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Predictors of Frequent Emergency Department Use and Hospitalization among Patients with Substance-Related Disorders Recruited in Addiction Treatment Centers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116607. [PMID: 35682194 PMCID: PMC9180458 DOI: 10.3390/ijerph19116607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/24/2022] [Accepted: 05/27/2022] [Indexed: 12/10/2022]
Abstract
Few studies have assessed the overall impact of outpatient service use on acute care use, comparing patients with different types of substance-related disorders (SRD) and multimorbidity. This study aimed to identify sociodemographic and clinical characteristics and outpatient service use that predicted both frequent ED use (3+ visits/year) and hospitalization among patients with SRD. Data emanated from 14 Quebec (Canada) addiction treatment centers. Quebec administrative health databases were analyzed for a cohort of 17,819 patients over a 7-year period. Multivariable logistic regression models were produced. Patients with polysubstance-related disorders, co-occurring SRD-mental disorders, severe chronic physical illnesses, and suicidal behaviors were at highest risk of both frequent ED use and hospitalization. Having a history of homelessness, residing in rural areas, and using more outpatient services also increased the risk of acute care use, whereas high continuity of physician care protected against acute care use. Serious health problems were the main predictor for increased risk of both frequent ED use and hospitalization among patients with SRD, whereas high continuity of care was a protective factor. Improved quality of care, motivational, outreach and crisis interventions, and more integrated and collaborative care are suggested for reducing acute care use.
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Profiles of high emergency department users with mental disorders. Am J Emerg Med 2022; 54:131-141. [DOI: 10.1016/j.ajem.2022.01.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 11/20/2022] Open
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Armoon B, Grenier G, Cao Z, Huỳnh C, Fleury MJ. Frequencies of emergency department use and hospitalization comparing patients with different types of substance or polysubstance-related disorders. Subst Abuse Treat Prev Policy 2021; 16:89. [PMID: 34922562 PMCID: PMC8684146 DOI: 10.1186/s13011-021-00421-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2021] [Indexed: 01/20/2023] Open
Abstract
Background This study measured emergency department (ED) use and hospitalization for medical reasons among patients with substance-related disorders (SRD), comparing four subgroups: cannabis-related disorders, drug-related disorders other than cannabis, alcohol-related disorders and polysubstance-related disorders, controlling for various clinical, sociodemographic and service use variables. Methods Clinical administrative data for a cohort of 22,484 patients registered in Quebec (Canada) addiction treatment centers in 2012-13 were extracted for the years 2009-10 to 2015-16. Using negative binomial models, risks of frequent ED use and hospitalization were calculated for a 12-month period (2015-16). Results Patients with polysubstance-related disorders used ED more frequently than other groups with SRD. They were hospitalized more frequently than patients with cannabis or other drug-related disorders, but less frequently than those with alcohol-related disorders. Patients with alcohol-related disorders used ED more frequently than those with cannabis-related disorders and underwent more hospitalizations than both patients with cannabis-related and other drug-related disorders. Co-occurring SRD-mental disorders or SRD-chronic physical illnesses, more years with SRD, being women, living in rural territories, more frequent consultations with usual general practitioner or outpatient psychiatrist, and receiving more interventions in community healthcare centers increased frequency of ED use and hospitalization, whereas both adverse outcomes decreased with high continuity of physician care. Behavioral addiction, age less than 45 years, living in more materially deprived areas, and receiving 1-3 interventions in addiction treatment centers increased risk of frequent ED use, whereas living in semi-urban areas decreased ED use. Patients 25-44 years old receiving 4+ interventions in addiction treatment centers experienced less frequent hospitalization. Conclusion Findings showed higher risk of ED use among patients with polysubstance-related disorders, and higher hospitalization risk among patients with alcohol-related disorders, compared with patients affected by cannabis and other drug-related disorders. However, other variables contributed substantially more to the frequency of ED use and hospitalization, particularly clinical variables regarding complexity and severity of health conditions, followed by service use variables. Another important finding was that high continuity of physician care helped decrease the use of acute care services. Strategies like integrated care and outreach interventions may enhance SRD services. Supplementary Information The online version contains supplementary material available at 10.1186/s13011-021-00421-7.
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Affiliation(s)
- Bahram Armoon
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada
| | - Guy Grenier
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada
| | - Zhirong Cao
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada
| | - Christophe Huỳnh
- Institut universitaire sur les dépendances du Centre intégré universitaire de santé et des services sociaux du Centre-Sud-de-l'Île-de-Montréal, 950 Louvain Est, Montréal, Québec, H2M 2E8, Canada
| | - Marie-Josée Fleury
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada. .,Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC, H3A 1A1, Canada.
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Kaltsidis G, Bamvita JM, Grenier G, Fleury MJ. Predictors of Frequent Emergency Department Utilization for Mental Health Reasons. J Behav Health Serv Res 2021; 48:259-273. [PMID: 32185614 DOI: 10.1007/s11414-020-09695-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Overcrowding in emergency departments (ED) jeopardizes quality and access to health care, which represents a major issue for service delivery. This study determined predictors of frequent ED utilization among 320 patients recruited from six hospital ED in Quebec (Canada). Data collection included patient interviews and administrative databanks. A hierarchical linear regression analysis was performed using the Andersen Behavioral Model as a framework, with variables organized into predisposing, enabling, and needs factors. Results showed that needs factors were most strongly associated with ED utilization, particularly schizophrenia and personality disorders. Predisposing and enabling factors each contributed one variable to the model: past hospitalization for Mental Health (MH) reasons, and having regular care from an outpatient psychiatrist over the 12 months prior to interview at the ED, respectively. Increasing integration of MH services in networks may reduce unnecessary ED utilization and overcrowding, while providing better accessibility and care continuity for patients who visit ED for MH reasons.
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Affiliation(s)
- Gesthika Kaltsidis
- Department of Psychiatry, McGill University, Montreal, QC, Canada.,Douglas Mental Health University Institute Research Centre, Montreal, QC, Canada
| | - Jean-Marie Bamvita
- Douglas Mental Health University Institute Research Centre, Montreal, QC, Canada
| | - Guy Grenier
- Douglas Mental Health University Institute Research Centre, Montreal, QC, Canada
| | - Marie-Josée Fleury
- Department of Psychiatry, McGill University, Montreal, QC, Canada. .,Douglas Mental Health University Institute Research Centre, Montreal, QC, Canada.
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5
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Lewer D, Freer J, King E, Larney S, Degenhardt L, Tweed EJ, Hope VD, Harris M, Millar T, Hayward A, Ciccarone D, Morley KI. Frequency of health-care utilization by adults who use illicit drugs: a systematic review and meta-analysis. Addiction 2020; 115:1011-1023. [PMID: 31705770 PMCID: PMC7210080 DOI: 10.1111/add.14892] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 06/04/2019] [Accepted: 11/04/2019] [Indexed: 11/26/2022]
Abstract
AIMS To summarize evidence on the frequency and predictors of health-care utilization among people who use illicit drugs. DESIGN Systematic search of MEDLINE, EMBASE and PsychINFO for observational studies reporting health-care utilization published between 1 January 2000 and 3 December 2018. We conducted narrative synthesis and meta-analysis following a registered protocol (identifier: CRD42017076525). SETTING AND PARTICIPANTS People who use heroin, powder cocaine, crack cocaine, methamphetamine, amphetamine, ecstasy/3,4-methylenedioxymethamphetamine (MDMA), cannabis, hallucinogens or novel psychoactive substances; have a diagnosis of 'substance use disorder'; or use drug treatment services. MEASUREMENTS Primary outcomes were the cumulative incidence (risk) and rate of care episodes in three settings: primary care, hospital admissions (in-patient) and emergency department (ED). FINDINGS Ninety-two studies were included, 84% from North America and Australia. Most studies focused on people using heroin, methamphetamine or crack cocaine, or who had a diagnosis of drug dependence. We were able to conduct a meta-analysis of rates across 25 studies reporting ED episodes and 25 reporting hospital admissions, finding pooled rates of 151 [95% confidence interval (CI) = 114-201] and 41 (95% CI = 30-57) per 100 person-years, respectively; on average 4.8 and 7.1 times more often than the general population. Heterogeneity was very high and was not explained by drugs used, country of study, recruitment setting or demographic characteristics. Predictors of health-care utilization were consistent across studies and included unstable housing, drug injection and mental health problems. Opioid substitution therapy was consistently associated with reduced ED presentation and hospital admission. There was minimal research on health-care utilization by people using ecstasy/MDMA, powder cocaine, hallucinogens or novel psychoactive substances. CONCLUSIONS People who use illicit drugs are admitted to emergency department or hospital several times more often than the general population.
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Affiliation(s)
- Dan Lewer
- UCL Collaborative Centre for Inclusion HealthInstitute of Epidemiology and Health Care UCLLondonUK
- National Addictions Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
| | - Joseph Freer
- Centre for Primary Care and Public HealthQueen Mary University of LondonLondonUK
| | - Emma King
- UCL Collaborative Centre for Inclusion HealthInstitute of Epidemiology and Health Care UCLLondonUK
| | - Sarah Larney
- National Drug and Alcohol Research Centre (NDARC)University of New South WalesRandwick,NSWAustralia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre (NDARC)University of New South WalesRandwick,NSWAustralia
| | - Emily J. Tweed
- MRC/CSO Social and Public Health Sciences UnitUniversity of GlasgowGlasgowUK
| | - Vivian D. Hope
- Public Health InstituteLiverpool John Moores UniversityLiverpoolUK
| | - Magdalena Harris
- Department of Public Health, Environments and SocietyLondon School of Hygiene and Tropical Medicine, LondonUK
| | - Tim Millar
- Centre for Mental Health and SafetyThe University of ManchesterManchesterUK
| | - Andrew Hayward
- UCL Collaborative Centre for Inclusion HealthInstitute of Epidemiology and Health Care UCLLondonUK
| | - Dan Ciccarone
- Department of Family and Community MedicineUniversity of CaliforniaSan FranciscoCAUSA
| | - Katherine I. Morley
- National Addictions Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
- Centre for Epidemiology and Biostatistics, Melbourne School of Global and Population HealthThe University of MelbourneMelbourneAustralia
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Penzenstadler L, Gentil L, Huỳnh C, Grenier G, Fleury MJ. Variables associated with low, moderate and high emergency department use among patients with substance-related disorders. Drug Alcohol Depend 2020; 207:107817. [PMID: 31887605 DOI: 10.1016/j.drugalcdep.2019.107817] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 12/12/2019] [Accepted: 12/14/2019] [Indexed: 11/27/2022]
Abstract
AIMS This study identified factors associated with frequency of emergency department (ED) use for medical reasons among patients with substance-related disorders (SRD) in Quebec (Canada) for 2014-15. METHODS Participants (n = 4731) were categorized as: 1) low (1 visit/year), 2) moderate (2 visits/year), and 3) high (3+ visits/year) ED users. Independent variables included predisposing, enabling and needs factors based on the Andersen Behavioral Model. Multinomial logistic regression identified associated variables. RESULTS Factors positively associated with moderate and high ED use included adjustment disorders, suicidal behavior, alcohol-induced disorders, less urgent to non-urgent illness acuity, referral to local health community services centers (LHCSC) at discharge, and living in a materially deprived area. Factors positively associated with high ED use only included anxiety disorders, alcohol use disorders, drug use disorders, chronic physical illness, subacute problems, prior ED use for MD and/or SRD, prior LHCSC medical interventions, physician consultation within one month after discharge, living in very deprived or middle-class areas, and, negatively, being hospitalized for medical reasons in second ED visit. Moderate ED use only was negatively associated with alcohol intoxication and being referred to a GP at ED discharge. CONCLUSIONS Compared to low ED users, most high users with SRD were men presenting more complex and severe conditions. They visited ED mainly for subacute or non-urgent problems. Compared to low ED users, most moderate users had alcohol-induced disorders, less alcohol intoxication, and acute common MD. They visited ED mainly for non-urgent care. Diverse strategies should be implemented to reduce ED visits, targeting each group.
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Affiliation(s)
- Louise Penzenstadler
- Douglas Mental Health University Institute (Research Centre), McGill University, Department of Psychiatry, 6875 LaSalle Boulevard, Montréal, Québec H4H 1R3, Canada; Service d'addictologie, Département de psychiatrie, Hôpitaux Universitaires Genève, Rue du Grand-Pré 70c, 1202 Genève, Switzerland
| | - Lia Gentil
- Douglas Mental Health University Institute (Research Centre), McGill University, Department of Psychiatry, 6875 LaSalle Boulevard, Montréal, Québec H4H 1R3, Canada; Institut universitaire sur les dépendances, Centre intégré universitaire de santé et des services sociaux du Centre-Sud-de-l'Île-de-Montréal, 950 Louvain East, Montréal, Québec H2M 2E8, Canada
| | - Christophe Huỳnh
- Institut universitaire sur les dépendances, Centre intégré universitaire de santé et des services sociaux du Centre-Sud-de-l'Île-de-Montréal, 950 Louvain East, Montréal, Québec H2M 2E8, Canada
| | - Guy Grenier
- Douglas Mental Health University Institute (Research Centre), McGill University, Department of Psychiatry, 6875 LaSalle Boulevard, Montréal, Québec H4H 1R3, Canada
| | - Marie-Josée Fleury
- Douglas Mental Health University Institute (Research Centre), McGill University, Department of Psychiatry, 6875 LaSalle Boulevard, Montréal, Québec H4H 1R3, Canada.
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Kromka W, Simpson S. A Narrative Review of Predictors of Adult Mental Health Emergency Department Return Visits and Interventions to Reduce Repeated Use. J Emerg Med 2019; 57:671-682. [DOI: 10.1016/j.jemermed.2019.08.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 06/10/2019] [Accepted: 08/01/2019] [Indexed: 11/15/2022]
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Lesage A, Vanasse A, Potvin S, Dumais A. Retraction: Caractérisation des premiers épisodes de schizophrénie à partir de bases de données administratives de santé jumelées. [Characterization of First Episodes of Schizophrenia from Combined Administrative Databases]. Beaudoin, M., Potvin, S., Dellazizzo, L., Surprenant, M., Lesage, A., Vanasse, A., Ngamini-Ngui, A.† et Dumais, A. Santé mentale au Québec. 2018 Fall ; 43(2) : 83-105.PMID : 32338687. SANTE MENTALE AU QUEBEC 2019. [PMID: 33270396 DOI: 10.7202/1058611ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This corrects the article DOI: https://doi.org/10.7202/1058611ar.
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9
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Chiu Y, Racine-Hemmings F, Dufour I, Vanasse A, Chouinard MC, Bisson M, Hudon C. Statistical tools used for analyses of frequent users of emergency department: a scoping review. BMJ Open 2019; 9:e027750. [PMID: 31129592 PMCID: PMC6537981 DOI: 10.1136/bmjopen-2018-027750] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Frequent users represent a small proportion of emergency department users, but they account for a disproportionately large number of visits. Their use of emergency departments is often considered suboptimal. It would be more efficient to identify and treat those patients earlier in their health problem trajectory. It is therefore essential to describe their characteristics and to predict their emergency department use. In order to do so, adequate statistical tools are needed. The objective of this study was to determine the statistical tools used in identifying variables associated with frequent use or predicting the risk of becoming a frequent user. METHODS We performed a scoping review following an established 5-stage methodological framework. We searched PubMed, Scopus and CINAHL databases in February 2019 using search strategies defined with the help of an information specialist. Out of 4534 potential abstracts, we selected 114 articles based on defined criteria and presented in a content analysis. RESULTS We identified four classes of statistical tools. Regression models were found to be the most common practice, followed by hypothesis testing. The logistic regression was found to be the most used statistical tool, followed by χ2 test and t-test of associations between variables. Other tools were marginally used. CONCLUSIONS This scoping review lists common statistical tools used for analysing frequent users in emergency departments. It highlights the fact that some are well established while others are much less so. More research is needed to apply appropriate techniques to health data or to diversify statistical point of views.
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Affiliation(s)
- Yohann Chiu
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - François Racine-Hemmings
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Isabelle Dufour
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Alain Vanasse
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | | | - Mathieu Bisson
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Catherine Hudon
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
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Fleury MJ, Fortin M, Rochette L, Grenier G, Huỳnh C, Pelletier É, Vasiliadis HM. Assessing quality indicators related to mental health emergency room utilization. BMC Emerg Med 2019; 19:8. [PMID: 30646847 PMCID: PMC6332534 DOI: 10.1186/s12873-019-0223-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 01/04/2019] [Indexed: 01/13/2023] Open
Abstract
Background This descriptive study compared 2014–15 to 2005–06 data on the quality of mental health services (MHS) in relation to emergency room (ER) use to assess the impact of the 2005 Quebec MH reform regarding access, continuity and appropriateness of care for patients with mental illnesses (PMI). Methods Data emanated from the Quebec Integrated Chronic Disease Surveillance System (Quebec/Canada). Participants (865,255 for 2014–15; 817,395 for 2005–06) were age 12 or over, with at least one MI, including substance use disorders (SUD), diagnosed during an ER visit, outpatient treatment or hospitalization. Variables included: access (ER use/frequency, hospitalization rates, outpatient consultations preceding an ER visit), care continuity (outpatient consultations following an ER visit/hospitalization, consecutive returns to the ERs), and care appropriateness (high ER use, recurrence of yearly ER visits, length of hospitalization). Frequency distributions were calculated on sex, age and geographic area for ER visits/hospitalizations in 2014–15, and between 2014 and 15 and 2005–06. Results PMI accounted for 12 % of the Quebec population in 2014–15 (n = 865,255), of whom 39% visited an ER for any reason. Amount and frequency of ER use and number/length of hospitalizations were almost twice as high for PMI versus patients without MI; 17% of PMI were also high/very high ER users and were frequently hospitalized. Among PMI, ER users were also frequent users of outpatient services despite a lack of follow-up appointments after ER visits or hospitalizations. Findings revealed some positive changes over time, such as decreased ER and hospitalization rates; yet overall access, continuity and appropriateness of care, as measured in this study, remained low. Conclusions This study demonstrated that the Quebec reform did not produce a substantial impact on ER use or substantially improved care, as hypothesized. Better access and continuity of care should be promoted to reduce the high prevalence of ER use among PMI. Quality improvement in MHS may be realized if ERs are supported by substantial and well-integrated community MH networks.
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Affiliation(s)
- Marie-Josée Fleury
- Department of Psychiatry, McGill University, Montreal, QC, Canada. .,Douglas Mental Health University Institute Research Centre, 6875 LaSalle Blvd., Montreal, QC, H4H 1R3, Canada.
| | - Marilyn Fortin
- Douglas Mental Health University Institute Research Centre, 6875 LaSalle Blvd., Montreal, QC, H4H 1R3, Canada
| | - Louis Rochette
- Quebec National Institute of Public Health, Quebec, QC, Canada
| | - Guy Grenier
- Douglas Mental Health University Institute Research Centre, 6875 LaSalle Blvd., Montreal, QC, H4H 1R3, Canada
| | - Christophe Huỳnh
- Centre de recherche et d'expertise en dépendance, Montréal, QC, Canada.,Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Ile-de-Montréal, Montréal, QC, Canada
| | - Éric Pelletier
- Quebec National Institute of Public Health, Quebec, QC, Canada
| | - Helen-Maria Vasiliadis
- Département des sciences de la santé communautaires, Université de Sherbrooke, Sherbrooke, QC, Canada.,Centre de recherche de l'hôpital Charles LeMoyne, Longueuil, QC, Canada
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Fleury MJ, Fortin M, Rochette L, Grenier G, Huỳnh C, Pelletier É, Lesage A, Vasiliadis HM. Utilisation de l’urgence au Québec des patients avec des troubles mentaux incluant les
troubles liés aux substances psychoactives. SANTE MENTALE AU QUEBEC 2018. [DOI: 10.7202/1058613ar] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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12
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Huynh C, Ferland F, Blanchette-Martin N, Ménard JM, Fleury MJ. Factors Influencing the Frequency of Emergency Department Utilization by Individuals with Substance Use Disorders. Psychiatr Q 2016; 87:713-728. [PMID: 26875101 DOI: 10.1007/s11126-016-9422-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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.
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Affiliation(s)
- Christophe Huynh
- Centre de réadaptation en dépendance de Montréal - Institut universitaire, 950, rue de Louvain Est, Montreal, QC, H2M 2E8, Canada.
| | - Francine Ferland
- Centre de réadaptation en dépendance de Québec, 2525, chemin de la Canardière, Quebec, QC, G1J 2G3, Canada.,Centre de réadaptation en dépendance de Chaudière-Appalaches, 419, Dorimène-Desjardins, Lévis, QC, G6V 5V3, Canada
| | - Nadine Blanchette-Martin
- Centre de réadaptation en dépendance de Québec, 2525, chemin de la Canardière, Quebec, QC, G1J 2G3, Canada.,Centre de réadaptation en dépendance de Chaudière-Appalaches, 419, Dorimène-Desjardins, Lévis, QC, G6V 5V3, Canada
| | - Jean-Marc Ménard
- Centre de réadaptation en dépendance Domrémy-de-la-Mauricie-Centre-du-Québec, 440 rue des Forges, Trois-Rivières, QC, G9A 2H5, Canada
| | - Marie-Josée Fleury
- Centre de réadaptation en dépendance de Montréal - Institut universitaire, 950, rue de Louvain Est, Montreal, QC, H2M 2E8, Canada.,Department of Psychiatry, McGill University, Douglas Mental Health University Institute Research Centre, Quebec, Canada
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13
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Cranwell K, Polacsek M, McCann TV. Improving mental health service users' with medical co-morbidity transition between tertiary medical hospital and primary care services: a qualitative study. BMC Health Serv Res 2016; 16:302. [PMID: 27456864 PMCID: PMC4960840 DOI: 10.1186/s12913-016-1567-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 07/20/2016] [Indexed: 11/10/2022] Open
Abstract
Background Mental health service users have high rates of medical co-morbidity but frequently experience problems accessing and transitioning between tertiary medical and primary care services. The aim of this study was to identify ways to improve service users’ with medical co-morbidity care and experience during their transition between tertiary medical hospitals and primary care services. Method Experience-based co-design (EBCD) qualitative study incorporating a focus group discussion. The study took place in a large tertiary medical service, incorporating three medical hospitals, and primary care services, in Melbourne, Australia. A purposive sample of service users and their caregivers and tertiary medical and primary care clinicians participated in the focus group discussion, in August 2014. A semi-structured interview guide was used to inform data collection. A thematic analysis of the data was undertaken. Results Thirteen participants took part in the focus group interview, comprising 5 service users, 2 caregivers and 6 clinicians. Five themes were abstracted from the data, illustrating participants’ perspectives about factors that facilitated (clinicians’ expertise, engagement and accessibility enhancing transition) and presented as barriers (improving access pathways; enhancing communication and continuity of care; improving clinicians’ attitudes; and increasing caregiver participation) to service users’ progress through tertiary medical and primary care services. A sixth theme, enhancing service users’ transition, incorporated three strategies to enhance their transition through tertiary medical and primary care services. Conclusion EBCD is a useful approach to collaboratively develop strategies to improve service users’ with medical co-morbidity and their caregivers’ transition between tertiary medical and primary care services. A whole-of-service approach, incorporating policy development and implementation, change of practice philosophy, professional development education and support for clinicians, and acceptance of the need for caregiver participation, is required to improve service users’ transition.
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Affiliation(s)
- Kate Cranwell
- Community Services, Western Health, Melbourne, VIC, Australia
| | - Meg Polacsek
- Community Services, Western Health, Melbourne, VIC, Australia.,Centre for Chronic Disease, College of Health and Biomedicine, Discipline of Nursing, Victoria University, PO Box 14428, Melbourne, VIC, 8001, Australia
| | - Terence V McCann
- Centre for Chronic Disease, College of Health and Biomedicine, Discipline of Nursing, Victoria University, PO Box 14428, Melbourne, VIC, 8001, Australia.
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Huỳnh C, Ngamini Ngui A, Kairouz S, Lesage A, Fleury MJ. Factors associated with high use of general practitioner and psychiatrist services among patients attending an addiction rehabilitation center. BMC Psychiatry 2016; 16:258. [PMID: 27450676 PMCID: PMC4957405 DOI: 10.1186/s12888-016-0974-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 06/14/2016] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND This study aimed to 1) identify the characteristics of individuals with substance use disorders (SUDs) who make high use of services provided by general practitioners (GP) and psychiatrists while receiving services concurrently from an addiction rehabilitation center (ARC), and 2) to compare high service users to moderate and low service users. METHODS Data were compiled for 4,407 individuals with SUDs who were receiving services from an ARC in 2004. The data came from the merging of four databases: the ARC data registry (January 1(st), 2004-December 31, 2004), the Quebec Health Insurance Board database (March 31, 2003-April 1st, 2005), the Quebec provincial database for hospitalizations (March 31, 2003-April 1st, 2005), and the Quebec National Institute of Public Health database (2004). Independent variables were grouped according to the Andersen Behavioral Model of Health Services Use: predisposing, enabling and need factors. Generalized estimating equations analyses were performed to assess the influence of individual and neighborhood-level characteristics on high use of services outside the ARC provided by GPs and psychiatrists. Benjamini-Hochberg's procedure was applied to correct for multiple comparisons. RESULTS About 97 % of individuals attending the ARC consulted a GP or a psychiatrist during the two-year study period, for a mean of 1.5 consultations per month. Findings revealed that 5 % of the sample made 26 % of all consultations over the two years, and they were defined as high users. No single predisposing factor was associated with high use. One enabling factor significantly increased the risk of being a high user of services from general practitioners and psychiatrists: receiving services at the ARC for three years prior to 2004. Four needs factors, all related to mental health diagnoses (schizophrenia, mood disorder, anxiety disorder, personality disorder), predicted high use of general practitioner and psychiatrist services. CONCLUSIONS This study found that nearly all individuals with SUDs receiving services from an ARC were users of health services from GPs and psychiatrists outside the ARC. High users most probably accessed them in inpatient settings. No previous study has compared high service users with low and moderate users among individuals with SUDs. Considering that ARCs are treating individuals with complex needs, some of whom make high use of medical professionals, both ARCs and their clients could benefit from increased collaboration and integration between the addictions and mental healthcare sectors.
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Affiliation(s)
- Christophe Huỳnh
- Centre de recherche et d'expertise en dépendance du Centre intégré universitaire de santé et des services sociaux du Centre-Sud-de-l'Île-de-Montréal, 950 Louvain East, Montréal, Québec, H2M 2E8, Canada. .,Douglas Mental Health University Institute, McGill University, 6875 LaSalle Boulevard, Montréal, Québec, H4H 1R3, Canada.
| | | | - Sylvia Kairouz
- Department of Sociology and Anthropology, Concordia University, 1455 de Maisonneuve Boulevard West, Montréal, Québec H2G 1M8 Canada
| | - Alain Lesage
- Centre de recherche Fernand-Seguin, Institut universitaire en santé mentale de Montréal, 7401 Hochelaga Street, Montréal, Québec H1N 3M5 Canada
| | - Marie-Josée Fleury
- Centre de recherche et d’expertise en dépendance du Centre intégré universitaire de santé et des services sociaux du Centre-Sud-de-l’Île-de-Montréal, 950 Louvain East, Montréal, Québec H2M 2E8 Canada ,Douglas Mental Health University Institute, McGill University, 6875 LaSalle Boulevard, Montréal, Québec H4H 1R3 Canada
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Hensen MJ, de Mooij LD, Theunissen J, Dekker J, Willemsen M, Zoeteman J, Peen J, de Wit MAS. Pathways through care of severely mentally ill individuals experiencing multiple public crisis events: a qualitative description. BMC Psychiatry 2016; 16:84. [PMID: 27036706 PMCID: PMC4818537 DOI: 10.1186/s12888-016-0787-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 03/18/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Patients experiencing severe mental illnesses (SMI) need continuing support and remain vulnerable in many domains. Crisis interventions and compulsory admissions are common, causing a huge burden on police, health workers, the community and patients. The aim of this retrospective case-file study is to determine profiles of SMI-patients and their pathways through care among those experiencing multiple public crisis events. METHODS Data from a larger study of 323 SMI-patients in Amsterdam were used. These data were linked to data of the public mental health care (PMHC) in order to identify persons that experienced crisis interventions (CI's) between January 2004 and November 2012. The cut-off point for inclusion in the study population was set on three CI's, resulting in a group of 47 SMI-patients. PMHC and mental health care (MHC) data were linked in order to identify profiles in patterns of care. Qualitative content analysis was used to gather and analyze chronological timelines. RESULTS Three profiles were identified: SMI-patients with CI's during continuous MHC, SMI-patients with CI's after discharge and SMI-patients with CI's during unstable MHC. For each profile events prior to, during and after a CI were identified. CONCLUSIONS PMHC and MHC can possibly identify cases with a high risk of CI's and predict these events based on the results of this study. CI's seem inevitable for a group of SMI-patients in care but they do not only require acute psychiatric care. The collaboration between MHC, PMHC and police could be further developed in a quick and effective triage in order to tackle the complexity of problems of the SMI-patients.
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Affiliation(s)
- Mariëtte J. Hensen
- Public Health Service Amsterdam, Department of Epidemiology, Health Promotion, and Care Innovation, Amsterdam, The Netherlands
| | | | - Jan Theunissen
- GGZ Ingeest Mental Health Care, Amsterdam, The Netherlands
| | - Jack Dekker
- Arkin Mental Health Care, Research department, Amsterdam, The Netherlands
| | - Michael Willemsen
- Public Health Service Amsterdam, Department of Public Mental Health Care, Amsterdam, The Netherlands
| | - Jeroen Zoeteman
- Arkin Mental Health Care, Department of Emergency Psychiatry, Amsterdam, The Netherlands
| | - Jaap Peen
- Arkin Mental Health Care, Research department, Amsterdam, The Netherlands
| | - Matty A. S. de Wit
- Public Health Service Amsterdam, Department of Epidemiology, Health Promotion, and Care Innovation, Amsterdam, The Netherlands
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Fleury MJ, Grenier G, Bamvita JM. Predictors of frequent recourse to health professionals by people with severe mental disorders. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2015; 60:77-86. [PMID: 25886658 PMCID: PMC4344949 DOI: 10.1177/070674371506000205] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2014] [Accepted: 07/01/2014] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Based on Andersen's behavioural model, our study sought to determine predictors and blocks of factors that could explain why people with severe mental disorders (SMDs) more often seek the services of health professionals. METHODS This longitudinal study involved 292 users with SMDs located in Le Sud-Ouest, the southwest borough of Montreal. Data were collected from participants' medical records and through 7 questionnaires. Using Andersen's Behavioral Model of Health Services Use, independent variables were divided into 3 classes-predisposing factors, enabling factors, and need factors-and were introduced in this order in a hierarchical logistic model. RESULTS Among 292 users, 110 (37.7%) were frequent users who consulted about one health professional every 3 days. Participants who were more likely to call on health professionals were single and older, depended on welfare as their main source of income, lived in supervised housing, suffered from schizophrenia, schizophrenia spectrum disorders, and adjustment disorders, and, marginally, exhibited multiple mental disorders. CONCLUSION Mental health services could promote strategies to overcome the reluctance of younger people to seek professional services. Professionals should pay close attention to subsidiary conditions, such as adjustment disorders, from which people with SMDs may suffer. Interventions to improve the socioeconomic condition of unemployed people with SMDs may help to reduce health care service use among that clientele. Programs such as supported employment should be tailored and enhanced for people receiving welfare to decrease stigmatization and improve job market integration.
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Affiliation(s)
- Marie-Josée Fleury
- Associate Professor, Department of Psychiatry, McGill University, Montreal, Quebec; Researcher, Douglas Mental Health University Institute Research Centre, Montreal, Quebec; Scientific Director, Centre Dollard-Cormier, University Institute on Dependences, Montreal, Quebec
- Correspondence: Douglas Mental Health University Institute Research Centre, 6875 LaSalle Boulevard, Montreal, QC H4H 1R3;
| | - Guy Grenier
- Research Associate, Douglas Mental Health University Institute Research Centre, Montreal, Quebec
| | - Jean-Marie Bamvita
- Research Agent, Douglas Mental Health University Institute Research Centre, Montreal, Quebec
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