Are People Who Inject Drugs Frequent Users of Emergency Department Services? A Cohort Study (2008–2013)

Nambiar, Dhanya; Spelman, Tim; Stoové, Mark; Dietze, Paul

doi:10.1080/10826084.2017.1341921

Cited by 30 publications

(26 citation statements)

References 52 publications

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“…However, Australians rarely present to the ED purely for assistance with withdrawal. 9 Non-English speakers and those with insufficient contact information were excluded. In Australia, OUD has greatly affected the homeless population, many of whom may not have a mobile phone.…”

Section: Randomised Controlled Trialsmentioning

confidence: 99%

“…8 Some patients with OUD have complex health needs, often feel marginalised from primary care and may have limited resources meaning that they often seek health care from the ED. 9 Despite the high rates of overdose deaths post-ED discharge, this population is not routinely granted access to treatment with buprenorphine, which is potentially life-saving and can alleviate the symptoms of withdrawal. 10 The ED may offer an opportunity to engage patients with OUD in treatment, link them in with longer term services, and promote strategies to reduce drug-related harms such as postdischarge overdose.…”

Section: Introductionmentioning

confidence: 99%

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Review article: Rapid review of the emergency department‐initiated buprenorphine for opioid use disorder

Salter

Hutton

Cantwell

et al. 2020

Emerg Medicine Australasia

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Opioid-related harms have been increasing in Australia over the last 5 years. Patients with opioid use disorder are over-represented in ED presentations. Opioid agonist treatment is the most effective community-based treatment. Buprenorphine is considered the safest of these treatments to use in the ED setting. This rapid review investigated the effectiveness of initiating buprenorphine in the ED setting. Medline, Embase, Emcare, PSYCinfo, CINAHL and Cochrane Central Register of Controlled Trials databases were searched. Randomised and non-randomised studies published in peer-reviewed journals that involved the initiation of buprenorphine in the ED setting were considered eligible. The search revealed 350 articles of which 11 were included in the review; three articles representing two randomised controlled trials (RCTs) and eight observational studies. Data were extracted from included papers and risk of bias assessed on the RCTs. One well-conducted RCT showed that buprenorphine initiated in the ED does improve treatment engagement up to 2 months after an ED visit. Eight observational studies, one with a comparator group reported positive results for this intervention. There is strong evidence that clinicians should consider commencing buprenorphine in the ED for patients with opioid use disorder when combined with a direct and supported referral or 'warm handover' to community care. Further implementation studies and investigation of long-acting injectable buprenorphine treatment are required.

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Section: Randomised Controlled Trialsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Review article: Rapid review of the emergency department‐initiated buprenorphine for opioid use disorder

Salter

Hutton

Cantwell

et al. 2020

Emerg Medicine Australasia

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“…Data on reasons for ED presentation by people with OUD are scarce, but among people who use and inject drugs (commonly opioids), the most frequent reasons for ED presentation are drug-related, including overdose and skin and soft-tissue infections [9,10]. In one cohort of people who inject drugs (72% of whom injected opioids), almost half of all ED presentations were triaged as semi-urgent or non-urgent [8]. Although this is similar to the proportion of semi-urgent and non-urgent presentations nationally [11], given their higher overall presentation rates, reducing low-acuity presentations among people with OUD may provide particular benefits.…”

Section: Introductionmentioning

confidence: 99%

Reductions in emergency department presentations associated with opioid agonist treatment vary by geographic location: A retrospective study in New South Wales, Australia

Jones

Shanahan

Dobbins

et al. 2019

Drug and Alcohol Review

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Introduction and Aims It is not known if the reduction in ED use during periods of OAT occurs across urgent and low acuity presentations. We aimed to compare the incidence and costs of urgent and low acuity ED presentations of people with opioid use disorder (OUD) in and out of opioid agonist treatment (OAT). Design and Methods This was a retrospective cohort study (N=24,875), using linked administrative health data from New South Wales (NSW), Australia. Urgent and low acuity ED incidence and associated costs were calculated for periods in and out of OAT. GEE models estimated the adjusted incidence rate ratio (IRR) for ED presentations. Average costs per person‐day were calculated with bootstrap confidence intervals. Results Incidence of urgent presentations was lower in OAT compared to out of OAT [IRR (95%CI): 0.65 (0.61‐0.69)]. In major cities, low acuity presentations were lower during OAT compared to timeout of OAT [IRR (95%CI): 0.82 (0.70‐0.96)], in regional/remote areas, low acuity presentations were higher during OAT [IRR (95%CI): 2.65 (1.66‐4.21)]. In major cities, average costs for low acuity presentations in OAT were 28% lower atA$0.50 (95%CI: A$0.48‐A$0.52) and A$0.69 (95%CI: A$0.66‐A$0.71) out of OAT, but 103% higher in regional/remote NSW, at A$2.12 (95%CI: A$1.91‐A$2.34) in OAT and A$1.04 (95%CI: A$0.91‐A$1.16) out of OAT. Discussion and Conclusions OAT was associated with reductions in urgent ED presentations and associated costs among people with OUD. Geographical variation was evident for low acuity ED presentations, highlighting the need to increase access to OAT in regional/remote areas.

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“…The ongoing, systematic gathering of clinical and non-clinical data could provide timely, actionable information on new or emerging drug trends and help facilitate prompt intervention and responses [ 9 , 10 ]. PWID frequently attend hospital emergency departments (EDs) [ 11 ], including for overdose-related presentations [ 12 ], and so ED data offer potential utility for surveillance and a rich source of information on drug-related morbidity.…”

Section: Introductionmentioning

confidence: 99%

“…In this paper we examine F-codes and T-codes in ED attendances among a cohort of known PWID, whose drug use trends [ 5 , 19 ], rates of ED attendance and reasons for presentation [ 11 , 20 ] have been characterised previously. Here, we focus specifically on the extent to which different ICD-10 codes are used in coding overdose attendances and consider the implications of this coding for understanding patterns and trends in the presentations of PWID in the ED.…”

Section: Introductionmentioning

confidence: 99%

Drug overdose in the ED: a record linkage study examining emergency department ICD-10 coding practices in a cohort of people who inject drugs

Rico

Nambiar

Stoové

et al. 2018

BMC Health Serv Res

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BackgroundDrug overdose is a leading cause of mortality and morbidity amongst people who inject drugs (PWID). Drug overdose surveillance typically relies on the International Classification of Diseases (ICD-10) coding system, however its real world utilisation and the implications for surveillance have not been well characterised. This study examines the patterns of ICD-10 coding pertaining to drug overdoses within emergency departments for a cohort of known PWID.MethodsCohort data from 688 PWID was linked to statewide emergency department administrative data between January 2008 and June 2013. ICD-10 diagnostic codes pertaining to poisonings by drugs, medicaments and biological substances (T-codes T36-T50) as well as mental and behavioural disorders due to psychoactive substance use (F-codes F10-F19) were examined.ResultsThere were 449 unique ED presentations with T or F code mentions contributed by 168 individuals. Nearly half of the T and F codes used were non-specific and did not identify either a drug class (n = 160, 36%) or clinical reaction (n = 46, 10%) and 8% represented withdrawal states. T and F codes could therefore be used to reasonably infer an illicit drug overdose in only 42% (n = 188) of cases. Majority of presentations with T or F overdose codes recorded only one diagnostic code per encounter (83%) and representing multiple-drug overdose (F19.- = 18%) or unidentified substances (T50.9 = 17%) using a single, broad diagnostic code was common.ConclusionsReliance on diagnoses alone when examining ED data will likely significantly underestimate incidence of specific drug overdose due to frequent use of non-specific ICD-10 codes and the use of single diagnostic codes to represent polysubstance overdose. Measures to improve coding specificity should be considered and further work is needed to determine the best way to use ED data in overdose surveillance.

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Are People Who Inject Drugs Frequent Users of Emergency Department Services? A Cohort Study (2008–2013)

Abstract: PWID use EDs at a higher rate than the general population, and typically present with injuries and mental and behavioral disorders. Referrals to drug treatment, mental health, and social support services can improve patient care and reduce the burden on EDs.

Cited by 30 publications

References 52 publications

Review article: Rapid review of the emergency department‐initiated buprenorphine for opioid use disorder

Review article: Rapid review of the emergency department‐initiated buprenorphine for opioid use disorder

Reductions in emergency department presentations associated with opioid agonist treatment vary by geographic location: A retrospective study in New South Wales, Australia

Drug overdose in the ED: a record linkage study examining emergency department ICD-10 coding practices in a cohort of people who inject drugs

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