A prospective cohort study of hospital separations among people who inject drugs in Australia: 2008–2013

Abstract

ObjectivesInjecting drug use is a persistent behaviour that increases the risk of morbidities and mortality. We assessed the burden of hospital separations among people who inject drugs (PWID), the excess compared to the general population and characteristics of separations associated with frequent use.DesignProspective cohort study.SettingAll public and private hospitals in Victoria.Participants757 community-based PWID with hospital separations between January 2008 and June 2013 identified through record linkage, who contributed over 3729 person-years.Primary and secondary outcome measuresCounts, proportions and rates of hospital separations, descriptive administrative data including all diagnoses, comparison of separation rates to the general population, trend in separations and factors associated with frequent separations.ResultsThere were 2106 separations in the cohort. The most common principal diagnoses were related to mental and behavioural disorders (31%), but social circumstances influencing health was the most common group of diagnoses (61%) when all contributing diagnoses for each patient were considered. Separation rates were up to three times higher than in the age-matched population, and there was a 12% increase in separations every 6 months. Over a quarter (29%) of the cohort had frequent separations (defined as two or more separations in a calendar year), which were associated with mental health-related diagnoses, being discharged to locations other than a patient’s residence, having a medical as opposed to surgical intervention, seasonal patterns, relationship status and gender.ConclusionsMental health conditions and other characteristics associated with separations and frequent separations in particular, emphasise the importance of providing referrals to harm reduction, social services and mental health services at discharge in order to reduce excess hospital separations among PWID.

Frequency of health‐care utilization by adults who use illicit drugs: a systematic review and meta‐analysis

“…All infections, and particularly pneumonias, were important causes of health‐care utilization in HIV‐positive opiate users . Infections were less important causes of health‐care utilization in Australia . Traumas, injuries and mental health problems were important causes of ED utilization and hospital admission in all countries .…”

Comparison of Demographic, Epidemiological, Immunological, and Clinical Characteristics of Patients with HIV Mono-infection Versus Patients Co-infected with HCV or/and HBV: A Serbian Cohort Study

“…Intravenous drug use per se causes many health problems and therefore might accelerate the progression of immunodeficiency [39,40]. Furthermore, IVDUs have repeatedly been associated with low level of responsibility towards their health, and hesitation to seek for medical help, what puts them at high risk for disease progression [41][42][43]. However, considering that majority of IVDUs in our study were undergoing treatment for addiction, which improves their awareness and responsibility towards health and socialization, other causes for rapid progression to AIDS in HIV/HCV coinfected patients should also be considered.…”

Lifetime prevalence and correlates of self-harm and suicide attempts among male prisoners with histories of injecting drug use

“…Intervention opportunities are, however, not restricted to specialist mental health services. Australian research exploring the use of tertiary health services among PWID found PWID to be frequent users of emergency department (ED) and tertiary healthcare services and that ED presentations and hospital separations were most commonly related to mental and behavioural disorders (Nambiar et al, 2018; Nambiar et al, 2017). Similarly, a study of ambulance attendances among recently released prisoners found that one in twelve attendances involved self-harm or self-harm/suicidal ideation (Borschmann, Young, et al, 2017).…”