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

Abstract

Background This study identified patient profiles in terms of their quality of outpatient care use, associated sociodemographic and clinical characteristics, and adverse outcomes based on frequent emergency department (ED) use, hospitalization, and death from medical causes. Methods A cohort of 18,215 patients with substance-related disorders (SRD) recruited in addiction treatment centers was investigated using Quebec (Canada) health administrative databases. A latent class analysis was produced, identifying three profiles of quality of outpatient care use, while multinomial and logistic regressions tested associations with patient characteristics and adverse outcomes, respectively. Results Profile 1 patients (47% of the sample), labeled “Low outpatient service users”, received low quality of care. They were mainly younger, materially and socially deprived men, some with a criminal history. They had more recent SRD, mainly polysubstance, and less mental disorders (MD) and chronic physical illnesses than other Profiles. Profile 2 patients (36%), labeled “Moderate outpatient service users”, received high continuity and intensity of care by general practitioners (GP), while the diversity and regularity in their overall quality of outpatient service was moderate. Compared with Profile 1, they were older, less likely to be unemployed or to live in semi-urban areas, and most had common MD and chronic physical illnesses. Profile 3 patients (17%), labeled “High outpatient service users”, received more intensive psychiatric care and higher quality of outpatient care than other Profiles. Most Profile 3 patients lived alone or were single parents, and fewer lived in rural areas or had a history of homelessness, versus Profile 1 patients. They were strongly affected by MD, mostly serious MD and personality disorders. Compared with Profile 1, Profile 3 had more frequent ED use and hospitalizations, followed by Profile 2. No differences in death rates emerged among the profiles. Conclusions Frequent ED use and hospitalization were strongly related to patient clinical and sociodemographic profiles, and the quality of outpatient services received to the severity of their conditions. Outreach strategies more responsive to patient needs may include motivational interventions and prevention of risky behaviors for Profile 1 patients, collaborative GP-psychiatrist care for Profile 2 patients, and GP care and intensive specialized treatment for Profile 3 patients.

Profiles of Emergency Department Users with Psychiatric Disorders Related to Barriers to Outpatient Care

“…This study was conducted in accordance with the Declaration of Helsinki and approved by the Douglas Mental Health University Institute ethics committee (IUSMD [20][21][22][23][24][25][26].…”

“…The typologies pertaining to ED users with psychiatric disorders have mostly focused on the socio-demographic and clinical characteristics of high ED users, mostly finding them to be young, single, male, and with medical comorbidities, but few typology studies have examined patient service use patterns [23,24]. One recent Canadian study that identified three profiles regarding the quality of outpatient care use for patients with SRDs found that the profile with the most frequent ED use and hospitalizations was made up of high outpatient service users mostly affected by psychiatric disorders and personality disorders [25]. Another study identified three profiles of moderate ED users with psychiatric disorders: one composed of young males with SRDs who were low outpatient service users; one of middle-aged females with common psychiatric disorders; and one of older patients with cooccurring psychiatric disorders-chronic physical illnesses.…”