Factors Influencing the Frequency of Emergency Department Utilization by Individuals with Substance Use Disorders

Abstract

This study assessed the characteristics of individuals with substance use disorders (ISUDs) according to their frequency of emergency department (ED) utilization, and examined which variables were associated with an increase in ED visits using Andersen's model. Data linkage of administrative databanks from three sources [addiction rehabilitation centre registry, physician billing systems, and hospital discharge databank] for 4526 ISUDs was performed. Predisposing, enabling and need factors associated with number of ED visits were determined using a negative binomial regression model and generalised estimating equations. The rate of ED utilization for this population was 9.6 %. Increased number of ED visits was associated with the following variables: older age, social fragmentation, number of consultations with general practitioners, number of consultations with psychiatrists, number of consultations with other types of physicians, alcohol abuse, drug abuse, schizophrenia, anxiety disorders, personality disorders, co-occurring substance dependence and mental disorders, co-occurring substance dependence and chronic physical disorders, and co-occurring mental health disorders and chronic physical disorders. By contrast, a diagnosis of substance dependence, co-occurring drug and alcohol abuse, and a co-occurring diagnosis of substance dependence with mental health and chronic physical disorders decreased ED visits. Efforts to reduce avoidable use of EDs should focus on chronic-disease management and other related strategies aimed at reinforcing services to ISUDs in the community, especially for ISUDs with a co-occurring diagnosis of either mental health disorders or chronic physical disorders.

National Prevalence of Alcohol and Other Substance Use Disorders Among Emergency Department Visits and Hospitalizations: NHAMCS 2014–2018

“…4 , 29 – 32 AUD acute care visits and SUD acute care visits were more common among individuals with coexisting depression and required more non-psychiatric mental health evaluations, consistent with prior studies finding individuals with coexisting psychiatric and AUD/SUD are more likely to access acute care services. 33 – 36 Despite the relationship between AUD/SUD and psychiatric illness, inpatient behavioral treatment and access to dual mental health and addiction treatment services after discharge are largely unavailable and underfunded nationwide. 37 Our finding of AUD acute care visits and SUD acute care visits being highly associated with Medicaid insurance raises further concern.…”

Factors Related to 30-day Readmission following Hospitalization for Any Medical Reason among Patients with Mental Disorders: Facteurs liés à la réhospitalisation à 30 jours suivant une hospitalisation pour une raison médicale chez des patients souffrant de troubles mentaux

“…Hierarchical logistic regression was conducted, with clinical variables introduced first into the model, as the variables most highly correlated with ED visits and hospitalizations according to the literature, followed by sociodemographic variables, then service use variables. 45 –47 A stepwise forward method was also used for the estimation of parameters in the hierarchical logistic regression model. Odds ratios were calculated with 95% confidence intervals.…”

Typology of patients who use emergency departments for mental and substance use disorders

“…15 The findings of these studies may be classified in terms of needs, predisposing and enabling factors, based on the Andersen Behavioral Model, 16 the main explanatory model for healthcare service use, including emergency department use in the general population, 17 or among people affected by MDs and/or SUDs. [18][19][20] Needs factors include clinical variables (e.g. diagnoses); predisposing factors include individual characteristics, such as sociodemographic variables (e.g.…”