The relationship between outpatient service use and emergency department visits among people treated for mental and substance use disorders: analysis of population-based administrative data in British Columbia, Canada

Abstract

Background Research findings on the association between outpatient service use and emergency department (ED) visits for mental and substance use disorders (MSUDs) are mixed and may differ by disorder type. Methods We used population-based linked administrative data in British Columbia, Canada to examine associations between outpatient primary care and psychiatry service use and ED visits among people ages 15 and older, comparing across people treated for three disorder categories: common mental disorders (MDs) (depressive, anxiety, and/or post-traumatic stress disorders), serious MDs (schizophrenia spectrum and/or bipolar disorders), and substance use disorders (SUDs) in 2016/7. We used hurdle models to examine the association between outpatient service use and odds of any ED visit for MSUDs as well count of ED visits for MSUDs, stratified by cohort in 2017/8. Results Having had one or more MSUD-related primary care visit was associated with lower odds of any ED visit among people treated for common MDs and SUDs but not people treated for serious MDs. Continuity of primary care was associated with slightly lower ED use in all cohorts. One or more outpatient psychiatrist visits was associated with lower odds of ED visits among people treated for serious MDs and SUDs, but not among people with common MDs. Conclusion Findings highlight the importance of expanded access to outpatient specialist mental health services, particularly for people with serious MDs and SUDs, and collaborative models that can support primary care providers treating people with MSUDs.

The Health and Psychosocial Profiles of Adults Who Sought Mental Health and Addiction Specialty Services Through a Centralized Intake Process in Nova Scotia in 2020 and 2021

“…Despite the implementation of the Intake service, some people may visit ED for MHA services or use ED as the first point of contact for MHA services. 13,17,19 In Nova Scotia, several specialty MHA programs such as Early Psychosis Intervention, Mood Disorder Program, and Opioid Use Program take referrals directly from ED, primary care physicians, schools, and self/family referrals. Therefore, the observed proportions of contacting the MHA Intake are an underestimation of people who need MHA specialty services in Nova Scotia.…”

“…There are also a number of Canadian studies on the MHA services use among those who received MHA services using health administrative data such as physician billing, hospitalization, and emergency department (ED) visits. [11][12][13][14][15][16][17][18][19] In Canada, most people with an MHA problem are first seen by primary care physicians, and a physician's referral is often needed to access specialized MHA services. 20 However, many people with MHA needs do not receive the services in a timely manner due to various barriers to care.…”

Trends in Involuntary Psychiatric Hospitalization in British Columbia: Descriptive Analysis of Population-Based Linked Administrative Data from 2008 to 2018

“…45,46 Among British Columbians who had emergency department visits for an MSUDs in 2017/2018, ∼25% with a serious mental disorder, and 75% with a substance use disorder (of which over half had a concurrent mental disorder) had no psychiatry visits in the year preceding their emergency department visit. 47 Roughly 25% with a serious mental disorder, and with a substance use disorder also had no mental health-related primary care visits. 47 The expansion of community services may thus help reduce involuntary hospitalizations, while interventions such as assertive community treatment may help reduce psychiatric hospitalizations for people with high levels of hospital use.…”

“…47 Roughly 25% with a serious mental disorder, and with a substance use disorder also had no mental health-related primary care visits. 47 The expansion of community services may thus help reduce involuntary hospitalizations, while interventions such as assertive community treatment may help reduce psychiatric hospitalizations for people with high levels of hospital use. 48 Increasing MSUD prevalence may also be contributing to rising involuntary hospitalizations.…”

Pan-Canadian study of psychiatric care (PCPC): protocol for a mixed-methods study

“…In Ontario, about 70% of people do not see a psychiatrist in the 30 days following a psychiatric hospitalisation discharge,5 8 and about 60% do not see one within 6 months of a suicide attempt 9. Poor access to psychiatric care could lead to relapse, rehospitalisation, avoidable costs to the healthcare system and death in the case of low post-suicide follow-up 10–12…”