Frequencies of emergency department use and hospitalization comparing patients with different types of substance or polysubstance-related disorders

Abstract

Background This study measured emergency department (ED) use and hospitalization for medical reasons among patients with substance-related disorders (SRD), comparing four subgroups: cannabis-related disorders, drug-related disorders other than cannabis, alcohol-related disorders and polysubstance-related disorders, controlling for various clinical, sociodemographic and service use variables. Methods Clinical administrative data for a cohort of 22,484 patients registered in Quebec (Canada) addiction treatment centers in 2012-13 were extracted for the years 2009-10 to 2015-16. Using negative binomial models, risks of frequent ED use and hospitalization were calculated for a 12-month period (2015-16). Results Patients with polysubstance-related disorders used ED more frequently than other groups with SRD. They were hospitalized more frequently than patients with cannabis or other drug-related disorders, but less frequently than those with alcohol-related disorders. Patients with alcohol-related disorders used ED more frequently than those with cannabis-related disorders and underwent more hospitalizations than both patients with cannabis-related and other drug-related disorders. Co-occurring SRD-mental disorders or SRD-chronic physical illnesses, more years with SRD, being women, living in rural territories, more frequent consultations with usual general practitioner or outpatient psychiatrist, and receiving more interventions in community healthcare centers increased frequency of ED use and hospitalization, whereas both adverse outcomes decreased with high continuity of physician care. Behavioral addiction, age less than 45 years, living in more materially deprived areas, and receiving 1-3 interventions in addiction treatment centers increased risk of frequent ED use, whereas living in semi-urban areas decreased ED use. Patients 25-44 years old receiving 4+ interventions in addiction treatment centers experienced less frequent hospitalization. Conclusion Findings showed higher risk of ED use among patients with polysubstance-related disorders, and higher hospitalization risk among patients with alcohol-related disorders, compared with patients affected by cannabis and other drug-related disorders. However, other variables contributed substantially more to the frequency of ED use and hospitalization, particularly clinical variables regarding complexity and severity of health conditions, followed by service use variables. Another important finding was that high continuity of physician care helped decrease the use of acute care services. Strategies like integrated care and outreach interventions may enhance SRD services.

Predictors of Frequent Emergency Department Use and Hospitalization among Patients with Substance-Related Disorders Recruited in Addiction Treatment Centers

“…Patients with serious MD are recognized as frequent acute care users [ 32 , 33 ]. Studies have shown that SRD, particularly polysubstance-related disorders (64% of the sample), increase the risk of co-occurring MD [ 34 ] and severe chronic physical illnesses [ 35 ], contributing to acute care use [ 36 ]. Suicidal behaviors were also elevated in the cohort at around 16%.…”

Profiles of quality of outpatient care use, associated sociodemographic and clinical characteristics, and adverse outcomes among patients with substance-related disorders

“…Profile 3 also had the highest percentage of patients with frequent ED use and hospitalizations, roughly twice the percentage found in Profile 1. Chronic SRD [ 8 ], serious MD [ 59 , 60 ] and personality disorders [ 61 ] have been found to increase the risk of frequent ED use and hospitalizations. A majority of patients in Profile 3 also lived alone or were single parents, conditions usually related to more adverse outcomes [ 62 , 63 ].…”

“…More intensive and continuous outpatient care by various health professionals is usually required for patients affected by multimorbidity [ 7 ]. Patients with SRD are often affected by co-occurring chronic physical illnesses and mental disorders (MD), increasing the risk of acute care use [ 8 ] and premature death [ 9 ]. SRD also increases the risk of death by accident, suicide, or homicide [ 10 , 11 ].…”

“…SRD also increases the risk of death by accident, suicide, or homicide [ 10 , 11 ]. Yet, high quality of care, defined as higher SRD treatment frequency [ 8 ] and overall continuity of care [ 12 , 13 ], reportedly decrease ED use and hospitalizations among patients with SRD. SRD treatment completion is also linked to improved health conditions and lower risk of death [ 14 ].…”

Trends and outcomes of Alcoholic Intoxication in Trauma Patients

“…Excessive alcohol use in the United States was estimated to cause an average of 80,000 deaths each year and cost states a median of $2.9 billion in 2006 3 . Also, usage of emergency departments and hospitalizations was highest among those with alcohol-related disorders when compared to other substance-related disorders 4 . Looking at hospital emergency department data, alcohol usage has shown to be a main risk factor for morbidity and mortality in relation to both intentional and unintentional injury 5 , particularly in violence-related injuries 5 .…”