Utilization of emergency and hospital services among individuals in substance abuse treatment

Cederbaum, Julie A.; Guerrero, Erick G.; Mitchell, Keyon R; Kim, Tina

doi:10.1186/1747-597x-9-16

Cited by 21 publications

(37 citation statements)

References 16 publications

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“…ED presentation was consistently associated with regular or recent injecting , sex work, diagnosed hepatitis C , diagnosed HIV , female sex , homelessness or unstable housing , crack cocaine or stimulant use , alcohol use , polydrug use and mental health problems .…”

Section: Resultsmentioning

confidence: 99%

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

Lewer

Freer

King³

et al. 2020

Addiction

114

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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, ecstasy/3,4-methylenedioxymethamphetamine (MDMA), cannabis, hallucinogens or novel psychoactive substances; have a diagnosis of 'substance use disorder'; or use drug treatment services. Measurements Primary outcomes were the cumulative incidence (risk) and rate of care episodes in three settings: primary care, hospital admissions (in-patient) and emergency department (ED).Findings Ninety-two studies were included, 84% from North America and Australia. Most studies focused on people using heroin, methamphetamine or crack cocaine, or who had a diagnosis of drug dependence. We were able to conduct a meta-analysis of rates across 25 studies reporting ED episodes and 25 reporting hospital admissions, finding pooled rates of 151 [95% confidence interval (CI) = 114-201] and 41 (95% CI = 30-57) per 100 person-years, respectively; on average 4.8 and 7.1 times more often than the general population. Heterogeneity was very high and was not explained by drugs used, country of study, recruitment setting or demographic characteristics. Predictors of health-care utilization were consistent across studies and included unstable housing, drug injection and mental health problems. Opioid substitution therapy was consistently associated with reduced ED presentation and hospital admission. There was minimal research on health-care utilization by people using ecstasy/MDMA, powder cocaine, hallucinogens or novel psychoactive substances.Conclusions People who use illicit drugs are admitted to emergency department or hospital several times more often than the general population.

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Section: Resultsmentioning

confidence: 99%

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

Lewer

Freer

King³

et al. 2020

Addiction

114

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“…20,23,25,48 The intervention is manual based and relies on the common addiction group therapy format. 2 Although patients with AOD disorders often use episodic care rather than comprehensive health services, similar to other patients, 4,5 the intervention helped them better connect with their overall health care and improve communication with their physician.…”

Section: Discussionmentioning

confidence: 99%

“…1–4 They often rely on emergency services, seldom using preventive services even when they have health insurance, 5–7 with that trend increasing in recent years. 8 At the same time, health care has a key role in positive AOD use outcomes and lower cost trajectories.…”

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confidence: 99%

Examination of the Effects of an Intervention Aiming to Link Patients Receiving Addiction Treatment With Health Care

Weisner

Felicia

et al. 2016

JAMA Psychiatry

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IMPORTANCE Research has shown that higher activation and engagement with health care is associated with better self-management. To our knowledge, the linkage intervention (LINKAGE) is the first to engage patients receiving addiction treatment with health care using the electronic health record and a patient activation approach. OBJECTIVE To examine the effects of an intervention aiming to link patients receiving addiction treatment with health care. DESIGN, SETTING, AND PARTICIPANTS A nonrandomized clinical trial evaluating the LINKAGE intervention vs usual care by applying an alternating 3-month off-and-on design over 30 months. Participants were recruited from an outpatient addiction treatment clinic in a large health system between April 7, 2011, and October 2, 2013. INTERVENTIONS Six group-based, manual-guided sessions on patient engagement in health care and the use of health information technology resources in the electronic health record, as well as facilitated communication with physicians, vs usual care. MAIN OUTCOMES AND MEASURES Primary outcomes, measured at 6 months after enrollment, were patient activation (by interview using the Patient Activation Measure), patient engagement in health care (by interview and electronic health record), and alcohol, drug, and depression outcomes (by interview using the Addiction Severity Index for alcohol and drug outcomes and Patient Health Questionnaire (PHQ) for depression). RESULTS A total of 503 patients were recruited and assigned to the LINKAGE (n = 252) or usual care (n = 251) conditions, with no differences in baseline characteristics between conditions. The mean (SD) age of the patients was 42.5 (11.8) years, 31.0% (n = 156) were female, and 455 (90.5%) completed the 6-month interview. Compared with usual care participants, LINKAGE participants showed an increase in the mean number of log-in days (incidence rate ratio, 1.53; 95% CI, 1.19–1.97; P = .001). Similar results were found across types of patient portal use (communicating by email, viewing laboratory test results and information, and obtaining medical advice). LINKAGE participants were more likely to talk with their physicians about addiction problems (odds ratio, 2.30; 95% CI, 1.52–3.49; P < .001). Although 6-month abstinence rates were high for both conditions (≥70.0% for both) and depression symptoms improved (the proportion with scores≥15 on the 9-item PHQ dropped from 15.1% [38 of 252] to 8.0% [18 of 225] among LINKAGE participants), there were no differences between conditions. Those who received all intervention components had significantly better alcohol and other drug outcomes than those who received fewer intervention components. CONCLUSIONS AND RELEVANCE Findings support the feasibility and effectiveness of the LINKAGE intervention in helping patients receiving addiction treatment engage in health care and increase communication with their physicians. The intervention did not affect short-term abstinence or depression outcomes. Understanding if the LINKAGE intervention helps ...

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“…[2,3,5,6,8] Utilizing the ER as entry level into care is not only more costly than a primary care visit, but also associated with delayed medical care which can further drive costs upward. [19,20] There is a great disparity between the amount spent on managing the health care impact of substance abuse and the actual treatment of substance abuse, with managing the impact receiving the lion's share of such spending.…”

Section: Discussionmentioning

confidence: 99%

“…[3] Cederbaum and colleagues note an increased use of emergency room (ER) services by individuals suffering from mental health and substance use disorders. [5] Chronic drug users utilize 30% more ER services than the general population. [6] The Drug Abuse Warning Network (DAWN) reports nearly 4.6 million drug related ER visits in 2009, representing an 81% increase since 2004.…”

Section: Introductionmentioning

confidence: 99%

Reduction in healthcare utilization and costs following residential integrated treatment for co-occurring substance use and mental health disorders

Morse¹,

Bride

2016

JHA

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Objective: The purpose of this study was to examine the impact of residential, integrated treatment for co-occurring substance use and mental health disorders on healthcare utilization and costs. More specifically, we compared pre-and post-treatment utilization of emergency room (ER) services and hospital stays for medical, mental health, and substance use problems. Methods: Data from 1,394 patients who attended private, residential treatment for co-occurring disorders and participated in follow-up data collection at 6 months were analyzed using chi-square and t-tests to evaluate what changes, if any, occurred preand post-treatment in regard to ER and hospital overnight utilization. Results: Significant reductions in the number ER visits and overnight stays were realized across the three services domains examined: medical, mental health and substance use. Conclusions: Private, residential treatment for substance use and mental health disorder can support an overall reduction in the utilization and costs of acute care services such as ER visits and hospital overnight stays.

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Utilization of emergency and hospital services among individuals in substance abuse treatment

Cited by 21 publications

References 16 publications

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

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

Examination of the Effects of an Intervention Aiming to Link Patients Receiving Addiction Treatment With Health Care

Reduction in healthcare utilization and costs following residential integrated treatment for co-occurring substance use and mental health disorders

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