18-1.75) and for inpatient stays, IRR=2.14 (95% CI=1.47-3.11). Having both conditions was associated with increased ED visits (IRR=1.62, 95% CI=1.38-1.91) and inpatient stays (IRR=4.16, 95% CI=2.98-5.82). Substance use disorder alone was associated only with higher risk for ED visits compared with neither condition (IRR=1.23, 95% CI=1.01-1.50). CONCLUSIONS Mental illness with or without co-occurring substance use disorder is a strong driver of acute health care utilization after interaction with the criminal legal system. Interventions tailored to the unique needs of individuals with mental illness or substance use disorder are needed for those with recent criminal legal involvement.
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Affiliation(s)
- Harini Shah
- School of Medicine (Shah), Department of Medicine, Division of General Internal Medicine (Hawks, Walker, Egede), and Center for Advancing Population Science (Hawks, Walker, Egede), Medical College of Wisconsin, Milwaukee
| | - Laura Hawks
- School of Medicine (Shah), Department of Medicine, Division of General Internal Medicine (Hawks, Walker, Egede), and Center for Advancing Population Science (Hawks, Walker, Egede), Medical College of Wisconsin, Milwaukee
| | - Rebekah J Walker
- School of Medicine (Shah), Department of Medicine, Division of General Internal Medicine (Hawks, Walker, Egede), and Center for Advancing Population Science (Hawks, Walker, Egede), Medical College of Wisconsin, Milwaukee
| | - Leonard E Egede
- School of Medicine (Shah), Department of Medicine, Division of General Internal Medicine (Hawks, Walker, Egede), and Center for Advancing Population Science (Hawks, Walker, Egede), Medical College of Wisconsin, Milwaukee
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Tomovic M, Balfour ME, Cho T, Prathap N, Harootunian G, Mehreen R, Ostrovsky A, Goldman ML. Patient Flow and Reutilization of Crisis Services Within 30 Days in a Comprehensive Crisis System. Psychiatr Serv 2024:appips20230232. [PMID: 38410037 DOI: 10.1176/appi.ps.20230232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
OBJECTIVE Crisis services are undergoing an unprecedented expansion in the United States, but research is lacking on crisis system design. This study describes how individuals flow through a well-established crisis system and examines factors associated with reutilization of such services. METHODS This cross-sectional study used Medicaid claims to construct episodes describing the flow of individuals through mobile crisis, specialized crisis facility, emergency department, and inpatient services. Claims data were merged with electronic health record (EHR) data for the subset of individuals receiving care at a crisis response center. A generalized estimating equation was used to calculate adjusted odds ratios for demographic, clinical, and operational factors associated with reutilization of services within 30 days of an episode's end point. RESULTS Of 41,026 episodes, most (57.4%) began with mobile crisis services or a specialized crisis facility rather than the emergency department. Of the subset (N=9,202 episodes) with merged EHR data, most episodes (63.3%) were not followed by reutilization. Factors associated with increased odds of 30-day reutilization included Black race, homelessness, stimulant use, psychosis, and episodes beginning with mobile crisis services or ending with inpatient care. Decreased odds were associated with depression, trauma, and involuntary legal status. Most (59.3%) episodes beginning with an involuntary legal status ended with a voluntary status. CONCLUSIONS Crisis systems can serve a large proportion of individuals experiencing psychiatric emergencies and divert them from more restrictive and costly levels of care. Understanding demographic, clinical, and operational factors associated with 30-day reutilization may aid in the design and implementation of crisis systems.
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Affiliation(s)
- Milos Tomovic
- School of Medicine, Georgetown University, Washington, D.C. (Tomovic); Connections Health Solutions and Department of Psychiatry, University of Arizona, Tucson (Balfour); Department of Pediatrics, University of California San Francisco, San Francisco (Cho); Center for Health Information and Research (CHIR), College of Health Solutions, Arizona State University, Tempe (Prathap, Harootunian); Social Innovation Ventures, Lewes, Delaware (Mehreen, Ostrovsky); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Goldman)
| | - Margaret E Balfour
- School of Medicine, Georgetown University, Washington, D.C. (Tomovic); Connections Health Solutions and Department of Psychiatry, University of Arizona, Tucson (Balfour); Department of Pediatrics, University of California San Francisco, San Francisco (Cho); Center for Health Information and Research (CHIR), College of Health Solutions, Arizona State University, Tempe (Prathap, Harootunian); Social Innovation Ventures, Lewes, Delaware (Mehreen, Ostrovsky); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Goldman)
| | - Ted Cho
- School of Medicine, Georgetown University, Washington, D.C. (Tomovic); Connections Health Solutions and Department of Psychiatry, University of Arizona, Tucson (Balfour); Department of Pediatrics, University of California San Francisco, San Francisco (Cho); Center for Health Information and Research (CHIR), College of Health Solutions, Arizona State University, Tempe (Prathap, Harootunian); Social Innovation Ventures, Lewes, Delaware (Mehreen, Ostrovsky); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Goldman)
| | - Nishanth Prathap
- School of Medicine, Georgetown University, Washington, D.C. (Tomovic); Connections Health Solutions and Department of Psychiatry, University of Arizona, Tucson (Balfour); Department of Pediatrics, University of California San Francisco, San Francisco (Cho); Center for Health Information and Research (CHIR), College of Health Solutions, Arizona State University, Tempe (Prathap, Harootunian); Social Innovation Ventures, Lewes, Delaware (Mehreen, Ostrovsky); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Goldman)
| | - Gevork Harootunian
- School of Medicine, Georgetown University, Washington, D.C. (Tomovic); Connections Health Solutions and Department of Psychiatry, University of Arizona, Tucson (Balfour); Department of Pediatrics, University of California San Francisco, San Francisco (Cho); Center for Health Information and Research (CHIR), College of Health Solutions, Arizona State University, Tempe (Prathap, Harootunian); Social Innovation Ventures, Lewes, Delaware (Mehreen, Ostrovsky); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Goldman)
| | - Raihana Mehreen
- School of Medicine, Georgetown University, Washington, D.C. (Tomovic); Connections Health Solutions and Department of Psychiatry, University of Arizona, Tucson (Balfour); Department of Pediatrics, University of California San Francisco, San Francisco (Cho); Center for Health Information and Research (CHIR), College of Health Solutions, Arizona State University, Tempe (Prathap, Harootunian); Social Innovation Ventures, Lewes, Delaware (Mehreen, Ostrovsky); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Goldman)
| | - Andrey Ostrovsky
- School of Medicine, Georgetown University, Washington, D.C. (Tomovic); Connections Health Solutions and Department of Psychiatry, University of Arizona, Tucson (Balfour); Department of Pediatrics, University of California San Francisco, San Francisco (Cho); Center for Health Information and Research (CHIR), College of Health Solutions, Arizona State University, Tempe (Prathap, Harootunian); Social Innovation Ventures, Lewes, Delaware (Mehreen, Ostrovsky); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Goldman)
| | - Matthew L Goldman
- School of Medicine, Georgetown University, Washington, D.C. (Tomovic); Connections Health Solutions and Department of Psychiatry, University of Arizona, Tucson (Balfour); Department of Pediatrics, University of California San Francisco, San Francisco (Cho); Center for Health Information and Research (CHIR), College of Health Solutions, Arizona State University, Tempe (Prathap, Harootunian); Social Innovation Ventures, Lewes, Delaware (Mehreen, Ostrovsky); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Goldman)
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Brown L, Rishel Brakey H, Page K. Voices of the unhoused from Santa Fe, New Mexico: A mixed methods study of health status, substance use, and community harm reduction program perspectives. J Prev Interv Community 2024; 52:73-97. [PMID: 38757899 DOI: 10.1080/10852352.2024.2352266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
No published studies have examined the community service priorities and harm reduction perspectives of unhoused people in Santa Fe, New Mexico. We conducted a mixed methods pilot study of 56 unhoused people at community locations in Santa Fe to: (1) assess the current prevalence of chronic medical conditions and substance use; (2) highlight community service priorities; and (3) explore views of innovative community harm reduction programs. Our first hypothesis was there would be high prevalence of chronic medical conditions, for which we found high prevalence of post-traumatic stress disorder, major depression, substance use disorders, chronic pain, and hypertension. Our second hypothesis was that we would find top community service priorities of housing, food, and health care. We found long- and short-term housing and food, but not healthcare, top priorities. Our third hypothesis was that we would find mixed support for community harm reduction initiatives like managed alcohol programs and overdose prevention centers. We found positive, not mixed, support for these community harm reduction programs among Santa Fe's unhoused. Unhoused study participants ranged in age 27-77 years, with lifetime years unhoused from less than one year to 63 years. Study limitations included small sample size, convenience sampling, and descriptive results. Policies and program initiatives supporting additional Housing First options, managed alcohol programs, and overdose prevention centers in the Santa Fe community are clearly indicated to increase engagement with this vulnerable population. Future research should focus on inclusion of the perspectives of the unhoused in the design, conduct, evaluation, and dissemination of community programs to meet the needs of the unhoused, with re-defined outcomes to include changes in quality of life, program engagement, demarginalization, and future goals and plans, beyond currently utilized health and social service program outcome measures.
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Affiliation(s)
- Laura Brown
- Center for Alcohol, Substance Use, and Addictions, University of New Mexico, Albuquerque, New Mexico, USA
| | - Heidi Rishel Brakey
- Clinical and Translational Science Center, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Kimberly Page
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
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10
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Fleury MJ, Cao Z, Grenier G, Huỳnh C. Profiles of patients with substance-related disorders who dropped out or not from addiction treatment. Psychiatry Res 2023; 329:115532. [PMID: 37837812 DOI: 10.1016/j.psychres.2023.115532] [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: 05/08/2023] [Revised: 10/02/2023] [Accepted: 10/06/2023] [Indexed: 10/16/2023]
Abstract
This longitudinal study identified profiles of patients with substance-related disorders (SRD) who did or did not drop out of specialized addiction treatment, integrating various patterns of outpatient service use. Medical administrative databases of Quebec (Canada) were used to investigate a cohort of 16,179 patients with SRD who received specialized addiction treatment. Latent class analysis identified patient profiles, based on multi-year outpatient service use. Four patient profiles related to treatment dropout were identified: patients who did not drop out and were low service users (Profile 1); patients who did not drop out and were high service users (Profile 2); patients who dropped out and were low service users (Profile 3); patients who dropped out and were high service users (Profile 4). Profile 1 had the best health and social conditions, while Profile 4 had the worst. The risks of being frequent emergency department users, being hospitalized or dying were highest in Profile 4, followed by Profiles 3, 2 and 1. Assertive treatment programs may be suited to Profile 4 and intensive case management programs to Profile 3. Collaborative care with higher psychosocial interventions and regularity of care may be extended to Profile 2 and interventions integrating motivational treatment to Profile 1.
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Affiliation(s)
- Marie-Josée Fleury
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC, Canada, H3A 1A1; Douglas Hospital Research Centre, 6875 LaSalle Blvd, Montreal, QC, Canada, H4H 1R3.
| | - Zhirong Cao
- Douglas Hospital Research Centre, 6875 LaSalle Blvd, Montreal, QC, Canada, H4H 1R3
| | - Guy Grenier
- Douglas Hospital Research Centre, 6875 LaSalle Blvd, Montreal, QC, Canada, H4H 1R3
| | - Christophe Huỳnh
- Institut universitaire sur les dépendances, Centre intégré universitaire de santé et des services sociaux du Centre-Sud-de-l'Île-de-Montréal, 950, rue de Louvain, Montreal, QC, Canada, H2M 2E8
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11
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Ho ZV, Arias SA, Kunicki ZJ, Sarkar IN, Chen ES. Characterizing suicidal ideation, suicidal behaviors, and service utilization among unhoused individuals using a health information exchange. J Clin Psychol 2023; 79:2542-2555. [PMID: 37433045 PMCID: PMC10592413 DOI: 10.1002/jclp.23566] [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: 01/07/2023] [Revised: 05/25/2023] [Accepted: 06/29/2023] [Indexed: 07/13/2023]
Abstract
INTRODUCTION Unhoused individuals have high rates of suicidal ideation (SI) and suicidal behaviors (SB), but few have studied the relative timing of homelessness and SI/SB. Our study examines the potential to use state-wide electronic health record data from Rhode Island's health information exchange (HIE) to identify temporal relationships, service utilization, and associations of SI/SB among unhoused individuals. METHODS We use timestamped HIE data for 5368 unhoused patients to analyze service utilization and the relative timing of homelessness versus SI/SB onset. Multivariable models identified associations of SI/SB, hospitalization, and repeat acute care utilization within 30 days from clinical features representing 10,000+ diagnoses captured within the HIE. RESULTS The onset of SI typically precedes homelessness onset, while the onset of SB typically follows. Weekly rates of suicide-related service utilization increased over 25 times the baseline rate during the week before and after homelessness onset. Over 50% of encounters involving SI/SB result in hospitalization. Of those engaging in acute care for suicide-related reasons, we found high rates of repeat acute care encounters. CONCLUSION HIEs are a particularly valuable resource for understudied populations. Our study demonstrates how longitudinal, multi-institutional data from an HIE can be used to characterize temporal associations, service utilization, and clinical associations of SI and behaviors among a vulnerable population at scale. Increasing access to services that address co-occurring SI/SB, mental health, and substance use is needed.
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Affiliation(s)
- Zandra V Ho
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
- Center for Biomedical Informatics, Brown University, Providence, Rhode Island, USA
| | - Sarah A Arias
- Department of Psychiatry and Human Behavior, Brown University, Providence, Rhode Island, USA
- Department of Psychosocial Research, Butler Hospital, Providence, Rhode Island, USA
| | - Zachary J Kunicki
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
- Department of Psychiatry and Human Behavior, Brown University, Providence, Rhode Island, USA
- Department of Psychosocial Research, Butler Hospital, Providence, Rhode Island, USA
| | - Indra Neil Sarkar
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
- Center for Biomedical Informatics, Brown University, Providence, Rhode Island, USA
- Rhode Island Quality Institute, Providence, Rhode Island, USA
| | - Elizabeth S Chen
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
- Center for Biomedical Informatics, Brown University, Providence, Rhode Island, USA
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12
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Fleury MJ, Cao Z, Grenier G, Ferland F. Profiles of quality of life among patients using emergency departments for mental health reasons. Health Qual Life Outcomes 2023; 21:116. [PMID: 37880748 PMCID: PMC10601205 DOI: 10.1186/s12955-023-02200-3] [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: 08/14/2023] [Accepted: 10/11/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND This study identified profiles associated with quality of life (QoL) and sociodemographic and clinical characteristics of patients using emergency departments (ED) for mental health reasons and associated these profiles with patient service use. METHODS Recruited in four Quebec (Canada) ED networks, 299 patients with mental disorders (MD) were surveyed from March 1st, 2021, to May 13th, 2022. Data from medical records were collected and merged with survey data. Cluster analysis was conducted to identify QoL profiles, and comparison analyses used to assess differences between them. RESULTS Four QoL profiles were identified: (1) Unemployed or retired men with low QoL, education and household income, mostly having substance-related disorders and bad perceived mental/physical health conditions; (2) Men who are employed or students, have good QoL, high education and household income, the least personality disorders, and fair perceived mental/physical health conditions; (3) Women with low QoL, multiple mental health problems, and very bad perceived mental/physical health conditions; (4) Mostly women with very good QoL, serious MD, and very good perceived mental/physical health conditions. CONCLUSION The profiles with the highest QoL (4 and 2) had better overall social characteristics and perceived their health conditions as superior. Profile 4 reported the highest level of satisfaction with services used. To improve QoL programs like permanent supportive housing, individual placement and support might be better implemented, and satisfaction with care more routinely assessed in response to patient needs - especially for Profiles 1 and 3, that show complex health and social conditions.
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Affiliation(s)
- Marie-Josée Fleury
- Department of Psychiatry, McGill University, Douglas Mental Health University Institute Research Centre Montreal, Montreal, QC, Canada.
- Douglas Mental Health University Institute Research Centre Montreal, Montreal, QC, Canada.
- Douglas Hospital Research Centre, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada.
| | - Zhirong Cao
- Douglas Mental Health University Institute Research Centre Montreal, Montreal, QC, Canada
| | - Guy Grenier
- Douglas Mental Health University Institute Research Centre Montreal, Montreal, QC, Canada
| | - Francine Ferland
- School of Social Work, Addiction Rehabilitation Center, Laval University, National Capital University Integrated Health and Social Services Center, Quebec City, QC, Canada
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13
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Chatton A, Khazaal Y, Penzenstadler L. A 13-item Health of the Nation Outcome Scale (HoNOS-13): validation by item response theory (IRT) in patients with substance use disorder. Addict Sci Clin Pract 2023; 18:64. [PMID: 37876018 PMCID: PMC10594779 DOI: 10.1186/s13722-023-00416-8] [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: 05/14/2023] [Accepted: 10/06/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND The Health of the Nation Outcome Scale (HoNOS) is a widely used 12-item tool to assess mental health and social functioning. The French version has an added 13th item measuring adherence to psychotropic medication. The aim of the current study is to uncover the unknown pattern of the new item 13 and to compare the unidimensional and multidimensional fit of the new HoNOS-13 using Item Response Theory (IRT). This research question was studied among inpatients with substance use disorder (SUD). METHODS Six hundred and nine valid questionnaires of HoNOS-13 were analyzed using unidimensional (one-factor) and multidimensional (two-factor) IRT modeling. RESULTS The multidimensional model suggesting a first factor capturing psychiatric/impairment-related issues and a second factor reflecting social-related issues yielded better goodness-of-fit values compared to the unidimensional solution. This resulted in an improvement of all slope parameters which in turn translates to better discriminative power. Significant improvement in item location parameters were observed as well. The new item 13 had a good discriminative power (1.17) and covered a wide range of the latent trait (- 0.14 to 2.64). CONCLUSIONS We were able to validate the 13-item questionnaire including medication compliance and suggest that the HoNOS-13 can be recommended as a clinical evaluation tool to assess the problems and treatment needs for inpatients with SUD. Interestingly, the majority of item response categories are endorsed by respondents who are below and above the average levels of HoNOS. This indicates that the scale is able to discriminate between participants both at the low and at the high ends of the latent trait continuum. More importantly, the new item 13 has a good discriminative power and covers a broad range of the latent trait below and above the mean. It therefore has the desired profile of a good item and is a useful measure for the assessment of mental health and social functioning. Trial registration ClinicalTrials.gov, Identifier: NCT03551301. Registered: 11.06.2018. Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03551301 .
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Affiliation(s)
- Anne Chatton
- Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
- Department of Medicine, University of Geneva, Geneva, Switzerland
| | - Yasser Khazaal
- Addiction Medicine, Department of Psychiatry, Lausanne University Hospital and Lausanne University, Rue du Bugnon 23A, 1011, Lausanne, Switzerland.
- Department of Psychiatry and Addictology, Montréal University, Montréal, Canada.
- Department of Medicine, University of Geneva, Geneva, Switzerland.
| | - Louise Penzenstadler
- Division of Addiction Psychiatry, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
- Department of Medicine, University of Geneva, Geneva, Switzerland
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14
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Courchesne-Krak NS, Marienfeld CB, Kepner W. What Brings You in Today? Sex, Race, Substance Type, and Other Sociodemographic and Health-Related Characteristics Predict if Substance Use is the Main Reason for a Clinical Encounter. THE YALE JOURNAL OF BIOLOGY AND MEDICINE 2023; 96:277-291. [PMID: 37780998 PMCID: PMC10524817 DOI: 10.59249/udrg5942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
Background: Substance-related diagnoses (SRDs) are a common healthcare presentation. This study identified sociodemographic and health-related characteristics associated with having an SRD as the primary reason for a clinical encounter compared to those with an SRD who are treated for other reasons. Methods: Electronic health record (EHR) data on patients with an SRD (n=12,358, ages 18-90) were used to assess if an SRD was the primary reason for a clinical encounter from January 1, 2012-January 1, 2018. Patients were matched on key demographic characteristics at a 1:1 ratio. Adjusting for covariates, odds ratios, and 95% confidence intervals were calculated. Results: In the matched cohort of 8,630, most reported male sex (65.8%), White race (70.0%), and single marital status (62.7%) with a mean age of 47.2 (SD=14.6). Patient reported female sex, Black race, age 70+, married status, and low-income (<$50,000) were associated with a lower likelihood of presenting to care for an SRD as the primary reason for a clinical encounter. A nicotine-, alcohol-, opioid-, or stimulant-related diagnosis was associated with a higher likelihood of presenting to care for an SRD as the primary reason for the clinical visit. Conclusion: This is the first study to investigate whether sociodemographic and health-related characteristics were associated with having an SRD as the primary reason for a clinical encounter. Using rigorous methods, we investigated a unique clinical question adding new knowledge to predictors of patients seeking clinical care. Understanding these predictors can help us better align service provision with population needs and inform new approaches to tailoring care.
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Affiliation(s)
| | - Carla B. Marienfeld
- Department of Psychiatry, University of California, San Diego, La Jolla, CA,
USA
| | - Wayne Kepner
- Department of Psychiatry, University of California, San Diego, La Jolla, CA,
USA
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15
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Nolen S, Wilson T, Jacka BP, Li Y, Beaudoin FL, Marshall BD. Prevalence and correlates of experiencing drug-related discrimination among people who use drugs presenting at emergency department at high risk of opioid overdose. Addict Behav Rep 2023; 17:100496. [PMID: 37249941 PMCID: PMC10213175 DOI: 10.1016/j.abrep.2023.100496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 05/08/2023] [Accepted: 05/13/2023] [Indexed: 05/31/2023] Open
Abstract
Objectives Our objective is to determine if specific sociodemographic characteristics were associated with perceived drug-related discrimination among people who use drugs (PWUD) presenting for care in the emergency department (ED). Methods We conducted a secondary analysis of data from the Navigator trial, a randomized control trial of two behavioral interventions in the ED for people at risk of an opioid overdose. Participants included adult patients presenting to two Rhode Island EDs. Eligible participants included those high risk for an opioid overdose, resided or received most of their healthcare in Rhode Island, and were able to provide consent. The primary outcome of this analysis was self-reported feelings of drug-related discrimination by the medical community. The independent variables of interest included race/ethnicity, gender identity, and sexual orientation. Log-binomial multivariable regression models were constructed with all three independent variables of interest and a selection of sociodemographic covariates. Results Of 620 eligible participants, 251 (40.5%) reported ever experiencing drug-related discrimination in their lifetime. In the adjusted model, participants who identified as women and participants who identified as LGBQIA+ were more likely to report experiencing drug-related discrimination from the medical community in EDs. Racial/ethnic minority groups were less likely than White (non-Hispanic) participants to report drug-related discrimination. Discussion In this study population, White participants reported more drug-related discrimination than their minority counterparts, although female and LGBQIA+ patients reported more discrimination. Future studies should further assess the significance of these intersecting identities on self-reported discrimination. This knowledge could improve ED-based interventions, policies, and services for PWUD.
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Affiliation(s)
- Shayla Nolen
- Department of Epidemiology, Brown University School of Public Health, 121 South Main St, Box G-S-121-2, Providence, RI 02912, USA
| | - Taneisha Wilson
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Brendan P. Jacka
- Department of Epidemiology, Brown University School of Public Health, 121 South Main St, Box G-S-121-2, Providence, RI 02912, USA
| | - Yu Li
- Department of Epidemiology, Brown University School of Public Health, 121 South Main St, Box G-S-121-2, Providence, RI 02912, USA
| | - Francesca L. Beaudoin
- Department of Epidemiology, Brown University School of Public Health, 121 South Main St, Box G-S-121-2, Providence, RI 02912, USA
| | - Brandon D.L. Marshall
- Department of Epidemiology, Brown University School of Public Health, 121 South Main St, Box G-S-121-2, Providence, RI 02912, USA
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16
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Holmes C, Holmes K, Scarborough J, Hunt J, d'Etienne JP, Ho AF, Alanis N, Kirby R, Schrader CD, Wang H. The status of patient portal use among Emergency Department patients experiencing houselessness: A large-scale single-center observational study. Am J Emerg Med 2023; 66:118-123. [PMID: 36739786 DOI: 10.1016/j.ajem.2023.01.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 01/10/2023] [Accepted: 01/15/2023] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE Patient portal (PP) use has rapidly increased in recent years. However, the PP use status among houseless patients is largely unknown. We aim to determine 1) the PP use status among Emergency Department (ED) patients experiencing houselessness, and 2) whether PP use is linked to the increase in patient clinic visits. METHODS This is a single-center retrospective observational study. From March 1, 2019, to February 28, 2021, houseless patients who presented at ED were included. Their PP use status, including passive PP use (log-on only PP) and effective PP use (use PP of functions) was compared between houseless and non-houseless patients. The number of clinic visits was also compared between these two groups. Lastly, a multivariate logistic regression was analyzed to determine the association between houseless status and PP use. RESULTS We included a total of 236,684 patients, 13% of whom (30,956) were houseless at time of their encounter. Fewer houseless patients had effective PP use in comparison to non-houseless patients (7.3% versus 11.6%, p < 0.001). In addition, a higher number of clinic visits were found among houseless patients who had effective PP use than those without (18 versus 3, p < 0.001). The adjusted odds ratio of houseless status associated with PP use was 0.48 (95% CI 0.46-0.49, p < 0.001). CONCLUSIONS Houselessness is a potential risk factor preventing patient portal use. In addition, using patient portals could potentially increase clinic visits among the houseless patient population.
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Affiliation(s)
- Chad Holmes
- Department of Emergency Medicine, Integrative Emergency Services, JPS Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA.
| | - Katherine Holmes
- Department of Emergency Medicine, Integrative Emergency Services, JPS Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA.
| | - Jon Scarborough
- Department of Emergency Medicine, Integrative Emergency Services, JPS Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA.
| | - Joel Hunt
- Department of Family Medicine, JPS Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA.
| | - James P d'Etienne
- Department of Emergency Medicine, Integrative Emergency Services, JPS Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA.
| | - Amy F Ho
- Department of Emergency Medicine, Integrative Emergency Services, JPS Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA.
| | - Naomi Alanis
- Department of Emergency Medicine, Integrative Emergency Services, JPS Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA.
| | - Ryan Kirby
- Department of Emergency Medicine, Integrative Emergency Services, JPS Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA.
| | - Chet D Schrader
- Department of Emergency Medicine, Integrative Emergency Services, JPS Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA.
| | - Hao Wang
- Department of Emergency Medicine, Integrative Emergency Services, JPS Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA.
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17
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Oblath R, Herrera CN, Were LPO, Syeda HS, Duncan A, Ferguson T, Kalesan B, Perez DC, Taglieri J, Borba CPC, Henderson DC. Long-Term Trends in Psychiatric Emergency Services Delivered by the Boston Emergency Services Team. Community Ment Health J 2023; 59:370-380. [PMID: 36001197 PMCID: PMC9399566 DOI: 10.1007/s10597-022-01015-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 08/04/2022] [Indexed: 01/25/2023]
Abstract
Rising psychiatric emergency department (ED) presentations pose significant financial and administrative burdens to hospitals. Alternative psychiatric emergency services programs have the potential to alleviate this strain by diverting non-emergent mental health issues from EDs. This study explores one such program, the Boston Emergency Services Team (BEST), a multi-channel psychiatric emergency services provider intended for the publicly insured and uninsured population. BEST provides evaluation and treatment for psychiatric crises through specialized psychiatric EDs, a 24/7 hotline, psychiatric urgent care centers, and mobile crisis units. This retrospective review examines the sociodemographic and clinical characteristics of 225,198 BEST encounters (2005-2016). Of note, the proportion of encounters taking place in ED settings decreased significantly from 70 to 58% across the study period. Findings suggest that multi-focal, psychiatric emergency programs like BEST have the potential to reduce the burden of emergency mental health presentations and improve patient diversion to appropriate psychiatric care.
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Affiliation(s)
- Rachel Oblath
- Department of Psychiatry, Boston Medical Center, Boston, USA. .,BEST Partnership for Behavioral Health, Racial, and Social Justice, Boston Medical Center, Boston, USA.
| | - Carolina N Herrera
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, USA
| | - Lawrence P O Were
- Department of Health Sciences, Boston University's College of Health and Rehabilitation Sciences: Sargent College, Boston, USA.,Department of Global Health, Boston University School of Public Health, Boston, USA
| | - Haniya Saleem Syeda
- Department of Psychiatry, Boston Medical Center, Boston, USA.,BEST Partnership for Behavioral Health, Racial, and Social Justice, Boston Medical Center, Boston, USA
| | - Alison Duncan
- Department of Psychiatry, Boston Medical Center, Boston, USA.,BEST Partnership for Behavioral Health, Racial, and Social Justice, Boston Medical Center, Boston, USA.,Boston University School of Medicine, Boston, USA
| | - Tasha Ferguson
- Department of Psychiatry, Boston Medical Center, Boston, USA.,BEST Partnership for Behavioral Health, Racial, and Social Justice, Boston Medical Center, Boston, USA.,Boston University School of Medicine, Boston, USA
| | - Bindu Kalesan
- Department of Medicine, Center for Clinical Translational Epidemiology and Comparative Effectiveness Research, Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, USA
| | - Daisy C Perez
- Department of Psychiatry, Boston Medical Center, Boston, USA.,BEST Partnership for Behavioral Health, Racial, and Social Justice, Boston Medical Center, Boston, USA
| | - Joan Taglieri
- Department of Psychiatry, Boston Medical Center, Boston, USA.,Department of Psychiatry, Cambridge Health Alliance, Cambridge, USA.,Boston University School of Medicine, Boston, USA
| | - Christina P C Borba
- Department of Psychiatry, Boston Medical Center, Boston, USA.,BEST Partnership for Behavioral Health, Racial, and Social Justice, Boston Medical Center, Boston, USA.,Boston University School of Medicine, Boston, USA
| | - David C Henderson
- Department of Psychiatry, Boston Medical Center, Boston, USA.,BEST Partnership for Behavioral Health, Racial, and Social Justice, Boston Medical Center, Boston, USA.,Boston University School of Medicine, Boston, USA
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18
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Moss C, Anselmi L, Sutton M. Emergency department outcomes for patients experiencing homelessness in England: retrospective cross-sectional study. Eur J Public Health 2023; 33:161-168. [PMID: 36622179 PMCID: PMC10066478 DOI: 10.1093/eurpub/ckac191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Emergency departments (EDs) are an important point of access to health care for people experiencing homelessness. Evidence suggests that ED attendances by homeless people are more likely to result in leaving the ED without treatment, or dying in the ED. We investigate which diagnoses and patterns of health care use are associated with these (and other) discharge destinations and re-attendance within 7 days among homeless patients. METHODS We used national hospital data to analyze attendances of all 109 254 people experiencing homelessness who presented at any Type 1 ED in England over 2013-18. We used logistic regression to estimate the association of each outcome with primary diagnosis and patterns of healthcare use. RESULTS Compared with patients with no past ED use, patients with a high frequency of past ED use were more likely to leave without treatment and re-attend within 7 days. Patients not registered at a general practice were likelier to leave without treatment or die in the ED and had lower odds of unplanned re-attendance. A primary diagnosis of 'social problems' was associated with being discharged without follow-up. Patients with a psychiatric primary diagnosis were disproportionately likely to be referred to another health care professional/provider or an outpatient clinic. CONCLUSIONS Further research is needed to understand why some homeless patients leave the ED without treatment and whether their healthcare needs are being met. Some patients may be attending the ED frequently due to poor access to other services, such as primary care and social welfare.
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Affiliation(s)
- Charlie Moss
- Health Organisation, Policy and Economics (HOPE), Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, UK
| | - Laura Anselmi
- Health Organisation, Policy and Economics (HOPE), Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, UK
| | - Matt Sutton
- Health Organisation, Policy and Economics (HOPE), Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, UK
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19
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Kleber KT, Kravitz-Wirtz N, Buggs SL, Adams CM, Sardo AC, Hoch JS, Brown IE. Emergency department visit patterns in the recently discharged, violently injured patient: Retrospective cohort review. Am J Surg 2023; 225:162-167. [PMID: 35871849 DOI: 10.1016/j.amjsurg.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 06/21/2022] [Accepted: 07/14/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Analysis of the costs associated with emergency department (ED) visits after discharge for violent injury could highlight subgroups for the development of cost-effective interventions to support healing and prevent treatment failures in violently injured patients. METHODS A retrospective cohort review was conducted of all patients with return ED visits within 90 days of discharge after treatment for a violent injury occurring between July 1, 2016, and June 30, 2018. Hospital costs were calculated for each incidence and analyzed against demographic and injury type variables to identify trends. RESULTS 218 return ED visits were identified. Hospital costs showed a high frequency of low-cost visits. For more complex visits, distinct cost patterns were observed for Black and LatinX males compared to White males as a function of age. CONCLUSIONS Analysis of hospital cost per visit identified trends among different subgroups. Underlying etiologies presumably vary between groups, but hypothesis-driven further investigation and needs assessment is required. Understanding the driving forces behind these cost trends may aid in developing effective interventions.
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Affiliation(s)
- Kara T Kleber
- Department of Surgery, University of California Davis School of Medicine, 235 Stockton Blvd, Sacramento, CA, 95817, USA.
| | - Nicole Kravitz-Wirtz
- Violence Prevention Research Program, Department of Emergency Medicine, University of California Davis School of Medicine, 2315 Stockton Blvd, Sacramento, CA, 95817, USA.
| | - Shani L Buggs
- Violence Prevention Research Program, Department of Emergency Medicine, University of California Davis School of Medicine, 2315 Stockton Blvd, Sacramento, CA, 95817, USA.
| | - Christy M Adams
- Trauma Prevention Program, UC Davis Health, University of California Davis, 4900 Broadway, Suite 1650, Sacramento, CA, 95820, USA.
| | - Angela C Sardo
- University of California Davis School of Medicine, 4610 X St, Sacramento, CA, 95817, USA.
| | - Jeffrey S Hoch
- Division of Health Policy and Management, Department of Public Health Sciences and Center for Healthcare Policy and Research, University of California Davis, 4900 Broadway, Suite 1430, Sacramento, CA, 95820, USA.
| | - Ian E Brown
- Division of Trauma, Acute Care Surgery, and Surgical Critical Care, Department of Surgery University of California Davis Medical Center, 2335 Stockton Blvd, Sacramento, CA, 95817, USA.
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20
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Jegede O, Rhee TG, Stefanovics EA, Zhou B, Rosenheck RA. Rates and correlates of dual diagnosis among adults with psychiatric and substance use disorders in a nationally representative U.S sample. Psychiatry Res 2022; 315:114720. [PMID: 35834863 DOI: 10.1016/j.psychres.2022.114720] [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: 09/10/2021] [Revised: 07/02/2022] [Accepted: 07/07/2022] [Indexed: 11/17/2022]
Abstract
Treatment needs of adults diagnosed with both psychiatric and substance use disorders (i.e., dual diagnosis) have not received detailed characterization in a nationally representative US sample. Data from the National Epidemiologic Survey on Alcohol and Related Conditions Wave III were used to compare socio-behavioral, diagnostic, and service use characteristics of dually diagnosed adults to those with psychiatric disorders or SUDs alone. Adults with dual diagnosis were estimated to constitute 25.8% of those with any psychiatric disorder; 36.5% of those with any SUD and 17.8% of the 75.8 million adults with either disorder. Among those with psychiatric disorders, the independent correlates of dual diagnosis reflected substantial social or psychopathological disadvantages (e.g., violent behavior, poor mental health-related quality of life [HRQOL], police trouble, homelessness, and incarceration). Similarly, among those with SUD all independent correlates of dual diagnosis also reflected social or psychopathological disadvantages including poor mental HRQOL, witnessing trauma in childhood, childhood sex abuse, drug use diagnoses, suicide attempt, medical problems, having more than one SUD diagnosis, child neglect, repeated adult traumas, and less social support. Provision of medical, psychiatric, addiction and especially diverse social services in an integrated and accessible setting appear necessary and deserve further study.
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Affiliation(s)
- Oluwole Jegede
- Department of Psychiatry, Yale School of Medicine, 300 George Street, Suite 901, New Haven, CT 06511, United States; Connecticut Mental Health Center, 34 Park Street, New Haven CT 06519, United States.
| | - Taeho Greg Rhee
- Department of Psychiatry, Yale School of Medicine, 300 George Street, Suite 901, New Haven, CT 06511, United States; U.S. Department of Veterans Affairs New England Mental Illness Research, Education, and Clinical Center, 950 Campbell Avenue, West Haven, CT, United States; Department of Public Health Sciences, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT, United States
| | - Elina A Stefanovics
- Department of Psychiatry, Yale School of Medicine, 300 George Street, Suite 901, New Haven, CT 06511, United States; U.S. Department of Veterans Affairs New England Mental Illness Research, Education, and Clinical Center, 950 Campbell Avenue, West Haven, CT, United States
| | - Bin Zhou
- Yale School of Public Health, New Haven, CT, United States
| | - Robert A Rosenheck
- Department of Psychiatry, Yale School of Medicine, 300 George Street, Suite 901, New Haven, CT 06511, United States; U.S. Department of Veterans Affairs New England Mental Illness Research, Education, and Clinical Center, 950 Campbell Avenue, West Haven, CT, United States
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21
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Evaluation of the use of individualized patient care plans in frequent emergency department visitors with pain complaints. Int J Emerg Med 2022; 15:37. [PMID: 35996083 PMCID: PMC9394020 DOI: 10.1186/s12245-022-00440-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 08/13/2022] [Indexed: 11/15/2022] Open
Abstract
Background Pain is one of the most common complaints that patients present to the emergency department for; emergency medicine providers are tasked with providing appropriate pain relief while simultaneously limiting the risk of personal and societal harm that may result from opioid misuse. The Lakeland Regional Medical Center developed a medical management program that identified frequent emergency department visitors with a chief complaint of pain. Individualized care plans were developed for these patients. A retrospective review was then conducted to assess the efficacy of these care plans in reducing the number of emergency department visits for pain-related complaints by the patients entered into the medical management program. Results There were 294 patients; 65% were male, and the median age was 41 (interquartile range: 33 to 51). A total of 80% percent of the patients were white, and the payors were as follows: 53% were self-pay, 42% were government programs, and 5% had private insurance. The three most common chronic pain complaints were 39% abdominal pain, 24% back/neck pain, and 23% headache/migraine (patients could have more than one area of pain). A total of 60% of the patients had a primary care provider, and another 18% had a pain management provider in addition to primary care. Post plan admissions were significantly reduced to a median of 1 (IQR 0 to 3) with the Wilcoxon signed-rank test’s p-value of less than 0.001. Conclusion The authors describe their experience with a quality improvement initiative that identifies frequent emergency department visitors with a chief complaint of pain and provides individualized care plans to these patients. The goals of the program are to improve patient’s quality and consistency of care, through interventions that eliminate the prescribing of opioids while providing non-opioid alternatives.
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22
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Vohra N, Paudyal V, Price MJ. Homelessness and the use of Emergency Department as a source of healthcare: a systematic review. Int J Emerg Med 2022; 15:32. [PMID: 35902803 PMCID: PMC9330962 DOI: 10.1186/s12245-022-00435-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 07/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Persons experiencing homelessness (PEH) often use hospital Emergency Department (ED) as the only source of healthcare. The aim of this study was to undertake a systematic review to identify the prevalence, clinical reasons and outcomes in relation to ED visits by PEH. METHODS A protocol-led (CRD42020189263) systematic review was conducted using search of MEDLINE, EMBASE, CINAHL and Google Scholar databases. Studies that reported either the prevalence of homelessness in the ED or clinical reasons for presentation to ED by PEH and published in English language were included. Definitions of homelessness used by study authors were accepted. RESULTS From the screening of 1349 unique titles, a total of 36 studies were included. Wide variations in the prevalence and key cause of presentations were identified across the studies often linked to differences in country, study setting, disease classification and data collection methods. The proportion of ED visits contributed by PEH ranged from 0.41 to 19.6%. PEH made an average of 0.72 visits to 5.8 visits per person per year in the ED [rate ratio compared to non-homeless 1.63 to 18.75]. Up to a third and quarter of the visits were contributed by alcohol-related diagnoses and substance poisoning respectively. The percentage of PEH who died in the ED ranged from 0.1 to 0.5%. CONCLUSIONS Drug-, alcohol- and injury-related presentations dominate the ED visits by PEH. Wide variations in the data were observed in regard to attendance and treatment outcomes. There is a need for prevention actions in the community, integrated discharge and referral pathways between health, housing and social care to minimise frequent usage and improve attendance outcomes.
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Affiliation(s)
- Neha Vohra
- College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Vibhu Paudyal
- College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - Malcolm J Price
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.,NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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23
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Simko L, Birgisson NE, Pirrotta EA, Wang E. Waiting for Care: Length of Stay for ED Mental Health Patients by Disposition, Diagnosis, and Region (2009–2015). Cureus 2022; 14:e25604. [PMID: 35795515 PMCID: PMC9250335 DOI: 10.7759/cureus.25604] [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] [Accepted: 06/02/2022] [Indexed: 11/21/2022] Open
Abstract
Objective Emergency departments (EDs) face increasing mental health visits on a backdrop of insufficient mental health resources. We study ED length of stay (LOS) and disposition by 1) mental health vs. medical visits; 2) psychiatric vs. substance use visits; and 3) the four regions of the United States. Methods We used weighted data from the National Hospital Ambulatory Medical Care Survey (2009-2015). Visits by patients ages 18-64 were categorized into mental health and medical groups. The mental health group was then subdivided into psychiatric, substance use, and co-occurring disorders. The LOS was compared by disposition. Mental health vs. medical LOS and disposition were examined across four regions of the US. Results An estimated 28 million mental health and 526 million medical visits were included in the study. Mental health visits had a median (interquartile range [IQR]) of 3.7 (4.7) hours while medical visits had a median (IQR) of 2.6 (2.7) hours. Mental health compared to medical visits were more likely to result in admission or transfer and to last >6 and >12 hours. Mental health visits resulting in transfer had the longest LOS with a median (IQR) of 6.23 (7.7) hours. Of mental health visit types, co-occurring disorders visits were more likely to be >6 and >12 hours regardless of disposition. Across US regions, there was significant variation in disposition patterns for mental health vs. medical visits. The odds of mental health visits lasting >6 and >12 hours were greatest in the Northeast and the least in the South with a median (IQR) of 4.6 (5.8) hours and 3.3 (4.0) hours, respectively. Conclusions Metal health compared to medical visits had longer LOS, especially when the patient had co-occurring disorders or required transfer. Regionally, there is a large variation in disposition for mental health vs. medical visits. This study makes it clear that there are no standards for managing psychiatric emergencies.
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24
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Patterns in Medicaid Coverage and Service Utilization Among People with Serious Mental Illnesses. Community Ment Health J 2022; 58:729-739. [PMID: 34448985 DOI: 10.1007/s10597-021-00878-7] [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: 02/03/2021] [Accepted: 07/30/2021] [Indexed: 10/20/2022]
Abstract
Disruptions in Medicaid adversely affect service use and outcomes among individuals with serious mental illnesses (SMI). A retrospective longitudinal study examined Medicaid coverage and service utilization patterns among individuals with SMI (N = 8358) from 2007 to 2010. Only 36% of participants were continuously enrolled in Medicaid and 20% experienced multiple enrollment disruptions. Mental health diagnosis did not predict continuous coverage; however, individuals with schizophrenia were 19% more likely to have multiple coverage disruptions than those with depression (b = - 0.21; p < 0.01). Single and multiple coverage disruptions were associated with decreased rates of outpatient service days utilized (IRR = 0.77 and 0.65, respectively, p < 0.001) and decreased odds of not using acute care services (OR 0.26 and 0.19, respectively, p < 0.001). Future research should explore mechanisms underlying Medicaid stability and develop interventions that facilitate insurance stability and service utilization.
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25
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Luo J, Collier W, Magno-Padron D, Tieman J, Pires G, Moss W, Rosales M, Kim J, Agarwal JP, Kwok AC. Characteristics of Nonelderly Adult Health Care Persistent Super Utilizers in Utah. Popul Health Manag 2022; 25:472-479. [PMID: 35353618 DOI: 10.1089/pop.2021.0275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In the United States, the top 1% and top 5% of health care spenders account for 23% and 50% of total health care spending, respectively. These high spenders have been coined the term super utilizers (SU). The aim of this study was to identify the characteristics associated with these patients to aid in developing public health interventions aimed at transitioning patients out of the SU category and thus ultimately helping to control health care costs. The authors utilized the Utah All-Payer Claims Database and Utah Population Database from 2013 to 2015 to identify demographics, comorbid conditions, health care utilization, and cost characteristics of persistent super utilizers (PSU) (≥3 hospitalizations per year for 3 years) of health care compared with persistent nonsuper utilizers (PNSU) (<3 hospitalizations per year for 3 years). Multivariable logistic regression was utilized to identify the characteristics associated with PSU versus PNSU. Higher outpatient/Emergency Department/noninpatient (eg, visits with imaging and Centers for Medicare & Medicaid Services preventive visits) health care utilization and spending, and prevalence of comorbid disease and psychosocial conditions were associated with PSU. In multivariable analysis, factors such as heart disease, chronic kidney disease (CKD), diabetes, alcohol abuse, and depression were statistically significantly associated with higher odds of PSU, with the most noteworthy being CKD (odds ratio [OR] 6.85, 95% confidence interval [95% CI] 5.84-8.02; P < 0.001), alcohol abuse (OR 5.90, 95% CI 4.49-7.69; P < 0.001), and heart diseases (OR 4.41, 95% CI 3.74-5.18; P < 0.001). The annual health care cost of a PSU is about 11.5 times greater than a PNSU ($54,776 vs. $4801; P < 0.001).
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Affiliation(s)
- Jessica Luo
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Willem Collier
- Division of Biostatistics, Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - David Magno-Padron
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Joshua Tieman
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Giovanna Pires
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Whitney Moss
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Megan Rosales
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Jaewhan Kim
- Department of Physical Therapy and Athletic Training, and CTSI Health Economics Core, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Jayant P Agarwal
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Alvin C Kwok
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
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26
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Leonhardt M, Brodahl M, Cogan N, Lien L. How did the first COVID-19 lockdown affect persons with concurrent mental health and substance use disorders in Norway? A qualitative study. BMC Psychiatry 2022; 22:179. [PMID: 35287637 PMCID: PMC8919911 DOI: 10.1186/s12888-022-03812-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 02/24/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The outbreak of COVID-19 with its severe social restrictions touched the daily life of most people. While everyday social life becomes difficult for citizens with economic and cultural capital, it becomes even worse for vulnerable groups such as persons with mental health and substance use disorders, who are particularly vulnerable to social exclusion. The aim of this study is to investigate how the first COVID-19 lockdown affected the everyday life and health of persons with co-occurring mental health and substance use disorders. METHODS This qualitative study reports data from 17 individual interviews and one focus group of five participants, all with a self-reported mental health and substance use disorder. Interviews were conducted based on a semi-structured interview guide in September and October 2020 in a medium-sized local authority in Norway. Data were analysed using thematic analysis. A reference group of people with varied knowledge and experiences of the phenomenon were involved in study design, recruitment, data generation and analysis. RESULTS The analysis identified four interrelated main themes, describing how the first lockdown affected the everyday life and health of persons suffering from a mental health and substance use disorder: (1) The COVID-19 outbreak as a perceived challenge, (2) A decline in mental health and well-being, (3) Increased substance use challenges, and (4) Diverse experiences with health and social services. The results show that people with a co-occurring disorder have challenges with digital tools and/or do not have the appropriate equipment. Further, participants were not concerned about becoming infected themselves, but infecting others. CONCLUSIONS Persons with a mental health and substance use disorder face major challenges during the COVID-19 pandemic. There is a need to maintain continuous low-threshold services especially directed towards persons with co-occurring disorders during the pandemic. Furthermore, it is important to improve the digital skills of every service user or offer alternatives to digital consultations and meetings.
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Affiliation(s)
- Marja Leonhardt
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Post Box 104, 2381, Brumunddal, Norway. .,Faculty of Health Studies, VID Specialized University, Oslo, Norway.
| | - Morten Brodahl
- grid.412929.50000 0004 0627 386XNorwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Post Box 104, 2381 Brumunddal, Norway
| | - Nicola Cogan
- grid.11984.350000000121138138School of Psychological Sciences & Health, University of Strathclyde, 40 George Street, G1 1QE Glasgow, UK
| | - Lars Lien
- grid.412929.50000 0004 0627 386XNorwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Post Box 104, 2381 Brumunddal, Norway ,grid.477237.2Department of Health and Social Science, Inland Norway University of Applied Science, Elverum, Norway
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27
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Monti K, Bachi K, Gray M, Mahajan V, Sweeney G, Oprescu A, Munjal KG, Hurd YL, Lim S. Data mining-based clinical profiles of substance use-related emergency department utilizers. Am J Emerg Med 2022; 53:104-111. [PMID: 35007871 PMCID: PMC8844240 DOI: 10.1016/j.ajem.2021.12.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 12/22/2021] [Accepted: 12/23/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Substance-use is a prevalent presentation to the emergency department (ED); however, the clinical characterization of patients who are treated and discharged without admission for further treatment is under-investigated. The study aims to define and characterize the clinical profiles of this patient population. METHODS Patients' presentations were examined by clinical data mining (chart review) of ED records of substance use-related events of individuals discharged without admission for further treatment. Records (N = 199) from three major hospitals in New York City from March and June 2017 were randomly sampled with primary diagnosis of alcohol, opioid-related and other psychoactive substance-use presentations. Qualitative thematic coding of clinical presentation with inter-rater reliability was performed. Quantitative distinctive validity tested independence through Pearson's chi-squared and analysis of variance using Fisher's F-test. RESULTS Six distinct clinical profiles were identified, including, High Utilizers (chronically intoxicated with comorbid health conditions) (36.7%), Single Episode (20.1%), Service Request (14.1%), Altered Mental Status (13.6%), Overdose (9.0%), and Withdrawal (7.5%). The profiles differed (p < 0.05) in age, housing status, payor, mode of arrival, referral source, index visit time, prescribed treatment, triage acuity level, psychiatric history, and medical history. Differences (p < 0.05) between groups across clinical profiles in age and pain level at triage were observed. CONCLUSIONS The identified clinical profiles represent the broad spectrum and complex nature of substance use-related ED utilization, highlighting critical factors of psychosocial and mental-health comorbidities. These findings provide a preliminary foundation to support person-centered interventions to decrease substance use-related ED utilization and to increase engagement/linkage of patients to addiction treatment.
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Affiliation(s)
- Kristina Monti
- Addiction Institute of Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Keren Bachi
- Addiction Institute of Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America.
| | - Madeline Gray
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Vibhor Mahajan
- Addiction Institute of Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America.
| | - Gabrielle Sweeney
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Anna Oprescu
- Addiction Institute of Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Kevin G. Munjal
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Yasmin L. Hurd
- Addiction Institute of Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY,Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY,Department of Pharmacological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY,Corresponding author at: Hess Center for Science and Medicine Building, 10th Floor Room 105 Office, 1470 Madison Avenue, Box 1639, New York, NY 10029-6574
| | - Sabina Lim
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America.
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28
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Keen C, Kinner SA, Young JT, Jang K, Gan W, Samji H, Zhao B, Krausz M, Slaunwhite A. Prevalence of co-occurring mental illness and substance use disorder and association with overdose: a linked data cohort study among residents of British Columbia, Canada. Addiction 2022; 117:129-140. [PMID: 34033179 DOI: 10.1111/add.15580] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/23/2020] [Accepted: 05/12/2021] [Indexed: 11/28/2022]
Abstract
AIMS To estimate the treated prevalence of mental illness, substance use disorder (SUD) and dual diagnosis and the association between dual diagnosis and fatal and non-fatal overdose among residents of British Columbia (BC), Canada. DESIGN A retrospective cohort study using linked health, income assistance, corrections and death records. SETTING British Columbia (BC), Canada. PARTICIPANTS A total of 921 346 BC residents (455 549 males and 465 797 females) aged 10 years and older. MEASUREMENTS Hospital and primary-care administrative data were used to identify a history of mental illness only, SUD only, dual diagnosis or no history of SUD or mental illness (2010-14) and overdoses resulting in medical care (2015-17). We calculated crude incidence rates of non-fatal and fatal overdose by dual diagnosis history. Andersen-Gill and competing risks regression were used to examine the association between dual diagnosis and non-fatal and fatal overdose, respectively, adjusting for age, sex, comorbidities, incarceration history, social assistance, history of prescription opioid and benzodiazepine dispensing and region of residence. FINDINGS Of the 921 346 people in the cohort, 176 780 (19.2%), 6147 (0.7%) and 15 269 (1.7%) had a history of mental illness only, SUD only and dual diagnosis, respectively; 4696 (0.5%) people experienced 688 fatal and 6938 non-fatal overdoses. In multivariable analyses, mental illness only, SUD only and dual diagnosis were associated with increased rate of non-fatal [hazard ratio (HR) = 1.8, 95% confidence interval (CI) = 1.6-2.1; HR = 9.0, 95% CI = 7.0-11.5, HR = 8.7, 95% CI = 6.9-10.9, respectively] and fatal overdose (HR = 1.6, 95% CI = 1.3-2.0, HR = 4.3, 95% CI = 2.8-6.5, HR = 4.1, 95% CI = 2.8-6.0, respectively) compared with no history. CONCLUSIONS In a large sample of residents of British Columbia (Canada), approximately one in five people had sought care for a substance use disorder or mental illness in the past 5 years. The rate of overdose was elevated in people with a mental illness alone, higher again in people with a substance use disorder alone and highest in people with a dual diagnosis. The adjusted hazard rates were similar for people with substance use disorder only and people with a dual diagnosis.
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Affiliation(s)
- Claire Keen
- Justice Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Australia
| | - Stuart A Kinner
- Justice Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Australia.,Justice Health Group, Centre for Adolescent Health, Murdoch Children's Research Institute, Australia.,Mater Research Institute-UQ, University of Queensland, Australia.,Griffith Criminology Institute, Griffith University, Australia
| | - Jesse T Young
- Justice Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Australia.,Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia.,National Drug Research Institute, Curtin University, Perth, Western Australia, Australia
| | - Kerry Jang
- Department of Psychiatry, University of British Columbia, Canada
| | - Wenqi Gan
- Data and Analytic Services, BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, British Columbia, Canada
| | - Hasina Samji
- Clinical Prevention Services, BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, British Columbia, Canada.,Faculty of Health Sciences, Simon Fraser University, British Columbia, Canada
| | - Bin Zhao
- Data and Analytic Services, BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, British Columbia, Canada
| | - Michael Krausz
- Department of Psychiatry, University of British Columbia, Canada
| | - Amanda Slaunwhite
- Clinical Prevention Services, BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, British Columbia, Canada.,School of Population and Public Health, University of British Columbia, Canada
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29
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Ahmed H, Dennis JA. Assessment and Diagnosis of Mental Illness in EDs Among Individuals Without a Home: Findings from the National Hospital Ambulatory Care Survey. West J Emerg Med 2021; 22:1276-1282. [PMID: 34787551 PMCID: PMC8597683 DOI: 10.5811/westjem.2021.7.51882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 07/17/2021] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Homeless individuals lack resources for primary healthcare and as a result use the emergency department (ED) as a social safety net. Our primary objective in this study was to identify the differences between features of visits to United States (US) EDs made by patients without a home and patients who live in a private residence presenting with mental health symptoms or no mental health symptoms at triage. METHODS Data for this study come from the 2009-2017 National Health and Ambulatory Medical Care Survey, a nationally representative cross-sectional survey of ED visits in the US. We examined differences in waiting time, length of visit, and triage score among homeless patients, and privately housed and nursing home residents. We used logistic regression to determine the odds of receiving a mental health diagnosis. Residence, age, gender, race, urgency, and whether the person was seen in the ED in the previous 72 hours were controlled. RESULTS Homeless individuals made up less than 1% of all ED visits during this period. Of these visits, 47.2% resulted in a mental health diagnosis compared to those who live in a private residence. Adjusting for age, race, gender, triage score, and whether the person had been seen in the prior 72 hours, homeless individuals were still six times more likely to receive a mental health diagnosis despite reporting no mental health symptoms compared to individuals who lived in a private residence. Homeless individuals reporting mental health symptoms were two times more likely to receive a mental health diagnosis compared to privately housed and nursing home residents. CONCLUSIONS Homeless individuals are more likely to receive a mental health diagnosis in the ED whether or not they present with mental health symptoms at triage. This study suggests that homelessness as a status impacts how these individuals receive care in the ED. Community coordination is needed to expand treatment options for individuals experiencing emergent mental health symptoms.
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Affiliation(s)
- Hijab Ahmed
- Texas Tech University Health Sciences Center School of Medicine, Department of Emergency Medicine, Lubbock, Texas.,Texas Tech University Health Sciences Center, Department of Public Health, Lubbock, Texas
| | - Jeff A Dennis
- Texas Tech University Health Sciences Center, Department of Public Health, Lubbock, Texas
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30
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Zhang X, Wang N, Hou F, Ali Y, Dora-Laskey A, Dahlem CH, McCabe SE. Emergency Department Visits by Patients with Substance Use Disorder in the United States. West J Emerg Med 2021; 22:1076-1085. [PMID: 34546883 PMCID: PMC8463055 DOI: 10.5811/westjem.2021.3.50839] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 03/15/2021] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION We aimed to characterize emergency department (ED) utilization and clinical characteristics of patients with substance use disorder (SUD) seeking emergency care for all reasons. METHODS Using 2016-2017 ED data from the National Hospital Ambulatory Medical Care Survey, we investigated demographics, ED resource utilization, and clinical characteristics of patients with SUD vs those without SUD. RESULTS Of all adult ED visits (N = 27,609) in the US in 2016-2017, 11.1% of patients had SUD. Among ED patients with SUD, they were mostly non-Hispanic White (62.5%) and were more likely to be male (adjusted odds ratio [aOR] 1.80 confidence interval [CI], 1.66-1.95). Emergency department patients with SUD were also more likely to return to the ED within 72 hours (aOR 1.32, CI, 1.09-1.61) and more likely to be admitted to the hospital (aOR 1.28, CI, 1.14-1.43) and intensive care unit (aOR 1.40, CI, 1.05-1.85). CONCLUSION Patients with SUD have specific demographic, socioeconomic, and clinical characteristics associated with their ED visits. These findings highlight the importance of recognizing co-existing SUD as risk factors for increasing morbidity in acutely ill and injured patients, and the potential role of the ED as a site for interventions aimed at reducing harm from SUD.
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Affiliation(s)
- Xingyu Zhang
- University of Michigan School of Nursing, Department of Systems, Populations, and Leadership, Ann Arbor, Michigan, United States of America.,University of Pittsburgh Medical Center, Thomas E. Starzl Transplantation Institute, Pittsburgh, Pennsylvania, United States of America
| | - Ningyuan Wang
- University of Michigan, College of Literature, Science, and the Arts; Ann Arbor, Michigan, United States of America
| | - Fengsu Hou
- Shenzhen Kangning Hospital, Department of Public Health, Shenzhen, Guangdong Province, China
| | - Yaseen Ali
- University of Michigan, College of Literature, Science, and the Arts; Ann Arbor, Michigan, United States of America
| | - Aaron Dora-Laskey
- Michigan State University College of Human Medicine, Department of Emergency Medicine, East Lansing, Michigan, United States of America
| | - Chin Hwa Dahlem
- University of Michigan School of Nursing, Department of Health Behavior and Biological Sciences, Ann Arbor, Michigan, United States of America
| | - Sean Esteban McCabe
- University of Michigan School of Nursing, Department of Health Behavior and Biological Sciences, Ann Arbor, Michigan, United States of America.,University of Michigan, Institute for Social Research, Ann Arbor, Michigan
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31
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Thomas K, Browne AJ, Jiao S, Dooner C, Wright P, Slemon A, Diederich J, Wathen CN, Bungay V, Wilson E, Varcoe C. Media framing of emergency departments: a call to action for nurses and other health care providers. BMC Nurs 2021; 20:118. [PMID: 34217277 PMCID: PMC8254669 DOI: 10.1186/s12912-021-00606-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 05/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND As part of a larger study focused on interventions to enhance the capacity of nurses and other health care workers to provide equity-oriented care in emergency departments (EDs), we conducted an analysis of news media related to three EDs. The purpose of the analysis was to examine how media writers frame issues pertaining to nursing, as well as the health and social inequities that drive emergency department contexts, while considering what implications these portrayals hold for nursing practice. METHODS We conducted a search of media articles specific to three EDs in Canada, published between January 1, 2018 and May 1, 2019. Media items (N = 368) were coded by story and theme attributes. A thematic analysis was completed to understand how writers in public media present issues pertaining to nursing practice within the ED context. RESULTS Two overarching themes were found. First, in ED-related media that portrays health care needs of people experiencing health and social inequities, messaging frequently perpetuates stigmatizing discourses. Second, media writers portray pressures experienced by nurses working in the ED in a way that evades structural determinants of quality of care. Underlying both themes is an absence of perspectives and authorship from practicing nurses themselves. CONCLUSIONS We recommend that frontline nurses be prioritized as experts in public media communications. Nurses must be supported to gain critical media skills to contribute to media, to destigmatize the health care needs of people experiencing inequity who attend their practice, and to shed light on the structural causes of pressures experienced by nurses working within emergency department settings.
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Affiliation(s)
- Kimberley Thomas
- Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Annette J Browne
- School of Nursing, The University of British Columbia, Vancouver, BC, Canada.
| | - Sunny Jiao
- School of Nursing, The University of British Columbia, Vancouver, BC, Canada
| | - Caryn Dooner
- School of Nursing, The University of British Columbia, Vancouver, BC, Canada
| | - Patrice Wright
- The Faculty of Graduate and Postdoctoral Studies (Public Health/Nursing), The University of British Columbia, Vancouver, BC, Canada
| | - Allie Slemon
- School of Nursing, The University of British Columbia, Vancouver, BC, Canada
| | - Jennifer Diederich
- School of Nursing, The University of British Columbia, Vancouver, BC, Canada
| | - C Nadine Wathen
- Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada
| | - Vicky Bungay
- Capacity Research Unit, School of Nursing, The University of British Columbia, Vancouver, BC, Canada
| | - Erin Wilson
- School of Nursing, University of Northern British Columbia, Prince George, BC, Canada
| | - Colleen Varcoe
- School of Nursing, The University of British Columbia, Vancouver, BC, Canada
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Clinical characteristics, attendance outcomes and deaths of homeless persons in the emergency department: implications for primary health care and community prevention programmes. Public Health 2021; 196:117-123. [PMID: 34182257 DOI: 10.1016/j.puhe.2021.05.007] [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: 12/15/2020] [Revised: 04/17/2021] [Accepted: 05/12/2021] [Indexed: 01/31/2023]
Abstract
OBJECTIVES Persons experiencing homelessness (PEH) are known to be often excluded from primary health care and community prevention programmes leading to high use of hospital emergency departments (EDs). This study aimed to identify demographic features, clinical characteristics and attendance outcomes of PEH presenting to ED. STUDY DESIGN Analysis of routinely collected data set. METHODS Clinical presentations and drug prescription data of PEH who presented a major ED in the West Midlands region of England from 2014 to 2019 were extracted and analysed using descriptive and inferential statistics. RESULTS During the study period, 3271 of 596,198 presentations were made by PEH; 74% PEH attendees were male. Drug- and alcohol-related conditions, as well as pain and injury constituted the most frequent reasons for presentation, contributing to over half of all presentations. A significantly higher proportion of males (n = 481, 20.3%) presented with drug and alcohol problems than females (n = 93, 11.2%) (P ≤ 0.001). However, pain was the primary reason for presentation for twice as many female patients (n = 189, 22.8%) compared with males (n = 305, 12.9%) (P < 0.001). Nearly one in five left the ED before being assessed and a total of 39 patients (1.2%) died in the ED and 785 (24.0%) required in-patient admissions to the same hospital. CONCLUSIONS Drug, alcohol and pain including the need of opioid analgesics constituted the majority of presentations made by PEH in ED. The observed rate of death of PEH in ED is 12 times higher than the general population. A very high proportion of PEH also leave the ED before being treated. Future research should focus on strengthening community interventions, particularly to improve access to those at risk of dual diagnoses of substance misuse and mental health problems. Interventions involving multisector collaborations are needed to improve seamless discharge from ED and minimise repeat attendance. Gender differences in the nature of presentations and ED outcomes needs to be investigated further.
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The Checkpoint Program: Collaborative Care to Reduce the Reliance of Frequent Presenters on ED. Int J Integr Care 2021; 21:29. [PMID: 34220393 PMCID: PMC8231479 DOI: 10.5334/ijic.5532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction: Growing pressures upon Emergency Departments [ED] call for new ways of working with frequent presenters who, although small in number, place extensive demands on services, to say nothing of the costs and consequences for the patients themselves. EDs are often poorly equipped to address the multi-dimensional nature of patient need and the complex circumstances surrounding repeated presentation. Employing a model of intensive short-term community-based case management, the Checkpoint program sought to improve care coordination for this patient group, thereby reducing their reliance on ED. Method: This study employed a single group interrupted time series design, evaluating patient engagement with the program and year-on-year individual differences in the number of ED visits pre and post enrolment. Associated savings were also estimated. Results: Prior to intervention, there were two dominant modes in the ED presentation trends of patients. One group had a steady pattern with ≥7 presentations in each of the last four years. The other group had an increasing trend in presentations, peaking in the 12 months immediately preceding enrolment. Following the intervention, both groups demonstrated two consecutive year-on-year reductions. By the second year, and from an overall peak of 22.5 presentations per patient per annum, there was a 53% reduction in presentations. This yielded approximate savings of $7100 per patient. Discussion: Efforts to improve care coordination, when combined with proactive case management in the community, can impact positively on ED re-presentation rates, provided they are concerted, sufficiently intensive and embed the principles of integration. Conclusion: The Checkpoint program demonstrated sufficient promise to warrant further exploration of its sustainability. However, health services have yet to determine the ideal organisational structures and funding arrangements to support such initiatives.
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Self-reported Health Diagnoses and Demographic Correlates With Kratom Use: Results From an Online Survey. J Addict Med 2021; 14:244-252. [PMID: 31567595 DOI: 10.1097/adm.0000000000000570] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To determine whether diagnosed pre-existing health conditions correlate with Kratom demographics and use patterns. METHODS A cross-sectional, anonymous US national online survey was conducted among 8049 Kratom users in October, 2016 to obtain demographic, health, and Kratom use pattern information. RESULTS People who use Kratom to mitigate illicit drug dependence self-reported less pain and better overall health than individuals who used Kratom for acute/chronic pain. Self-reported improvements in pre-existing mental health symptoms (attention deficit and hyperactivity disorder/attention deficit disorder, anxiety, bipolar disorder, post-traumatic stress disorder, and depression) attributed to Kratom use were greater than those related to somatic symptoms (back pain, rheumatoid arthritis, acute pain, chronic pain, fibromyalgia). Demographic variables, including female sex, older age, employment status, and insurance coverage correlated with increased likelihood of Kratom use. CONCLUSIONS Kratom use may serve as a self-treatment strategy for a diverse population of patients with pre-existing health diagnoses. Healthcare providers need to be engaging with patients to address safety concerns and potential limitations of its use in clinical practice for specific health conditions.
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Li LT, Chuck C, Bokshan SL, Owens BD. Increased Total Cost and Lack of Diagnostic Utility for Emergency Department Visits After ACL Injury. Orthop J Sports Med 2021; 9:23259671211006711. [PMID: 34026918 PMCID: PMC8120546 DOI: 10.1177/23259671211006711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 01/03/2021] [Indexed: 11/21/2022] Open
Abstract
Background: Patients are commonly evaluated at the emergency department (ED) with acute anterior cruciate ligament (ACL) tears, but providers without orthopaedics training may struggle to correctly diagnose these injuries. Hypothesis: It was hypothesized that few patients would be diagnosed with an ACL tear while in the ED and that these patients would be of lower socioeconomic status and more likely to have public insurance. Study Design: Cohort study; Level of evidence, 3. Methods: The 2017 State Ambulatory Surgery and Services Database (SASD) and State Emergency Department Database (SEDD) from the state of Florida were utilized in this study. Cases with Current Procedural Terminology code 29888 (arthroscopically aided ACL reconstruction [ACLR]) were selected from the SASD, and data from the SEDD were matched to patients who had an ED visit for a knee injury within 120 days before ACLR. Chi-square analysis was used to test for differences in patient and surgical variables between the ED visit and nonvisit patient groups. A generalized linear model was created to model the effect of ED visit on total cost for an ACL injury. Results: While controlling for differences in patient characteristics and concomitant procedure usage, a visit to the ED added $4587 in total cost (P < .001). The ED visit cohort contained a greater proportion of patients with Medicaid (20.2% vs 9.1%), patients who were Black (18.4% vs 10.3%), and patients in the lowest income quartile (34.4% vs 25.0%) (P < .001 for all). In the ED visit cohort, 14.4% of patients received an allograft versus 10.1% in the non-ED visit cohort (P = .001) despite having a similar mean age. An ACL sprain was diagnosed in only 29 of the 645 (4.5%) patients who visited the ED. Conclusion: Utilizing the ED for care after an ACL injury was expensive, averaging a $4587 increase in total cost associated with ACLR. However, patients rarely left with a definitive diagnosis, with only 4.5% of patients who underwent ACLR being correctly diagnosed with an ACL tear in the ED. This additional cost was levied disproportionately on patients of low socioeconomic status and patients with Medicaid.
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Affiliation(s)
- Lambert T Li
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, Rhode Island, USA
| | - Carlin Chuck
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, Rhode Island, USA
| | - Steven L Bokshan
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, Rhode Island, USA
| | - Brett D Owens
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, Rhode Island, USA
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Raven MC, Niedzwiecki MJ, Kushel M. A randomized trial of permanent supportive housing for chronically homeless persons with high use of publicly funded services. Health Serv Res 2021; 55 Suppl 2:797-806. [PMID: 32976633 PMCID: PMC7518819 DOI: 10.1111/1475-6773.13553] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective To examine whether randomization to permanent supportive housing (PSH) versus usual care reduces the use of acute health care and other services among chronically homeless high users of county‐funded services. Data Sources Between 2015 and 2019, we assessed service use from Santa Clara County, CA, administrative claims data for all county‐funded health care, jail and shelter, and mortality. Study Design We conducted a randomized controlled trial among chronically homeless high users of multiple systems. We compared postrandomization outcomes from county‐funded systems using multivariate regression analysis. Data Collection We extracted encounter data from an integrated database capturing health care at county‐funded facilities, shelter and jails, county housing placement, and death certificates. Principal Findings We enrolled 423 participants (199 intervention; 224 control). Eighty‐six percent of those randomized to PSH received housing compared with 36 percent in usual care. On average, the 169 individuals housed by the PSH intervention have remained housed for 28.8 months (92.9 percent of the study follow‐up period). Intervention group members had lower rates of psychiatric ED visits IRR 0.62; 95% CI [0.43, 0.91] and shelter days IRR 0.30; 95% CI [0.17, 0.53], and higher rates of ambulatory mental health services use IRR 1.84; 95% CI [1.43, 2.37] compared to controls. We found no differences in total ED or inpatient use, or jail. Seventy (37 treatment; 33 control) participants died. Conclusions The intervention placed and retained frequent user, chronically homeless individuals in housing. It decreased psychiatric ED visits and shelter use, and increased outpatient mental health care, but not medical ED visits or hospitalizations. Limitations included more than one‐third of usual care participants received another form of subsidized housing, potentially biasing results to the null, and loss of power due to high death rates. PSH can house high‐risk individuals and reduce emergent psychiatric services and shelter use. Reductions in hospitalizations may be more difficult to realize.
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Affiliation(s)
- Maria C Raven
- Department of Emergency Medicine, University of California, San Francisco, San Francisco, CA, USA.,Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, USA.,Mathematica Policy Research, Oakland, CA, USA
| | - Matthew J Niedzwiecki
- Department of Emergency Medicine, University of California, San Francisco, San Francisco, CA, USA.,Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, USA.,Center for Vulnerable Populations, University of California, San Francisco, San Francisco, CA, USA
| | - Margot Kushel
- Mathematica Policy Research, Oakland, CA, USA.,Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.,UCSF Benioff Homelessness and Housing Initiative, San Francisco, CA, USA
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Schrader CD, Meyering SH, Kumar D, Alanis N, D'Etienne JP, Shaikh S, Vo V, Kamaria AR, Huettner N, Wang H. The Role of Using HEART Score to Risk Stratify Chest Pain Among Emergency Department High Utilizers. High Blood Press Cardiovasc Prev 2020; 28:69-78. [PMID: 33369723 DOI: 10.1007/s40292-020-00426-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 12/13/2020] [Indexed: 12/23/2022] Open
Abstract
The HEART score is used to effectively risk stratify undifferentiated chest pain patients in the Emergency Department (ED). It is unclear whether such risk stratification can be applied among ED high utilizers. We aim to determine the efficacy and safety of using the HEART score to predict 30-day short-term major adverse cardiac events (MACE) in ED high utilizers. We conducted a retrospective, observational study in which ED high utilizers were defined as patients who had four or more ED visits within the past 12 months. ED high utilizers presenting at the study ED with chest pain were enrolled. Patients in which the HEART score was utilized were placed in the HEART group and patients with no HEART scores documented were placed to the usual care group. Hospital admissions and cardiac stress tests performed during the index hospitalizations, and 30-day MACE rates were analyzed and compared between the HEART and usual care groups. From January 1, 2017 to December 31, 2019, a total of 8,315 patient visits from ED high utilizers were enrolled. In the HEART group, 49% of ED visits were admitted with 20% receiving stress tests. A 30-day MACE outcome occurred among 1.4% of visits. In the usual care group, 44% of ED visits were admitted, with only 9% receiving index stress tests and a 1.5% of 30-day MACE occurrence (p=0.727). The study showed that similar short-term MACE outcomes occurred between patients using HEART scores and usual care to risk stratify chest pain among ED high utilizers.
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Affiliation(s)
- Chet D Schrader
- Department of Emergency Medicine, John Peter Smith Health Network, 1500 S. Main St., Fort Worth, TX, 76104, USA
| | - Stefan H Meyering
- Department of Emergency Medicine, John Peter Smith Health Network, 1500 S. Main St., Fort Worth, TX, 76104, USA
| | - Darren Kumar
- Department of Cardiology, JPS Health Network, 1500 S. Main St., Fort Worth, TX, 76104, USA
| | - Naomi Alanis
- Department of Emergency Medicine, John Peter Smith Health Network, 1500 S. Main St., Fort Worth, TX, 76104, USA
| | - James P D'Etienne
- Department of Emergency Medicine, John Peter Smith Health Network, 1500 S. Main St., Fort Worth, TX, 76104, USA
| | - Sajid Shaikh
- Department of Information Technology, JPS Health Network, 1500 S. Main St., Fort Worth, TX, 76104, USA
| | - Vietvuong Vo
- Department of Emergency Medicine, John Peter Smith Health Network, 1500 S. Main St., Fort Worth, TX, 76104, USA
| | - Ankur R Kamaria
- Department of Cardiology, JPS Health Network, 1500 S. Main St., Fort Worth, TX, 76104, USA
| | - Nicole Huettner
- University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA
| | - Hao Wang
- Department of Emergency Medicine, John Peter Smith Health Network, 1500 S. Main St., Fort Worth, TX, 76104, USA.
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Bakos-Block C, Langabeer JR, Yatsco A, Cardenas-Turanzas M, Champagne-Langabeer T. Prevalence of Mental Health Disorders among Individuals Enrolled in an Emergency Response Program for Treatment of Opioid Use Disorder. SUBSTANCE ABUSE-RESEARCH AND TREATMENT 2020; 14:1178221820981998. [PMID: 33424227 PMCID: PMC7756048 DOI: 10.1177/1178221820981998] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 11/24/2020] [Indexed: 01/12/2023]
Abstract
Background Psychiatric co-occurring disorders among individuals with opioid use disorder has primarily focused on epidemiological surveys of patients in continuous or long-term treatment, yet little is known about the socio-economically vulnerable who are non-treatment seeking prior to an emergency response. Methods We retrospectively analyzed data from patients who had enrolled in a study involving home outreach to patients referred from police, emergency medical services (EMS), or hospital emergency departments following an emergency response. The sample is largely socio-economically vulnerable with high rates of unemployment and uninsured. Eligible consenting patients received an intervention consisting of medication (buprenorphine), behavioral counseling, and peer support. Participants completed semi-structured, psychological instruments to assess current and prior history for both substance use and mental health disorders. We used descriptive statistics to evaluate rates of co-occurring mental health comorbidity. Results Among 102 patients (average age = 36.5 years old), approximately 61 (59.8%) reported a prior mental health diagnosis, with 31 (30.3%) currently on medications for their diagnoses. Mood and anxiety disorders were most frequently recorded. Just over half (51%) had received any prior treatment for their substance use. Of those with dual disorders, 67.2% had experienced prior suicidal thoughts, and 63.7% reported polysubstance use of 5 or more substances. Conclusion Co-occurring psychiatric disorders, and specifically mood and anxiety disorders, appear to be prevalent in vulnerable populations at an increased rate. Mental health assessments should routinely be performed in the emergency setting and in early stages of treatment.
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Affiliation(s)
- Christine Bakos-Block
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston, TX, USA
| | - James R Langabeer
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston, TX, USA.,Department of Emergency Medicine, The University of Texas Health Science Center at Houston, TX, USA
| | - Andrea Yatsco
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston, TX, USA
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Holmes CT, Holmes KA, MacDonald A, Lonergan FR, Hunt JJ, Shaikh S, Cheeti R, D'Etienne JP, Zenarosa NR, Wang H. Dedicated homeless clinics reduce inappropriate emergency department utilization. J Am Coll Emerg Physicians Open 2020; 1:829-836. [PMID: 33145527 PMCID: PMC7593501 DOI: 10.1002/emp2.12054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 02/28/2020] [Accepted: 03/04/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The homeless patient population is known to have a high occurrence of inappropriate emergency department (ED) utilization. The study hospital initiated a dedicated homeless clinic targeting patients experiencing homelessness with a combination of special features. We aim to determine whether this mode of care can reduce inappropriate ED utilization among homeless patients. METHODS We conducted a retrospective observational study from July 1, 2017 to Dec 31, 2017. The study enrolled all homeless patients who visited any hospital regular clinic, dedicated homeless clinic, and ED at least once during the study period. ED homeless patients were divided into four groups (A: no clinic visits; B: those who only visited hospital regular clinic; C: those who only visited dedicated homeless clinic; and D: those who visited both hospital regular clinic and dedicated homeless clinic). The New York University algorithm was used to determine appropriate ED utilization. We compared inappropriate ED utilization among patients from these groups. Multivariate logistic regression was used to determine the risks of different clinical visits in association with inappropriate ED utilization. RESULTS A total of 16,323 clinic and 8511 ED visits occurred among 5022 unique homeless patients, in which 2450 unique patients were seen in hospital regular clinic, 784 patients in dedicated homeless clinic, 688 patients in both hospital regular clinic and dedicated homeless clinic, and 1110 patients with no clinic visits. Twenty-nine percent (230/784) of patients from dedicated homeless clinic utilized the ED, among which 21% (175/844) of their ED visits were considered inappropriate. In contrast, 40% of patients from hospital regular clinic utilized the ED, among which 29% were inappropriate (P < 0.001). The adjusted odds ratio (OR) was 0.61 (95% confidence interval [CI] = 0.50-0.74, P < 0.001) on dedicated homeless clinic predicting inappropriate ED visits in multivariate logistic regression. CONCLUSION Implementing a dedicated homeless clinic with these features can reduce ED inappropriate utilization among patients experiencing homelessness.
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Affiliation(s)
- Chad T. Holmes
- Department of Emergency MedicineJohn Peter Smith Health NetworkFort WorthTexas
- Integrative Emergency ServicesDallasTexas
| | - Katherine A. Holmes
- Department of Emergency MedicineJohn Peter Smith Health NetworkFort WorthTexas
- Integrative Emergency ServicesDallasTexas
| | - Andrew MacDonald
- Department of Emergency MedicineJohn Peter Smith Health NetworkFort WorthTexas
| | - Frank R. Lonergan
- Department of Family MedicineJohn Peter Smith Health NetworkFort WorthTexas
| | - Joel J. Hunt
- Department of Family MedicineJohn Peter Smith Health NetworkFort WorthTexas
| | - Sajid Shaikh
- Department of Information TechnologyJohn Peter Smith Health NetworkFort WorthTexas
| | - Radhika Cheeti
- Department of Information TechnologyJohn Peter Smith Health NetworkFort WorthTexas
| | - James P. D'Etienne
- Department of Emergency MedicineJohn Peter Smith Health NetworkFort WorthTexas
- Integrative Emergency ServicesDallasTexas
| | - Nestor R. Zenarosa
- Department of Emergency MedicineJohn Peter Smith Health NetworkFort WorthTexas
- Integrative Emergency ServicesDallasTexas
| | - Hao Wang
- Department of Emergency MedicineJohn Peter Smith Health NetworkFort WorthTexas
- Integrative Emergency ServicesDallasTexas
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Solmi M, Della Rocca F, Cianci V, Giacometti A, Alexopulos C, Granziol U, Favaro A, Fusar-Poli P, Zoleo M, Cremonese C. Emergency department and early detection of adolescents and young adults at risk of developing mental disorders: an exploratory study. RESEARCH IN PSYCHOTHERAPY: PSYCHOPATHOLOGY, PROCESS AND OUTCOME 2020; 23:459. [PMID: 33024725 PMCID: PMC7513608 DOI: 10.4081/ripppo.2020.459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 07/03/2020] [Indexed: 01/21/2023]
Abstract
The objective of this study is to assess the potential role of Emergency Department (ED) for early detection of mental disorders. Two cohorts (6,759 subjects aged 14 to 24 accessing ED, 165 subjects with mental disorders) were matched by ID and merged. Primary outcome was the proportion of individuals accessing ED before receiving a diagnosis of mental disorder in Mental Health Service (MHS). Secondary outcomes were age of first access to ED in subjects later accessing to MHS, and time from first ED access to receiving a diagnosis of mental disorder at MHS. We assessed whether gender, severity of ED presentation, and number of ED accesses predicted primary outcome. Almost half of individuals who later developed mental disorders (49.7%) accessed ED before access to MHS. Mean age of first ED contact among those later accessing to MHS was 17.34 (2.1), and ED access preceded access to MHS by 3.68 (2.11) years. Gender and severity of ED presentation were not associated with the access to MHS, while higher number of ED accesses was associated with later access to MHS (OR range: 1.17-1.36, p<0.05). Despite its limitations, the present study suggests ED might represent a contact point for individuals who later access to MHS. Future early detection programs should involve ED in their outreach and screening approaches. Additional studies are needed to assess if subjects earlier accessing to ED are at risk-of-developing or already suffer from a mental disorder, and to validate screening instruments specifically designed for ED.
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El-Mallakh RS, Goetz B, Nuru M, Weegens R, Yazdani U, Terrell C. Insurance expansion associated with reduced use of emergency psychiatric services. Am J Emerg Med 2020; 40:220-221. [PMID: 32505471 DOI: 10.1016/j.ajem.2020.05.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/19/2020] [Accepted: 05/20/2020] [Indexed: 11/18/2022] Open
Affiliation(s)
- Rif S El-Mallakh
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, KY, United States of America.
| | - Brenda Goetz
- Seven Counties Services, Louisville, KY, United States of America
| | - Mohammed Nuru
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, KY, United States of America
| | - Ryan Weegens
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, KY, United States of America
| | - Urooj Yazdani
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, KY, United States of America
| | - Christina Terrell
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, KY, United States of America
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Moore EM, Cheng TH, Castillo EG, Gelberg L, Ijadi-Maghsoodi R. Understanding Homelessness: A Call to Action and Curriculum Framework for Psychiatry Residencies. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2020; 44:344-351. [PMID: 31898302 PMCID: PMC7242141 DOI: 10.1007/s40596-019-01154-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 11/25/2019] [Indexed: 06/10/2023]
Affiliation(s)
| | | | - Enrico G Castillo
- Los Angeles County Department of Mental Health, Los Angeles, CA, USA
| | | | - Roya Ijadi-Maghsoodi
- Jane and Terry Semel Institute for Neuroscience & Human Behavior at UCLA, Los Angeles, CA, USA
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Penzenstadler L, Gentil L, Huỳnh C, Grenier G, Fleury MJ. Variables associated with low, moderate and high emergency department use among patients with substance-related disorders. Drug Alcohol Depend 2020; 207:107817. [PMID: 31887605 DOI: 10.1016/j.drugalcdep.2019.107817] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 12/12/2019] [Accepted: 12/14/2019] [Indexed: 11/27/2022]
Abstract
AIMS This study identified factors associated with frequency of emergency department (ED) use for medical reasons among patients with substance-related disorders (SRD) in Quebec (Canada) for 2014-15. METHODS Participants (n = 4731) were categorized as: 1) low (1 visit/year), 2) moderate (2 visits/year), and 3) high (3+ visits/year) ED users. Independent variables included predisposing, enabling and needs factors based on the Andersen Behavioral Model. Multinomial logistic regression identified associated variables. RESULTS Factors positively associated with moderate and high ED use included adjustment disorders, suicidal behavior, alcohol-induced disorders, less urgent to non-urgent illness acuity, referral to local health community services centers (LHCSC) at discharge, and living in a materially deprived area. Factors positively associated with high ED use only included anxiety disorders, alcohol use disorders, drug use disorders, chronic physical illness, subacute problems, prior ED use for MD and/or SRD, prior LHCSC medical interventions, physician consultation within one month after discharge, living in very deprived or middle-class areas, and, negatively, being hospitalized for medical reasons in second ED visit. Moderate ED use only was negatively associated with alcohol intoxication and being referred to a GP at ED discharge. CONCLUSIONS Compared to low ED users, most high users with SRD were men presenting more complex and severe conditions. They visited ED mainly for subacute or non-urgent problems. Compared to low ED users, most moderate users had alcohol-induced disorders, less alcohol intoxication, and acute common MD. They visited ED mainly for non-urgent care. Diverse strategies should be implemented to reduce ED visits, targeting each group.
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Affiliation(s)
- Louise Penzenstadler
- Douglas Mental Health University Institute (Research Centre), McGill University, Department of Psychiatry, 6875 LaSalle Boulevard, Montréal, Québec H4H 1R3, Canada; Service d'addictologie, Département de psychiatrie, Hôpitaux Universitaires Genève, Rue du Grand-Pré 70c, 1202 Genève, Switzerland
| | - Lia Gentil
- Douglas Mental Health University Institute (Research Centre), McGill University, Department of Psychiatry, 6875 LaSalle Boulevard, Montréal, Québec H4H 1R3, Canada; Institut universitaire sur les dépendances, Centre intégré universitaire de santé et des services sociaux du Centre-Sud-de-l'Île-de-Montréal, 950 Louvain East, Montréal, Québec H2M 2E8, Canada
| | - Christophe Huỳnh
- Institut universitaire sur les dépendances, Centre intégré universitaire de santé et des services sociaux du Centre-Sud-de-l'Île-de-Montréal, 950 Louvain East, Montréal, Québec H2M 2E8, Canada
| | - Guy Grenier
- Douglas Mental Health University Institute (Research Centre), McGill University, Department of Psychiatry, 6875 LaSalle Boulevard, Montréal, Québec H4H 1R3, Canada
| | - Marie-Josée Fleury
- Douglas Mental Health University Institute (Research Centre), McGill University, Department of Psychiatry, 6875 LaSalle Boulevard, Montréal, Québec H4H 1R3, Canada.
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Predictors of Multiple Emergency Department Utilization Among Frequent Emergency Department Users in 3 States. Med Care 2019; 58:137-145. [DOI: 10.1097/mlr.0000000000001228] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Homelessness in mental illness: Opportunities & prospects in the Indian context. Asian J Psychiatr 2019; 45:28-32. [PMID: 31476716 DOI: 10.1016/j.ajp.2019.08.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 08/22/2019] [Accepted: 08/22/2019] [Indexed: 11/22/2022]
Abstract
Homelessness is considered a serious public health concern. Bidirectional relationship has been established between homelessness and mental illness by research studies and its association with compromised well-being, poor quality of life and low productivity. Recent legislative enactments in India have necessitated on the part of the state to address issues related to the rights of persons with mental illness including shelter and housing. Therefore, it becomes imperative to discuss opportunities and prospects in India towards rehabilitating homeless mentally ill in context of existing programs, policies and legislations.
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