Abstract:Aims To summarize evidence on the frequency and predictors of health-care utilization among people who use illicit drugs. Design Systematic search of MEDLINE, EMBASE and PsychINFO for observational studies reporting healthcare utilization published between 1 January 2000 and 3 December 2018. We conducted narrative synthesis and meta-analysis following a registered protocol (identifier: CRD42017076525). Setting and participants People who use heroin, powder cocaine, crack cocaine, methamphetamine, amphetamine, … Show more
“…The results of this study con rm the high burden of disease for people with SUD. Our results for ED and hospitalizations episodes are in line with the results of previous studies [27]. At the same time, our study gives a better understanding of the number of contacts with general practitioners by people with SUD.…”
Section: Discussionsupporting
confidence: 92%
“…Indeed, many studies already pointed out that people with SUD heavily rely on emergency departments and are supposedly less in contact with general health care services [25,26]. As revealed by a recent meta-analysis, people with SUD have on average 4.8 times more episodes in emergency departments than the general population and are 7.1 times more often hospitalized [27]. However, the same review identi ed several gaps in the evidence such as the fact that little is known about the health seeking behavior of people with cannabis use disorders, MDMA or amphetamine use disorders, powder cocaine use disorders, as well as the lack of knowledge about the use of primary health care by people with SUD [27].…”
Background To describe the frequencies of health-care utilization by people with substance use disorder (SUD), more specifically contacts with the general practitioner (GP), the psychiatrist, the emergency departments (ED) and hospital admissions and to compare this frequency to the general population.Methods Data from the national register of people who were in treatment for SUD between 2011–2014 was linked to health care data from the Belgian health insurance (N = 30,905). Four comparators were matched on age, sex and place of residence to each subject in treatment for SUD (N = 123,620). Cases were further divided in five mutually exclusive categories based on the main SUD (opiates, crack/cocaine, stimulants, cannabis and alcohol). We calculated the average number of contacts with GP, psychiatrists and ED, and hospital admissions per person over a ten year period (2008–2017), computed descriptive statistics for each of the SUD and used negative binomial regression models to compare cases and comparators.Results Over the ten-year period, people in treatment for SUD overall had on average 60 GP contacts, 3.9 psychiatrist contacts, 7.8 visits to the ED, and 16 hospital admissions. Rate ratios, comparing cases and corresponding comparators, showed that people in treatment for SUD had on average 1.9 more contacts with a GP (95% CI 1.9-2.0), 7.4 more contacts with a psychiatrist (95% CI 7.0-7.7), 4.2 more ED visits (95% CI 4.2–4.3), and 6.4 more hospital admissions (95% CI 6.3–6.5).Conclusion The use of health services for people with SUD is between almost two (GP) and seven times (psychiatrist) higher than for comparators. People in treatment for alcohol use disorders have a higher burden of disease than people in treatment for other SUD. The use of health services remained stable in the five years before and after the moment people with SUD entered into treatment for SUD.
“…The results of this study con rm the high burden of disease for people with SUD. Our results for ED and hospitalizations episodes are in line with the results of previous studies [27]. At the same time, our study gives a better understanding of the number of contacts with general practitioners by people with SUD.…”
Section: Discussionsupporting
confidence: 92%
“…Indeed, many studies already pointed out that people with SUD heavily rely on emergency departments and are supposedly less in contact with general health care services [25,26]. As revealed by a recent meta-analysis, people with SUD have on average 4.8 times more episodes in emergency departments than the general population and are 7.1 times more often hospitalized [27]. However, the same review identi ed several gaps in the evidence such as the fact that little is known about the health seeking behavior of people with cannabis use disorders, MDMA or amphetamine use disorders, powder cocaine use disorders, as well as the lack of knowledge about the use of primary health care by people with SUD [27].…”
Background To describe the frequencies of health-care utilization by people with substance use disorder (SUD), more specifically contacts with the general practitioner (GP), the psychiatrist, the emergency departments (ED) and hospital admissions and to compare this frequency to the general population.Methods Data from the national register of people who were in treatment for SUD between 2011–2014 was linked to health care data from the Belgian health insurance (N = 30,905). Four comparators were matched on age, sex and place of residence to each subject in treatment for SUD (N = 123,620). Cases were further divided in five mutually exclusive categories based on the main SUD (opiates, crack/cocaine, stimulants, cannabis and alcohol). We calculated the average number of contacts with GP, psychiatrists and ED, and hospital admissions per person over a ten year period (2008–2017), computed descriptive statistics for each of the SUD and used negative binomial regression models to compare cases and comparators.Results Over the ten-year period, people in treatment for SUD overall had on average 60 GP contacts, 3.9 psychiatrist contacts, 7.8 visits to the ED, and 16 hospital admissions. Rate ratios, comparing cases and corresponding comparators, showed that people in treatment for SUD had on average 1.9 more contacts with a GP (95% CI 1.9-2.0), 7.4 more contacts with a psychiatrist (95% CI 7.0-7.7), 4.2 more ED visits (95% CI 4.2–4.3), and 6.4 more hospital admissions (95% CI 6.3–6.5).Conclusion The use of health services for people with SUD is between almost two (GP) and seven times (psychiatrist) higher than for comparators. People in treatment for alcohol use disorders have a higher burden of disease than people in treatment for other SUD. The use of health services remained stable in the five years before and after the moment people with SUD entered into treatment for SUD.
“…Epidemiological research and health interventions have focused on outcomes perceived to be ‘drug-related’, such as overdoses and HIV or hepatitis infections. Meanwhile, there is limited research into engagement with primary care services, healthcare quality, and treatment options for non-communicable diseases and mental health problems 14 . These are important areas of research because the population of people who use illicit opioids in England (as in many other countries) is ageing 15 and the majority of excess deaths are now caused by non-communicable diseases such as liver disease, chronic obstructive pulmonary disease, and cardiovascular disease 16 .…”
Background: People who use illicit opioids such as heroin have substantial health needs, but there are few longitudinal studies of general health and healthcare in this population. Most research to date has focused on a narrow set of outcomes, including overdoses and HIV or hepatitis infections. We developed and validated a cohort using UK primary care electronic health records (Clinical Practice Research Datalink GOLD and AURUM databases) to facilitate research into healthcare use by people who use illicit opioid use (HUPIO). Methods: Participants are patients in England with primary care records indicating a history of illicit opioid use. We identified codes including prescriptions of opioid agonist therapies (methadone and buprenorphine) and clinical observations such as ‘heroin dependence’. We constructed a cohort of patients with at least one of these codes and aged 18-64 at cohort entry, with follow-up between January 1997 and March 2020. We validated the cohort by comparing patient characteristics and mortality rates to other cohorts of people who use illicit opioids, with different recruitment methods. Results: Up to March 2020, the HUPIO cohort included 138,761 patients with a history of illicit opioid use. Demographic characteristics and all-cause mortality were similar to existing cohorts: 69% were male; the median age at index for patients in CPRD AURUM (the database with more included participants) was 35.3 (IQR 29.1-42.6); the average age of new cohort entrants increased over time; 76% had records indicating current tobacco smoking; patients disproportionately lived in deprived neighbourhoods; and all-cause mortality risk was 5.4 (95% CI 5.3-5.5) times the general population of England. Conclusions: Primary care data offer new opportunities to study holistic health outcomes and healthcare of this population. The large sample enables investigation of rare outcomes, whilst the availability of linkage to external datasets allows investigation of hospital use, cancer treatment, and mortality.
“…Ultimately, the response to reducing unnecessary hospitalizations will likely require interventions that are broader than a healthcare-based response. For example, programs that provide stable housing show promise in this regard [ 52 – 54 ] as do substance use disorder treatment and comprehensive support efforts [ 55 ]. These types of approaches warrant additional consideration.…”
Background: Given system-level focus on avoidance of unnecessary hospitalizations, better understanding admission decision-making is of utility. Our study sought to identify factors associated with hospital admission versus discharge from the Emergency Department (ED) for a population of patients who were assessed as having low medical acuity at time of decision. Methods: Using an institutional database, we identified ED admission requests received from March 1, 2018 to Feb 28, 2019 that were assessed by a physician at the time of request as potentially inappropriate based on lack of medical acuity. Focused chart review was performed to extract data related to patient demographics, socioeconomic information, measures of illness, and system-level factors such as previous healthcare utilization and day/time of presentation. A binary logistic regression model was constructed to correlate patient and system factors with disposition outcome of admission to the hospital versus discharge from the ED. Physician-reported contributors to admission decision-making and chief complaint/reason for admission were summarized. Results: A total of 349 (77.2%) of 452 calls resulted in admission to the hospital and 103 (22.8%) resulted in discharge from the ED. Predictors of admission included age over 65 (OR 3.5 [95%CI 1.1-11.6], p = 0.039), homelessness (OR 3.3 [95% CI 1.7-6.4], p=0.001), and night/weekend presentation (OR 2.0 [95%CI 1.1-3.5], p = 0.020). The most common contributing factors to the decision to admit reported by the responding physician included: lack of outpatient social support (35.8% of admissions), homelessness (33.0% of admissions), and substance use disorder (23.5% of admissions). Conclusions: Physician medical decision-making regarding the need for hospitalization incorporates consideration of individual patient characteristics, social setting, and system-level barriers. Interventions aimed at reducing unnecessary hospitalizations, especially those involving patients with low medical acuity, should focus on underlying unmet needs and involve a broad set of perspectives.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.