Which young people in England are most at risk of an alcohol-related revolving-door readmission career?

Hoy, Andrew

doi:10.1186/s12889-016-3891-2

Cited by 13 publications

(13 citation statements)

References 22 publications

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“… 1 Nevertheless, our findings are similar to those in the UK, where children with psychiatric and substance misuse disorders have high readmission rates. 32 Moreover, systematic reviews of studies across the globe report increasing overdose related hospital admissions, with peaks at the current time. 33 The World Health Organization’s 2014 Mental Health Atlas reports a wide gap in mental health services available between higher and lower income countries, especially as regards availability of day treatment and community residential facilities.…”

Section: Discussionmentioning

confidence: 99%

Age trends in 30 day hospital readmissions: US national retrospective analysis

Berry

Gay

Maddox

et al. 2018

BMJ

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ObjectiveTo assess trends in and risk factors for readmission to hospital across the age continuum.DesignRetrospective analysis.Setting and participants31 729 762 index hospital admissions for all conditions in 2013 from the US Agency for Healthcare Research and Quality Nationwide Readmissions Database.Main outcome measure30 day, all cause, unplanned hospital readmissions. Odds of readmission were compared by patients’ age in one year epochs with logistic regression, accounting for sex, payer, length of stay, discharge disposition, number of chronic conditions, reason for and severity of admission, and data clustering by hospital. The middle (45 years) of the age range (0-90+ years) was selected as the age reference group.ResultsThe 30 day unplanned readmission rate following all US index admissions was 11.6% (n=3 678 018). Referenced by patients aged 45 years, the adjusted odds ratio for readmission increased between ages 16 and 20 years (from 0.70 (95% confidence interval 0.68 to 0.71) to 1.04 (1.02 to 1.06)), remained elevated between ages 21 and 44 years (range 1.02 (1.00 to 1.03) to 1.12 (1.10 to 1.14)), steadily decreased between ages 46 and 64 years (range 1.02 (1.00 to 1.04) to 0.91 (0.90 to 0.93)), and decreased abruptly at age 65 years (0.78 (0.77 to 0.79)), after which the odds remained relatively constant with advancing age. Across all ages, multiple chronic conditions were associated with the highest adjusted odds of readmission (for example, 3.67 (3.64 to 3.69) for six or more versus no chronic conditions). Among children, young adults, and middle aged adults, mental health was one of the most common reasons for index admissions that had high adjusted readmission rates (≥75th centile).ConclusionsThe likelihood of readmission was elevated for children transitioning to adulthood, children and younger adults with mental health disorders, and patients of all ages with multiple chronic conditions. Further attention to the measurement and causes of readmission and opportunities for its reduction in these groups is warranted.

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Section: Discussionmentioning

confidence: 99%

Age trends in 30 day hospital readmissions: US national retrospective analysis

Berry

Gay

Maddox

et al. 2018

BMJ

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“…4,[9][10][11] Moreover, alcohol intoxication is associated with high likelihood of ED readmission and poorer psychiatric, substance use, and social outcomes over time. [12][13][14][15] Brief intervention (BI) is an efficacious preventive strategy for alcohol consumption and its consequences, 16,17 and its use in primary care is recommended by the World Health Organization and the US Preventive Services Task Force. 18,19 However, systematic reviews have found mixed results regarding the efficacy of BI conducted in the ED among young adults (eg, improvements in both intervention and control groups with only some significant between-group differences, 20 few differences in favor of ED-based BIs and poor study quality precluding firm conclusions, 21 small but significant effect size for alcohol use but not for alcohol-related problems).…”

Section: Introductionmentioning

confidence: 99%

Effect of a Novel Brief Motivational Intervention for Alcohol-Intoxicated Young Adults in the Emergency Department

et al. 2022

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ImportanceHeavy drinking among young adults is a major public health concern. Brief motivational interventions in the emergency department have shown promising but inconsistent results.ObjectiveTo test whether young adults receiving a newly developed brief motivational intervention reduce their number of heavy drinking days and alcohol-related problems over 1 year compared with participants receiving brief advice.Design, Setting, and ParticipantsThis randomized clinical trial was conducted at an emergency department of a tertiary care university hospital in Lausanne, Switzerland. Recruitment ran from December 2016 to August 2019. Follow-up was conducted after 1, 3, 6, and 12 months. All adults aged 18 to 35 years presenting for any cause and presenting with alcohol intoxication were eligible (N = 2108); 1764 were excluded or refused participation. Follow-up rate was 79% at 12 months and 89% of participants provided follow-up data at least once and were included in the primary analyses. Statistical analysis was performed from September 2020 to January 2021.InterventionsThe novel intervention was based on motivational interviewing and comprised in-person discussion in the emergency department and up to 3 booster telephone calls. The control group received brief advice.Main Outcomes and MeasuresPrimary outcomes were the number of heavy drinking days (at least 60 g of ethanol) over the previous month and the total score on the Short Inventory of Problems (0-45, higher scores indicating more problems) over the previous 3 months. Hypotheses tested were formulated before data collection.ResultsThere were 344 young adults included (median [IQR] age: 23 [20-28] years; 84 women [24.4%]). Among the 306 participants providing at least 1 follow-up point, a statistically significant time × group interaction was observed (β = −0.03; 95% CI, −0.05 to 0.00; P = .02), and simple slopes indicated an increase of heavy drinking days over time in the control (β = 0.04; 95% CI, 0.02 to 0.05; P &lt; .001) but not in the intervention group (β = 0.01; 95% CI, −0.01 to 0.03; P = .24). There was no effect on the Short Inventory of Problems score (β = −0.01; 95% CI, −0.03 to 0.02; P = .71).Conclusions and RelevanceThis randomized clinical trial found that a brief motivational intervention implemented in the emergency department provided beneficial effects on heavy drinking, which accounts for a substantial portion of mortality and disease burden among young adults.Trial RegistrationISRCTN registry: 13832949

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“…Previous inpatient care is thought to be one among the strongest determinants of readmission in non-inmates (12,31). Data are still missing for outpatient care in this population, yet the frequent occurrence of RD among patients with chronic and severely debilitating mental illness followed-up in the community (17)(18)(19)(20)(21) implies that this parameter is, at least, indirectly associated with RD. In our sample, the frequency of previous inpatient care was clearly higher in RD users (76.7%) compared to the two other groups (55 and 47.7%, respectively), yet this difference did not reach statistical significance.…”

Section: Revolving Door and Demographic Factorsmentioning

confidence: 99%

“…Lack of therapeutic alliance and treatment discontinuation are thought to increase RD, mainly in cases with concomitant substance abuse (15,16). However, the relative contribution of these parameters varies substantially as a function of care setting and population of reference (17)(18)(19)(20)(21). Although poor socio-economic status and compulsory admissions are not related to RD in most previous studies (1,17,(22)(23)(24), being unemployed and/or living in a residential facility (24) or having severe social disability (25), may lead to RD use of psychiatric facilities.…”

Section: Introductionmentioning

confidence: 99%

Determinants of Revolving Door in an Acute Psychiatric Ward for Prison Inmates

2021

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Among the different types of heavy use of mental health services, frequent inpatient admission in acute care units of individuals unable to return to their usual environment refers to as revolving-door (RD). RD in prisoners is related to increased violence (acted and supported) and suicidal recidivism. We explored the determinants of RD in 200 inmates from the Swiss-French speaking areas who were admitted to the sole acute psychiatric care unit for all of the Swiss-French counties, located in Geneva. The Cuzick's test for trend across ordered groups, Kruskal-Wallis test and oneway ANOVA were used to compare demographic and clinical variables between single (one admission, N = 100), frequent (3–7, N = 69) and RD (more than 8, N = 31) during a 12 months period. In addition, univariate and multivariable ordered logistic regression modes were built to examine the determinants of RD. The sample included 27 women (mean age: 31.2 years) and 173 men (34.5 years) who were admitted during the period 2014–2019. The vast majority were single (65%) with low level of education (<6 years, 78%). Suicidal behavior was the more frequent reason for admission (57%). Psychiatric history was positive in 77.5% of cases and in 54.5% of cases there was at least one episode of inpatient psychiatric care. The more frequent ICD-10 psychiatric diagnosis in the last admission were psychotic disorder (38%), personality disorder (29.5%) and adjustment disorder (19.5%). In contrast, depressive episodes (7%) and bipolar disorder (4.5%) were rare. Group comparison showed that the presence of court-ordered treatments, suicidal behavior, personality and psychotic disorders was associated with significantly increased frequency of RD use. In univariate models, the same factors were positively associated with RD, the highest odds ratio being found for court-ordered treatments (5.77) and personality disorders (2.14). In contrast, the diagnosis of adjustment disorders was related to decreased RD use (OR 0.25). Court-ordered treatments and personality disorders were the only factors to predict RD in multivariable regression models. These findings suggest that acute psychiatric care in these patients did not depend of environmental stressors but rather represents the expression of a long-lasting vulnerability related to their psychological profile and criminal status.

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Which young people in England are most at risk of an alcohol-related revolving-door readmission career?

Cited by 13 publications

References 22 publications

Age trends in 30 day hospital readmissions: US national retrospective analysis

Age trends in 30 day hospital readmissions: US national retrospective analysis

Effect of a Novel Brief Motivational Intervention for Alcohol-Intoxicated Young Adults in the Emergency Department

Determinants of Revolving Door in an Acute Psychiatric Ward for Prison Inmates

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