Characterizing people with frequent emergency department visits and substance use: a retrospective cohort study of linked administrative data in Ontario, Alberta, and B.C., Canada.
BMC Emerg Med
;22(1): 127, 2022 07 14.
ArtigoemInglês
|MEDLINE
| ID: mdl-35836121
ABSTRACT
BACKGROUND:
Substance use is common among people who visit emergency departments (EDs) frequently. We aimed to characterize subgroups within this cohort to better understand care needs/gaps, and generalizability of characteristics in three Canadian provinces.METHODS:
This was a retrospective cohort study (April 1st, 2013 to March 31st, 2016) of ED patients in Ontario, Alberta, and British Columbia (B.C.) We included patients ≥ 18 years with substance use-related healthcare contact during the study period and frequent ED visits, defined as those in the top 10% of ED utilization when all patients were ordered by annual ED visit number. We used linked administrative databases including ED visits and hospitalizations (all provinces); mental heath-related hospitalizations (Ontario and Alberta); and prescriptions, physician services, and mortality (B.C.). We compared to cohorts of people with (1) frequent ED visits and no substance use, and (2) non-frequent ED visits and substance use. We employed cluster analysis to identify subgroups with distinct visit patterns and clinical characteristics during index year, April 1st, 2014 to March 31st, 2015.RESULTS:
In 2014/15, we identified 19,604, 7,706, and 9,404 people with frequent ED visits and substance use in Ontario, Alberta, and B.C (median 37-43 years; 60.9-63.0% male), whose ED visits and hospitalizations were higher than comparison groups. In all provinces, cluster analyses identified subgroups with "extreme" and "moderate" frequent visits (median 13-19 versus 4-6 visits/year). "Extreme" versus "moderate" subgroups had more hospitalizations, mental health-related ED visits, general practitioner visits but less continuity with one provider, more commonly left against medical advice, and had higher 365-day mortality in B.C. (9.3% versus 6.6%; versus 10.4% among people with frequent ED visits and no substance use, and 4.3% among people with non-frequent ED visits and substance use). The most common ED diagnosis was acute alcohol intoxication in all subgroups.CONCLUSIONS:
Subgroups of people with "extreme" (13-19 visits/year) and "moderate" (4-6 visits/year) frequent ED visits and substance use had similar utilization patterns and characteristics in Ontario, Alberta, and B.C., and the "extreme" subgroup had high mortality. Our findings suggest a need for improved evidence-based substance use disorder management, and strengthened continuity with primary and mental healthcare. Texto completo:Disponível Coleções:Bases de dados internacionais Contexto em Saúde:ODS3 - Saúde e Bem-Estar /ODS3 - Meta 3.5 Prevenção e tratamento do consumo de substâncias psicoativas Problema de saúde:Meta 3.5 Prevenção e tratamento do consumo de substâncias psicoativas /Álcool Base de dados:MEDLINE Assunto principal:Transtornos Relacionados ao Uso de Substâncias /Serviço Hospitalar de Emergência Tipo de estudo:Estudo de etiologia /Estudo de incidência /Estudo observacional /Fatores de risco Limite:Feminino /Humanos /Masculino País/Região como assunto:América do Norte Idioma:Inglês Revista:BMC Emerg Med Assunto da revista:Medicina de Emergência Ano de publicação:2022 Tipo de documento:Artigo País de afiliação:Canadá
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