The association of psychiatric comorbidity and use of the emergency department among persons with substance use disorders: an observational cohort study

Curran, Geoffrey M.; Sullivan, Greer; Williams, Keith D.; Han, Xiaotong; Allee, Elise; Kotrla, Kathryn J.

doi:10.1186/1471-227x-8-17

Cited by 105 publications

(81 citation statements)

References 23 publications

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“…F requent emergency department (ED) users disproportionately utilize healthcare resources. 1 Existing literature also indicates a higher prevalence of chronic illness, psychiatric comorbidity, and lower socioeconomic status, [2][3][4][5][6][7][8][9][10] as well as higher mortality and adverse health outcomes compared to nonfrequent users. 11 Existing evidence suggests that frequent ED users are at-risk patients in whom interventions may improve outcomes.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of Interventions to Decrease Emergency Department Visits by Adult Frequent Users: A Systematic Review

Moe

Kirkland

Rawe

et al. 2017

Academic Emergency Medicine

169

138

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Objectives: Frequent emergency department (ED) users are high-risk and high-resource-utilizing patients. This systematic review evaluates effectiveness of interventions targeting adult frequent ED users in reducing visit frequency and improving patient outcomes.Methods: An a priori protocol was published in PROSPERO. Two independent reviewers screened, selected, rated quality, and extracted data. Third-party adjudication resolved disagreements. Rate ratios of post-versus pre-intervention ED visits were calculated. Data sources were from a comprehensive search that included seven databases and the gray literature. Eligibility criteria for selecting studies included experimental studies assessing the effect of interventions on frequent users' ED visits and patient-oriented outcomes.Results: A total of 6,865 citations were identified and 31 studies included. Designs were noncontrolled (n = 21) and controlled (n = 4) before-after studies and randomized controlled trials (n = 6). Frequent user definitions varied considerably and risk of bias was moderate to high. Studies examined general frequent users or those with psychiatric comorbidities, chronic disease, or low socioeconomic status or the elderly. Interventions included case management (n = 18), care plans (n = 8), diversion strategies (n = 3), printout case notes (n = 1), and social work visits (n = 1). Post-versus pre-intervention rate ratios were calculated for 25 studies and indicated a significant visit decrease in 21 (84%) of these studies. The median rate ratio was 0.63 (interquartile range = 0.41 to 0.71), indicating that the general effect of the interventions described was to decrease ED visits post-intervention. Significant visit decreases were found for a majority of studies in subgroup analyses based on 6-or 12-month follow-up, definition thresholds, clinical frequent user subgroups, and intervention types. Studies reporting homelessness found consistent improvements in stable housing. Overall, interstudy heterogeneity was high. The authors have no potential conflicts to disclose. PROSPERO registration number CRD42014015058. Study group authorship: Jessica Moe conceptualized and drafted the protocol, screened abstracts and articles for inclusion, extracted data, analyzed data, and wrote the manuscript; Scott Kirkland helped to draft the protocol, screened abstracts and articles for inclusion, analyzed data, assessed study quality, and wrote sections of the manuscript; Erin Rawe drafted the protocol and extracted data; Maria Ospina helped to draft the protocol, assessed study quality, and provided third-party adjudication for inclusion screening and quality assessment; Ben Vandermeer helped to plan and perform the statistical analysis; Sandy Campbell developed and ran the search strategy; Brian H. Rowe conceptualized the protocol, provided third-party adjudication for inclusion screening and quality assessment, analyzed data, and wrote a section of the manuscript. All authors reviewed, edited, and approved the final manuscript. Existing evide...

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Section: Discussionmentioning

confidence: 99%

Effectiveness of Interventions to Decrease Emergency Department Visits by Adult Frequent Users: A Systematic Review

Moe

Kirkland

Rawe

et al. 2017

Academic Emergency Medicine

169

138

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“…6 In a study of databases in Massachusetts, Kathleen Fuda and Rachel Immekus found that only 1 percent of state residents accounted for 17.6 percent of all ED visits. 7 Compared with other ED users, frequent users have more social, psychiatric, and substance abuse issues [8][9][10][11][12][13][14][15][16] and tend to be sicker, with medical conditions that are both more complex and more acute. [17][18][19][20][21][22] In addition, frequent users are more frequently admitted to the hospital, 15 incur higher costs, 23,24 and have higher mortality rates.…”

Section: Health Information Exchange Improves Identification Of Frequmentioning

confidence: 99%

Health Information Exchange Improves Identification Of Frequent Emergency Department Users

et al. 2013

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“…The profiled delineated was similar to other profiles found in international studies. 7,13,16 In this study, the most frequently reported reasons for seeking treatment were psychiatric complaints other than the use of PAS (23.1%), followed by the desire to treat/ hospitalize (20.8%), and intoxication (12, 5%). These data show the importance of performing an active investigation regarding the use of PAS, since nearly a quarter of patients have not reported PAS use as a complaint.…”

Section: Discussion Discussion Discussion Discussionmentioning

confidence: 63%

“…18 Dependents of multiple PAS have higher rates of recurring medical treatment in the emergency rooms, when compared to the population attended due to other PAS use disorders. 16 In the present study, when we evaluate the dependence of an exclusive PAS, alcohol was the substance most frequently reported. The prevalence of alcohol was also found in most studies that took place in emergency rooms.…”

Section: Discussion Discussion Discussion Discussionmentioning

confidence: 79%

Patients with psychoactive substance use disorders treated in a psychiatric emergency unit

Padilha

Santos-Júnior

Schettini

et al. 2016

Medicina (Ribeirão Preto)

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Modelo do Estudo: Estudo de prevalência. Objetivo: Descrever o perfil sócio demográfico e clínico de pacientes com transtornos relacionados ao uso de substâncias psicoativas (SPA) atendidos pela Psiquiatria da Unidade de Emergência Referenciada (UER) do Hospital de Clínicas (HC) da UNICAMP. Métodos e casuística: Estudo descritivo e quantitativo, que avaliou os pacientes com transtornos relacionados ao uso de SPA atendidos pela Psiquiatria da UER do HC-UNICAMP no período de 12 meses a partir de maio de 2010. Resultados: Foram avaliados 350 pacientes com transtornos por uso de SPA, representando 23.8% do total dos que procuraram atendimento psiquiátrico. Maioria do sexo masculino e mais jovens do que os demais pacientes. O principal motivo de atendimento foi queixa psiquiátrica outra que não o uso de SPA (23,1%), seguido do desejo de se tratar/internar (20,8%) e intoxicação (12,5%). 38,5% tinham diagnóstico de dependência de múltiplas SPA e 34,8% dependência exclusiva de álcool; 36% apresentavam comorbidade psiquiátrica. Quando comparados com os demais pacientes avaliados pela Psiquiatria, receberam mais medicações no atendimento e foram menos encaminhados à atenção primária. Conclusão: Há elevada taxa de atendimento de pessoas com problemas relacionados ao uso de SPA na emergência psiquiátrica. Dados sobre o perfil dos atendidos podem contribuir para a melhoria da assistência a esta população

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The association of psychiatric comorbidity and use of the emergency department among persons with substance use disorders: an observational cohort study

Cited by 105 publications

References 23 publications

Effectiveness of Interventions to Decrease Emergency Department Visits by Adult Frequent Users: A Systematic Review

Effectiveness of Interventions to Decrease Emergency Department Visits by Adult Frequent Users: A Systematic Review

Health Information Exchange Improves Identification Of Frequent Emergency Department Users

Patients with psychoactive substance use disorders treated in a psychiatric emergency unit

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