1
|
Oliveras C, Bruguera P, Cordero Torres I, Millán Hernández A, Pons MT, Guzmán Cortez PR, Gómez-Ramiro M, Vázquez Vallejo M, Salgado E, Asenjo Romero M, Vieta E, Gual A, López-Pelayo H, Balcells-Oliveró M. Another Round: Influence of Alcohol-Related Conditions and Other Drug Use-Related Disorders in Emergency Department Frequent Use - A Single-Site Matched Case-Control Study in Spain. Eur Addict Res 2024:1-13. [PMID: 39068928 DOI: 10.1159/000538987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 04/11/2024] [Indexed: 07/30/2024]
Abstract
INTRODUCTION Patients who make 5 or more visits per year to hospital emergency departments (EDs) are usually considered ED frequent users (FUs). This study aims to better characterize the influence of alcohol and other drug use-related disorders in this phenomenon in a European Mediterranean country with public, universal, tax-financed healthcare system. METHODS Matched case-control study. Cases were adults between 18 and 65 years old who consulted 5 or more times the ED of a tertiary hospital in Spain between December 2018 and November 2019. Each case was assigned a control of the same age and gender, who appeared to the ED on the same day, but who made 4 visits or less to the service during the study period. The electronic record of the first ED visit during this period was used to extract the variables of interest: emergency care received, clinical and social characteristics. Predictors of frequent ED use were identified with conditional logistic regression. RESULTS 609 case-control pairs (total n = 1,218) were selected. History of alcohol-related conditions (adjusted odds ratio [AOR] = 1.82 [95% CI: 1.26-2.64] p = 0.001) and also other drug use-related disorders (AOR = 1.50 [95% CI: 1.11-2.03] p = 0.009) significantly increased the probability of frequent use of emergency services. DISCUSSION/CONCLUSION Alcohol-related conditions and other drug use-related disorders must be evaluated in all ED FUs. Specific action protocols to concurrently address repeated attendance and addictions in the emergency room could be a good tool to reduce frequent ED use.
Collapse
Affiliation(s)
- Clara Oliveras
- Addictions Unit, Psychiatry and Psychology Service, ICN, Hospital Clinic Barcelona, Barcelona, Spain
- Department of Psychiatry and Clinical Psychology, Hospital Clínic de Barcelona, Barcelona, Spain
- Health and Addictions Research Group, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Universitat de Barcelona, Red de Investigación en Atención Primaria de Adicciones, RIAPAd (RICORS), Barcelona, Spain
| | - Pol Bruguera
- Addictions Unit, Psychiatry and Psychology Service, ICN, Hospital Clinic Barcelona, Barcelona, Spain
- Department of Psychiatry and Clinical Psychology, Hospital Clínic de Barcelona, Barcelona, Spain
- Health and Addictions Research Group, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Universitat de Barcelona, Red de Investigación en Atención Primaria de Adicciones, RIAPAd (RICORS), Barcelona, Spain
| | | | - Andrea Millán Hernández
- Health and Addictions Research Group, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Universitat de Barcelona, Red de Investigación en Atención Primaria de Adicciones, RIAPAd (RICORS), Barcelona, Spain
| | - Maria Teresa Pons
- Addictions Unit, Psychiatry and Psychology Service, ICN, Hospital Clinic Barcelona, Barcelona, Spain
- Department of Psychiatry and Clinical Psychology, Hospital Clínic de Barcelona, Barcelona, Spain
- Health and Addictions Research Group, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Universitat de Barcelona, Red de Investigación en Atención Primaria de Adicciones, RIAPAd (RICORS), Barcelona, Spain
| | - Pablo Rodrigo Guzmán Cortez
- Addictions Unit, Psychiatry and Psychology Service, ICN, Hospital Clinic Barcelona, Barcelona, Spain
- Department of Psychiatry and Clinical Psychology, Hospital Clínic de Barcelona, Barcelona, Spain
- Health and Addictions Research Group, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Universitat de Barcelona, Red de Investigación en Atención Primaria de Adicciones, RIAPAd (RICORS), Barcelona, Spain
| | - Marta Gómez-Ramiro
- Department of Psychiatry and Clinical Psychology, Hospital Clínic de Barcelona, Barcelona, Spain
- Hospital Clínic de Barcelona, Emergency Department, Barcelona, Spain
- Centro de Investigación en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Barcelona Clínic Schizophrenia Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, Barcelona, Spain
- Psychiatry Service, Complejo Hospitalario Universitario de Vigo, SERGAS, Spain, Translational Neuroscience Research Group, Galicia Sur Health Research Institute (IISGS), Barcelona, Spain
| | - Mireia Vázquez Vallejo
- Department of Psychiatry and Clinical Psychology, Hospital Clínic de Barcelona, Barcelona, Spain
- Hospital Clínic de Barcelona, Emergency Department, Barcelona, Spain
| | - Emilio Salgado
- Hospital Clínic de Barcelona, Emergency Department, Barcelona, Spain
- Clinical Toxicology Unit, Hospital Clínic de Barcelona, Barcelona, Spain
| | | | - Eduard Vieta
- Department of Psychiatry and Clinical Psychology, Hospital Clínic de Barcelona, Barcelona, Spain
- Centro de Investigación en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - Antoni Gual
- Addictions Unit, Psychiatry and Psychology Service, ICN, Hospital Clinic Barcelona, Barcelona, Spain
- Department of Psychiatry and Clinical Psychology, Hospital Clínic de Barcelona, Barcelona, Spain
- Health and Addictions Research Group, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Universitat de Barcelona, Red de Investigación en Atención Primaria de Adicciones, RIAPAd (RICORS), Barcelona, Spain
| | - Hugo López-Pelayo
- Addictions Unit, Psychiatry and Psychology Service, ICN, Hospital Clinic Barcelona, Barcelona, Spain
- Department of Psychiatry and Clinical Psychology, Hospital Clínic de Barcelona, Barcelona, Spain
- Health and Addictions Research Group, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Universitat de Barcelona, Red de Investigación en Atención Primaria de Adicciones, RIAPAd (RICORS), Barcelona, Spain
| | - Mercè Balcells-Oliveró
- Addictions Unit, Psychiatry and Psychology Service, ICN, Hospital Clinic Barcelona, Barcelona, Spain
- Department of Psychiatry and Clinical Psychology, Hospital Clínic de Barcelona, Barcelona, Spain
- Health and Addictions Research Group, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Universitat de Barcelona, Red de Investigación en Atención Primaria de Adicciones, RIAPAd (RICORS), Barcelona, Spain
| |
Collapse
|
2
|
Fleury MJ, Imboua A, Grenier G. Barriers and Facilitators to High Emergency Department Use Among Patients with Mental Disorders: A Qualitative Investigation. Community Ment Health J 2024; 60:869-884. [PMID: 38383882 DOI: 10.1007/s10597-024-01239-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 01/17/2024] [Indexed: 02/23/2024]
Abstract
This qualitative study explored reasons for high emergency department (ED) use (3 + visits/year) among 299 patients with mental disorders (MD) recruited in four ED in Quebec, Canada. A conceptual framework including healthcare system and ED organizational features, patient profiles, and professional practice guided the content analysis. Results highlighted insufficient access to and inadequacy of outpatient care. While some patients were quite satisfied with ED care, most criticized the lack of referrals or follow-up care. Patient profiles justifying high ED use were strongly associated with health and social issues perceived as needing immediate care. The main barriers in professional practice involved lack of MD expertise among primary care clinicians, and insufficient follow-up by psychiatrists in response to patient needs. Collaboration with outpatient care may be prioritized to reduce high ED use and improve ED interventions by strengthening the discharge process, and increasing access to outpatient care.
Collapse
Affiliation(s)
- Marie-Josée Fleury
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC, H3A 1A1, Canada.
- Douglas Hospital Research Centre, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada.
| | - Armelle Imboua
- Douglas Hospital Research Centre, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada
| | - Guy Grenier
- Douglas Hospital Research Centre, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada
| |
Collapse
|
3
|
Fleury MJ, Cao Z, Grenier G. Emergency Department Use among Patients with Mental Health Problems: Profiles, Correlates, and Outcomes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:864. [PMID: 39063441 PMCID: PMC11276606 DOI: 10.3390/ijerph21070864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Revised: 06/28/2024] [Accepted: 06/29/2024] [Indexed: 07/28/2024]
Abstract
Patients with mental health (MH) problems are known to use emergency departments (EDs) frequently. This study identified profiles of ED users and associated these profiles with patient characteristics and outpatient service use, and with subsequent adverse outcomes. A 5-year cohort of 11,682 ED users was investigated (2012-2017), using Quebec (Canada) administrative databases. ED user profiles were identified through latent class analysis, and multinomial logistic regression used to associate patients' characteristics and their outpatient service use. Cox regressions were conducted to assess adverse outcomes 12 months after the last ED use. Four ED user profiles were identified: "Patients mostly using EDs for accessing MH services" (Profile 1, incident MDs); "Repeat ED users" (Profile 2); "High ED users" (Profile 3); "Very high and recurrent high ED users" (Profile 4). Profile 4 and 3 patients exhibited the highest ED use along with severe conditions yet received the most outpatient care. The risk of hospitalization and death was higher in these profiles. Their frequent ED use and adverse outcomes might stem from unmet needs and suboptimal care. Assertive community treatments and intensive case management could be recommended for Profiles 4 and 3, and more extensive team-based GP care for Profiles 2 and 1.
Collapse
Affiliation(s)
- Marie-Josée Fleury
- Department of Psychiatry, McGill University, 1033, Pine Avenue West, Montreal, QC H3A 1A1, Canada
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, 6875 LaSalle Blvd., Montreal, QC H4H 1R3, Canada; (Z.C.); (G.G.)
| | - Zhirong Cao
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, 6875 LaSalle Blvd., Montreal, QC H4H 1R3, Canada; (Z.C.); (G.G.)
| | - Guy Grenier
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, 6875 LaSalle Blvd., Montreal, QC H4H 1R3, Canada; (Z.C.); (G.G.)
| |
Collapse
|
4
|
Fleury MJ, Cao Z, Grenier G, Rahme E. Profiles of quality of outpatient care among individuals with mental disorders based on survey and administrative data. J Eval Clin Pract 2024. [PMID: 39031622 DOI: 10.1111/jep.14052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 05/24/2024] [Accepted: 06/03/2024] [Indexed: 07/22/2024]
Abstract
RATIONALE Though it is crucial to contribute to patient recovery through access, diversity, continuity and regularity of outpatient care, still today most of these are deemed nonoptimal. Identifying patient profiles based on outpatient service use and quality of care indicators might help formulate more personalized interventions and reduce adverse outcomes. AIMS AND OBJECTIVES This study aimed to identify profiles of individuals with mental disorders (MDs) patterned after their outpatient care use and quality of care received, and to link those profiles to individual characteristics and subsequent outcomes. METHODS A cohort of 5669 individuals with MDs was considered based on data from the 2013-2014 and 2015-2016 Canadian Community Health Survey, which were linked to administrative data from the Quebec health insurance registry. Latent class analysis generated profiles based on service use over the 12 months preceding each respondent's interview, and comparative analyses were used to associate profiles with sociodemographic and clinical characteristics, and health outcomes over the three following months. RESULTS Four profiles were identified. Profile 1 (P-1) was labelled 'Low service use'; P-2 'Moderate general practitioner (GP) care and continuity and regularity of care'; P-3 'High GP care, continuity and regularity of care, and low psychiatrist care'; and P-4 'High psychiatrist care and regularity of care, and low GP care'. Profiles 3 and 4 (~50% of the cohort) were provided with better care, but showed worse outcomes, mainly acute care use due to more complex conditions and unmet needs. Profiles 1 and 2 had better outcomes as they showed fewer risk factors such as being younger and having better social conditions. CONCLUSION Intensity, diversity and regularity of care were higher in profiles with more complex MDs, chronic physical illnesses, and worse perceived health conditions. Adapting specific interventions for each profile, such as assertive community treatment or intensive case management for Profile 4, is recommended.
Collapse
Affiliation(s)
| | - Zhirong Cao
- Douglas Hospital Research Centre, Montreal, Quebec, Canada
| | - Guy Grenier
- Douglas Hospital Research Centre, Montreal, Quebec, Canada
| | - Elham Rahme
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| |
Collapse
|
5
|
Zhang Z, Das S. Unveiling the patterns: exploring social and clinical characteristics of frequent mental health visits to the emergency department-a comprehensive systematic review. DISCOVER MENTAL HEALTH 2024; 4:17. [PMID: 38802580 PMCID: PMC11130112 DOI: 10.1007/s44192-024-00070-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 05/16/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Frequent presenters (FPs) are a group of individuals who visit the hospital emergency department (ED) frequently for urgent care. Many among the group present with the main diagnosis of mental health conditions. This group of individual tend to use ED resources disproportionally and significantly affects overall healthcare outcomes. No previous reviews have examined the profiles of FPs with mental health conditions. AIMS This study aims to identify the key socio-demographic and clinical characteristics of patients who frequently present to ED with a mental health primary diagnosis by performing a comprehensive systematic review of the existing literature. METHOD PRISMA guideline was used. PubMed, PsycINFO, Scopus and Web of Science (WOS) were searched in May 2023. A manual search on the reference list of included articles was conducted at the same time. Covidence was used to perform extraction and screening, which were completed independently by two authors. Inclusion and exclusion criteria were defined. RESULTS The abstracts of 3341 non-duplicate articles were screened, with 40 full texts assessed for eligibility. 20 studies were included from 2004 to 2022 conducted in 6 countries with a total patient number of 25,688 (52% male, 48% female, mean age 40.7 years old). 27% were unemployed, 20% married, 41% homeless, and 17% had tertiary or above education. 44% had a history of substance abuse or alcohol dependence. The top 3 diagnoses are found to be anxiety disorders (44%), depressive disorders (39%) schizophrenia spectrum and other psychotic disorders (33%). CONCLUSION On average, FPs are middle-aged and equally prevalent in both genders. Current data lacks representation for gender-diverse groups. They are significantly associated with high rates of unemployment, homelessness, lower than average education level, and being single. Anxiety disorder, depressive disorder, and schizophrenia spectrum disorders are the most common clinical diagnoses associated with the group.
Collapse
Affiliation(s)
| | - Soumitra Das
- The University of Melbourne, Melbourne, Australia
- Western Health, Footscray, Australia
| |
Collapse
|
6
|
Fleury MJ, Cao Z, Grenier G. Characteristics for Low, High and Very High Emergency Department Use for Mental Health Diagnoses from Health Records and Structured Interviews. West J Emerg Med 2024; 25:144-154. [PMID: 38596910 PMCID: PMC11000562 DOI: 10.5811/westjem.18327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 11/17/2023] [Accepted: 11/22/2023] [Indexed: 04/11/2024] Open
Abstract
Introduction Patients with mental health diagnoses (MHD) are among the most frequent emergency department (ED) users, suggesting the importance of identifying additional factors associated with their ED use frequency. In this study we assessed various patient sociodemographic and clinical characteristics, and service use associated with low ED users (1-3 visits/year), compared to high (4-7) and very high (8+) ED users with MHD. Methods Our study was conducted in four large Quebec (Canada) ED networks. A total of 299 patients with MHD were randomly recruited from these ED in 2021-2022. Structured interviews complemented data from network health records, providing extensive data on participant profiles and their quality of care. We used multivariable multinomial logistic regression to compare low ED use to high and very high ED use. Results Over a 12-month period, 39% of patients were low ED users, 37% high, and 24% very high ED users. Compared with low ED users, those at greater probability for high or very high ED use exhibited more violent/disturbed behaviors or social problems, chronic physical illnesses, and barriers to unmet needs. Patients previously hospitalized 1-2 times had lower risk of high or very high ED use than those not previously hospitalized. Compared with low ED users, high and very high ED users showed higher prevalence of personality disorders and suicidal behaviors, respectively. Women had greater probability of high ED use than men. Patients living in rental housing had greater probability of being very high ED users than those living in private housing. Using at least 5+ primary care services and being recurrent ED users two years prior to the last year of ED use had increased probability of very high ED use. Conclusion Frequency of ED use was associated with complex issues and higher perceived barriers to unmet needs among patients. Very high ED users had more severe recurrent conditions, such as isolation and suicidal behaviors, despite using more primary care services. Results suggested substantial reduction of barriers to care and improvement on both access and continuity of care for these vulnerable patients, integrating crisis resolution and supported housing services. Limited hospitalizations may sometimes be indicated, protecting against ED use.
Collapse
Affiliation(s)
- Marie-Josée Fleury
- McGill University, Department of Psychiatry, Montreal, Canada
- Douglas Mental Health University Research Centre, Montreal, Canada
| | - Zhirong Cao
- Douglas Mental Health University Research Centre, Montreal, Canada
| | - Guy Grenier
- Douglas Mental Health University Research Centre, Montreal, Canada
| |
Collapse
|
7
|
Ruegenberg A, Schmiedhofer M, Kreutzberg A, Henschke C, Möckel M, Slagman A. [Black box: Attenders with psychosocial needs in the emergency department]. Med Klin Intensivmed Notfmed 2024; 119:10-17. [PMID: 36635440 PMCID: PMC10803686 DOI: 10.1007/s00063-022-00981-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 08/10/2022] [Accepted: 12/01/2022] [Indexed: 01/14/2023]
Abstract
OBJECTIVES The aims are (a) assessment of the prevalence of psychosocial emergencies in the emergency department (ED), (b) determination of the proportion of cases not coded as diagnosis (unreported cases), and (c) characterization of identified patients. METHODS In a retrospective study, psychosocial emergencies in one week were identified from routine documentation of the central ED of the Charité - Universitätsmedizin Berlin, Charité Campus Mitte (CCM). After exclusion of planned admitted cases, 862 patients were included in the study. The identified psychosocial emergencies were descriptively analyzed with regard to their sociodemographic and clinical characteristics and compared with other emergencies. RESULTS The prevalence of psychosocial emergencies in the reported period was 11.9% (n = 103). A large proportion of psychosocial emergencies were not coded (35.9%) or not fully coded (20.4%) as an ICD diagnosis (unreported cases). There was a statistically relevant difference in gender distribution with a significantly higher proportion of males among psychosocial emergencies (70.9%) compared to other emergencies (50.7%; p < 0.0001). The two most common treatment causes among psychosocial emergencies were substance abuse (66.0%) and homelessness (20.4%). CONCLUSIONS This study shows a relevant proportion of psychosocial emergencies among all treatments in ED routine data and a high proportion of cases not captured in the coded diagnoses. EDs thus represent an important point of contact for vulnerable patient groups but standardized screening and identification are still lacking.
Collapse
Affiliation(s)
- Alina Ruegenberg
- Notfallmedizinische Versorgungsforschung, Notfall- und Akutmedizin, Campus Virchow Klinikum (CVK), und Charité Campus Mitte (CCM), Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - Martina Schmiedhofer
- Notfallmedizinische Versorgungsforschung, Notfall- und Akutmedizin, Campus Virchow Klinikum (CVK), und Charité Campus Mitte (CCM), Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - Anika Kreutzberg
- Fachgebiet für Management im Gesundheitswesen, Gesundheitsökonomisches Zentrum Berlin, Technische Universität Berlin, Berlin, Deutschland
| | - Cornelia Henschke
- Fachgebiet für Management im Gesundheitswesen, Gesundheitsökonomisches Zentrum Berlin, Technische Universität Berlin, Berlin, Deutschland
| | - Martin Möckel
- Notfallmedizinische Versorgungsforschung, Notfall- und Akutmedizin, Campus Virchow Klinikum (CVK), und Charité Campus Mitte (CCM), Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - Anna Slagman
- Notfallmedizinische Versorgungsforschung, Notfall- und Akutmedizin, Campus Virchow Klinikum (CVK), und Charité Campus Mitte (CCM), Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
| |
Collapse
|
8
|
Fleury MJ, Cao Z, Grenier G, Huỳnh C. Profiles of patients with substance-related disorders who dropped out or not from addiction treatment. Psychiatry Res 2023; 329:115532. [PMID: 37837812 DOI: 10.1016/j.psychres.2023.115532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 10/02/2023] [Accepted: 10/06/2023] [Indexed: 10/16/2023]
Abstract
This longitudinal study identified profiles of patients with substance-related disorders (SRD) who did or did not drop out of specialized addiction treatment, integrating various patterns of outpatient service use. Medical administrative databases of Quebec (Canada) were used to investigate a cohort of 16,179 patients with SRD who received specialized addiction treatment. Latent class analysis identified patient profiles, based on multi-year outpatient service use. Four patient profiles related to treatment dropout were identified: patients who did not drop out and were low service users (Profile 1); patients who did not drop out and were high service users (Profile 2); patients who dropped out and were low service users (Profile 3); patients who dropped out and were high service users (Profile 4). Profile 1 had the best health and social conditions, while Profile 4 had the worst. The risks of being frequent emergency department users, being hospitalized or dying were highest in Profile 4, followed by Profiles 3, 2 and 1. Assertive treatment programs may be suited to Profile 4 and intensive case management programs to Profile 3. Collaborative care with higher psychosocial interventions and regularity of care may be extended to Profile 2 and interventions integrating motivational treatment to Profile 1.
Collapse
Affiliation(s)
- Marie-Josée Fleury
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC, Canada, H3A 1A1; Douglas Hospital Research Centre, 6875 LaSalle Blvd, Montreal, QC, Canada, H4H 1R3.
| | - Zhirong Cao
- Douglas Hospital Research Centre, 6875 LaSalle Blvd, Montreal, QC, Canada, H4H 1R3
| | - Guy Grenier
- Douglas Hospital Research Centre, 6875 LaSalle Blvd, Montreal, QC, Canada, H4H 1R3
| | - 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, rue de Louvain, Montreal, QC, Canada, H2M 2E8
| |
Collapse
|
9
|
Fleury MJ, Cao Z, Grenier G, Ferland F. Profiles of quality of life among patients using emergency departments for mental health reasons. Health Qual Life Outcomes 2023; 21:116. [PMID: 37880748 PMCID: PMC10601205 DOI: 10.1186/s12955-023-02200-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 10/11/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND This study identified profiles associated with quality of life (QoL) and sociodemographic and clinical characteristics of patients using emergency departments (ED) for mental health reasons and associated these profiles with patient service use. METHODS Recruited in four Quebec (Canada) ED networks, 299 patients with mental disorders (MD) were surveyed from March 1st, 2021, to May 13th, 2022. Data from medical records were collected and merged with survey data. Cluster analysis was conducted to identify QoL profiles, and comparison analyses used to assess differences between them. RESULTS Four QoL profiles were identified: (1) Unemployed or retired men with low QoL, education and household income, mostly having substance-related disorders and bad perceived mental/physical health conditions; (2) Men who are employed or students, have good QoL, high education and household income, the least personality disorders, and fair perceived mental/physical health conditions; (3) Women with low QoL, multiple mental health problems, and very bad perceived mental/physical health conditions; (4) Mostly women with very good QoL, serious MD, and very good perceived mental/physical health conditions. CONCLUSION The profiles with the highest QoL (4 and 2) had better overall social characteristics and perceived their health conditions as superior. Profile 4 reported the highest level of satisfaction with services used. To improve QoL programs like permanent supportive housing, individual placement and support might be better implemented, and satisfaction with care more routinely assessed in response to patient needs - especially for Profiles 1 and 3, that show complex health and social conditions.
Collapse
Affiliation(s)
- Marie-Josée Fleury
- Department of Psychiatry, McGill University, Douglas Mental Health University Institute Research Centre Montreal, Montreal, QC, Canada.
- Douglas Mental Health University Institute Research Centre Montreal, Montreal, QC, Canada.
- Douglas Hospital Research Centre, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada.
| | - Zhirong Cao
- Douglas Mental Health University Institute Research Centre Montreal, Montreal, QC, Canada
| | - Guy Grenier
- Douglas Mental Health University Institute Research Centre Montreal, Montreal, QC, Canada
| | - Francine Ferland
- School of Social Work, Addiction Rehabilitation Center, Laval University, National Capital University Integrated Health and Social Services Center, Quebec City, QC, Canada
| |
Collapse
|
10
|
Brown JL, Gause NK, Braun R, Punches B, Spatholt D, Twitty TD, Sprunger JG, Lyons MS. Substance Use and Mental Health Screening Within an Emergency Department-Based HIV Screening Program: Outcomes From 1 Year of Implementation. Health Promot Pract 2023:15248399231193005. [PMID: 37650616 DOI: 10.1177/15248399231193005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
INTRODUCTION The emergency department (ED) may be an optimal setting to screen for substance use disorders (SUDs) and co-occurring psychiatric disorders (CODs). We report on the frequency of problematic substance use and comorbid elevated mental health symptoms detected during a 1-year implementation period of an ED-based SUD/COD screening approach within an established ED HIV screening program. METHODS Patients (N = 1,924) were approached by dedicated HIV screening staff in an urban, Midwestern ED. Patients first completed measures assessing problematic alcohol (Alcohol Use Disorder Identification Test-Concise [AUDIT-C]) and substance use across 10 categories of substances (National Institute on Drug Abuse-Modified Alcohol, Smoking, and Substance Involvement Screening Test [NIDA-Modified ASSIST]). Patients with positive alcohol and/or substance use screens completed measures assessing symptoms of depression (Patient Health Questionnaire-9 [PHQ-9]), anxiety (Generalized Anxiety Disorder-7 [GAD-7]), and post-traumatic stress disorder (PTSD) (PTSD Checklist-Civilian [PCL-C]). RESULTS Patients were predominantly male (60.3%) with a mean age of 38.1 years (SD = 13.0); most identified as White (50.8%) or Black (44.8%). A majority (58.5%) had a positive screen for problematic alcohol and/or other substance use. Of those with a positive substance use screen (n = 1,126), 47.0% had a positive screen on one or more of the mental health measures with 32.1% endorsing elevated depressive symptoms, 29.6% endorsing elevated PTSD-related symptoms, and 28.5% endorsing elevated anxiety symptoms. CONCLUSIONS Among those receiving ED HIV screening, a majority endorsed problematic alcohol and/or other substance use and co-occurring elevated mental health symptoms. Substance use and mental health screening programs that can be integrated within other ED preventive services may enhance the identification of individuals in need of further assessment, referral, or linkage to substance use treatment services.
Collapse
Affiliation(s)
| | - Nicole K Gause
- Duquesne University Counseling Services, Pittsburgh, PA, USA
| | - Robert Braun
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Brittany Punches
- The Ohio State University, Columbus, OH, USA
- The Ohio State University Wexner Medical Center, Columbus, OH USA
| | - David Spatholt
- The Ohio State University Wexner Medical Center, Columbus, OH USA
| | | | - Joel G Sprunger
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Michael S Lyons
- The Ohio State University Wexner Medical Center, Columbus, OH USA
| |
Collapse
|
11
|
Graells M, Schaad L, Schmutz E, Moullin J, Hugli O, Daeppen JB, Ambrosetti J, Ombelli J, Golay M, Ribordy V, Bodenmann P, Grazioli VS. Experiences of Frequent Users of Emergency Departments in Health Care Setting in French-Speaking Switzerland: A Qualitative Study. Healthcare (Basel) 2023; 11:healthcare11091228. [PMID: 37174770 PMCID: PMC10178271 DOI: 10.3390/healthcare11091228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 04/21/2023] [Accepted: 04/24/2023] [Indexed: 05/15/2023] Open
Abstract
AIMS Frequent users of the emergency department (FUED; five ED visits or more per year) often have negative experiences in health care settings, potentially aggravating their health problems. Scarce research has explored FUED experiences in health care in Europe, none in Switzerland. Thus, this study aimed to conduct an in-depth exploration of FUED experiences in health care settings in Switzerland. METHODS Semi-structured interviews were conducted among 20 FUED (75% female; mean age = 40.6, SD = 12.8). Qualitative data were subject to inductive content analysis. RESULTS Five main themes emerged from the analysis. The main findings documented that FUED experiences in health care were mostly negative, leading to negative emotions, dissatisfaction and a loss of confidence in the system, although some positive experiences were reported as well. The relationship with health care workers was perceived as playing a key role in FUED experiences. CONCLUSION The findings indicate that FUED often have negative experiences in the health care system in Switzerland. The relationship with the health care staff is reported as a decisive ingredient of the experience in health care. Future research is needed to develop awareness-raising interventions for health care staff to improve FUED experiences in health care.
Collapse
Affiliation(s)
- Madison Graells
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, University of Lausanne, 1011 Lausanne, Switzerland
| | - Luana Schaad
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, University of Lausanne, 1011 Lausanne, Switzerland
| | - Elodie Schmutz
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, University of Lausanne, 1011 Lausanne, Switzerland
| | - Joanna Moullin
- Faculty Health Sciences, School of Population Health, Curtin University, Perth 6845, Australia
| | - Olivier Hugli
- Emergency Department, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland
| | - Jean-Bernard Daeppen
- Addiction Medicine, Department of Psychiatry, Lausanne University Hospital, 1011 Lausanne, Switzerland
| | - Julia Ambrosetti
- Emergency Department, Geneva University Hospital, 1205 Geneva, Switzerland
| | - Julien Ombelli
- Emergency Department, North Vaud Hospital Group, 1400 Yverdon-les-Bains, Switzerland
| | - Michel Golay
- Emergency Department, La Broye Hospital, 1530 Payerne, Switzerland
| | - Vincent Ribordy
- Emergency Department, Fribourg Hospital, 1700 Fribourg, Switzerland
| | - Patrick Bodenmann
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, University of Lausanne, 1011 Lausanne, Switzerland
| | - Véronique S Grazioli
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, University of Lausanne, 1011 Lausanne, Switzerland
| |
Collapse
|
12
|
Fleury MJ, Cao Z, Grenier G, Huỳnh C. Profiles of quality of outpatient care use, associated sociodemographic and clinical characteristics, and adverse outcomes among patients with substance-related disorders. Subst Abuse Treat Prev Policy 2023; 18:5. [PMID: 36641441 PMCID: PMC9840840 DOI: 10.1186/s13011-022-00511-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 12/22/2022] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND This study identified patient profiles in terms of their quality of outpatient care use, associated sociodemographic and clinical characteristics, and adverse outcomes based on frequent emergency department (ED) use, hospitalization, and death from medical causes. METHODS A cohort of 18,215 patients with substance-related disorders (SRD) recruited in addiction treatment centers was investigated using Quebec (Canada) health administrative databases. A latent class analysis was produced, identifying three profiles of quality of outpatient care use, while multinomial and logistic regressions tested associations with patient characteristics and adverse outcomes, respectively. RESULTS Profile 1 patients (47% of the sample), labeled "Low outpatient service users", received low quality of care. They were mainly younger, materially and socially deprived men, some with a criminal history. They had more recent SRD, mainly polysubstance, and less mental disorders (MD) and chronic physical illnesses than other Profiles. Profile 2 patients (36%), labeled "Moderate outpatient service users", received high continuity and intensity of care by general practitioners (GP), while the diversity and regularity in their overall quality of outpatient service was moderate. Compared with Profile 1, they were older, less likely to be unemployed or to live in semi-urban areas, and most had common MD and chronic physical illnesses. Profile 3 patients (17%), labeled "High outpatient service users", received more intensive psychiatric care and higher quality of outpatient care than other Profiles. Most Profile 3 patients lived alone or were single parents, and fewer lived in rural areas or had a history of homelessness, versus Profile 1 patients. They were strongly affected by MD, mostly serious MD and personality disorders. Compared with Profile 1, Profile 3 had more frequent ED use and hospitalizations, followed by Profile 2. No differences in death rates emerged among the profiles. CONCLUSIONS Frequent ED use and hospitalization were strongly related to patient clinical and sociodemographic profiles, and the quality of outpatient services received to the severity of their conditions. Outreach strategies more responsive to patient needs may include motivational interventions and prevention of risky behaviors for Profile 1 patients, collaborative GP-psychiatrist care for Profile 2 patients, and GP care and intensive specialized treatment for Profile 3 patients.
Collapse
Affiliation(s)
- Marie-Josée Fleury
- Douglas Hospital Research Centre, 6875 LaSalle Blvd, Montreal, Quebec, H4H 1R3, Canada. .,Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, Quebec, H3A 1A1, Canada.
| | - Zhirong Cao
- grid.412078.80000 0001 2353 5268Douglas Hospital Research Centre, 6875 LaSalle Blvd, Montreal, Quebec H4H 1R3 Canada
| | - Guy Grenier
- grid.412078.80000 0001 2353 5268Douglas Hospital Research Centre, 6875 LaSalle Blvd, Montreal, Quebec H4H 1R3 Canada
| | - Christophe Huỳnh
- grid.459278.50000 0004 4910 4652Institut universitaire sur les dépendances, Centre intégré universitaire de santé et des services sociaux du Centre-Sud-de-l’Île-de-Montréal, 950 Louvain Est, Montreal, Quebec H2M 2E8 Canada
| |
Collapse
|
13
|
Schaad L, Graells M, Kasztura M, Schmutz E, Moullin J, Hugli O, Daeppen JB, Ambrosetti J, Ombelli J, Golay M, Ribordy V, Grazioli VS, Bodenmann P. Perspectives of Frequent Users of Emergency Departments on a Case Management Intervention: A Qualitative Study. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2023; 60:469580231159745. [PMID: 36927138 PMCID: PMC10026145 DOI: 10.1177/00469580231159745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
BACKGROUND Effective management of frequent users of emergency departments (FUED) remains challenging. Case management (CM) has shown to improve patient quality of life while reducing ED visits and associated costs. However, little data is available on FUED's perception of CM outside of North America to further improve CM implementation. OBJECTIVES Explore the FUED's perspectives about CM in Switzerland. DESIGN, SETTING & PARTICIPANTS Semi-structured qualitative interviews eliciting FUED's experiences of CM were conducted among 20 participants (75% female; mean age = 40.6, SD = 12.8) across 6 hospital ED. OUTCOMES MEASURES & ANALYSIS Inductive content analysis. MAIN RESULTS Most participants were satisfied with the CM program. In particular, FUEDs identified the working relationship with the case manager (cm) as key for positive outcomes, and also valued the holistic evaluation of their needs and resources. Overall, patients reported increased motivation and health literacy, as well as facilitated interactions within the healthcare system. Conversely, a small number of participants reported negative views on CM (ie, stigmatization, lack of concrete outcomes). Barriers identified were cm's lack of time, COVID-19's negative impact on CM organization, as well as lack of clarity on the objectives of CM. FUED perceived CM as useful, in particular establishing a working relationship with the cm. Our results suggest that CM can be further improved by (1) professionals remaining non-judgmental toward FUED, (2) making sure the aims and objectives of the CM are understood by the participants, and (3) allowing more time for the cm to carry out their work.
Collapse
Affiliation(s)
- Luana Schaad
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, Chair of Medicine for Vulnerable Populations, Lausanne University, Switzerland
| | - Madison Graells
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, Chair of Medicine for Vulnerable Populations, Lausanne University, Switzerland
| | - Miriam Kasztura
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, Chair of Medicine for Vulnerable Populations, Lausanne University, Switzerland
| | - Elodie Schmutz
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, Chair of Medicine for Vulnerable Populations, Lausanne University, Switzerland
| | | | - Olivier Hugli
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, Chair of Medicine for Vulnerable Populations, Lausanne University, Switzerland
| | - Jean-Bernard Daeppen
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, Chair of Medicine for Vulnerable Populations, Lausanne University, Switzerland
| | | | - Julien Ombelli
- North Vaud Hospital Group, Yverdon-les-Bains, Switzerland
| | - Michel Golay
- Broye Intercantonal Hospital, Payerne, Switzerland
| | | | - Véronique S Grazioli
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, Chair of Medicine for Vulnerable Populations, Lausanne University, Switzerland
| | - Patrick Bodenmann
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health, Chair of Medicine for Vulnerable Populations, Lausanne University, Switzerland
| |
Collapse
|
14
|
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.
Collapse
|
15
|
Broder JS, Oliveira J E Silva L, Bellolio F, Freiermuth CE, Griffey RT, Hooker E, Jang TB, Meltzer AC, Mills AM, Pepper JD, Prakken SD, Repplinger MD, Upadhye S, Carpenter CR. Guidelines for Reasonable and Appropriate Care in the Emergency Department 2 (GRACE-2): Low-risk, recurrent abdominal pain in the emergency department. Acad Emerg Med 2022; 29:526-560. [PMID: 35543712 DOI: 10.1111/acem.14495] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/18/2022] [Accepted: 03/19/2022] [Indexed: 02/07/2023]
Abstract
This second Guideline for Reasonable and Appropriate Care in the Emergency Department (GRACE-2) from the Society for Academic Emergency Medicine is on the topic "low-risk, recurrent abdominal pain in the emergency department." The multidisciplinary guideline panel applied the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess the certainty of evidence and strength of recommendations regarding four priority questions for adult emergency department patients with low-risk, recurrent, undifferentiated abdominal pain. The intended population includes adults with multiple similar presentations of abdominal signs and symptoms recurring over a period of months or years. The panel reached the following recommendations: (1) if a prior negative computed tomography of the abdomen and pelvis (CTAP) has been performed within 12 months, there is insufficient evidence to accurately identify populations in whom repeat CTAP imaging can be safely avoided or routinely recommended; (2) if CTAP with IV contrast is negative, we suggest against ultrasound unless there is concern for pelvic or biliary pathology; (3) we suggest that screening for depression and/or anxiety may be performed during the ED evaluation; and (4) we suggest an opioid-minimizing strategy for pain control. EXECUTIVE SUMMARY: The GRACE-2 writing group developed clinically relevant questions to address the care of adult patients with low-risk, recurrent, previously undifferentiated abdominal pain in the emergency department (ED). Four patient-intervention-comparison-outcome-time (PICOT) questions were developed by consensus of the writing group, who performed a systematic review of the literature and then synthesized direct and indirect evidence to formulate recommendations, following GRADE methodology. The writing group found that despite the commonality and relevance of these questions in emergency care, the quantity and quality of evidence were very limited, and even fundamental definitions of the population and outcomes of interest are lacking. Future research opportunities include developing precise and clinically relevant definitions of low-risk, recurrent, undifferentiated abdominal pain and determining the scope of the existing populations in terms of annual national ED visits for this complaint, costs of care, and patient and provider preferences.
Collapse
Affiliation(s)
- Joshua S Broder
- Department of Surgery, Division of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | | | - Fernanda Bellolio
- Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Caroline E Freiermuth
- Department of Emergency Medicine, University of Cincinnati School of Medicine, Cincinnati, Ohio, USA
| | - Richard T Griffey
- Department of Emergency Medicine and Emergency Care Research Core, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Edmond Hooker
- Department of Health Services Administration, Xavier University, Cincinnati, Ohio, USA
| | - Timothy B Jang
- Department of Emergency Medicine, University of California Los Angeles, UCLA Santa Monica Medical Center, Torrance, California, USA
| | - Andrew C Meltzer
- Department of Emergency Medicine, George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Angela M Mills
- Department of Emergency Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA.,Society for Academic Emergency Medicine, Des Plaines, Illinois, USA
| | | | | | - Michael D Repplinger
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Suneel Upadhye
- Division of Emergency Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Christopher R Carpenter
- Department of Emergency Medicine and Emergency Care Research Core, Washington University School of Medicine, St. Louis, Missouri, USA.,Society for Academic Emergency Medicine, Des Plaines, Illinois, USA
| |
Collapse
|
16
|
Oliveira J. e Silva L, Prakken SD, Meltzer AC, Broder JS, Gerberi DJ, Upadhye S, Carpenter CR, Bellolio F. Depression and anxiety screening in emergency department patients with recurrent abdominal pain: An evidence synthesis for a clinical practice guideline. Acad Emerg Med 2022; 29:615-629. [PMID: 34665903 DOI: 10.1111/acem.14394] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 09/22/2021] [Accepted: 09/26/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Recurrent abdominal pain in the emergency department (ED) might represent an opportunity for screening of depression and/or anxiety. METHODS We systematically searched five databases for studies evaluating the effect of screening for depression and/or anxiety in ED patients with recurrent and undifferentiated abdominal pain. Given paucity of direct evidence, we also searched for indirect evidence including studies that assessed prevalence of depression and/or anxiety in EDs (not necessarily recurrent abdominal pain), diagnostic accuracy of screening tools, effectiveness of screening in other settings, and outcomes such as repeat ED visits of patients with abdominal pain who were screened in the ED. Two methodologists evaluated certainty in the evidence using the GRADE approach. RESULTS A total of 4,337 citations were reviewed, and zero studies were found on the effect of screening in patients with recurrent and undifferentiated abdominal pain in the ED. A total of 35 studies were included as relevant indirect evidence. In studies of ED patients with abdominal pain, depression ranged from 10% to 29%, while anxiety ranged from 18% to 50%. False positives appear to be an issue given relatively low specificity of screening tools. One randomized trial including ED patients with vague symptoms evaluated the effect of depression screening on a composite outcome of depression recognition, psychiatric consultation, or referral by the emergency physician (risk ratio = 1.49, 95% confidence interval [CI] = 0.49 to 4.53, very low certainty). One study reported that patients with undifferentiated abdominal pain who screened positive for depression have had increased ED recidivism (odds ratio = 3.17, 95% CI = 1.14 to 8.85, very low certainty). CONCLUSIONS We were unable to identify any evidence that confirms that depression or anxiety screening in ED patients with recurrent and undifferentiated abdominal pain improves outcomes or changes management downstream.
Collapse
Affiliation(s)
| | - Steven D. Prakken
- Department of Psychiatry Duke University Health System Durham North Carolina USA
| | - Andrew C. Meltzer
- Department of Emergency Medicine The George Washington University School of Medicine and Health Sciences Washington District of Columbia USA
| | - Joshua S. Broder
- Department of Surgery Division of Emergency Medicine Duke University School of Medicine Durham North Carolina USA
| | | | - Suneel Upadhye
- Department of Emergency Medicine McMaster University Hamilton Ontario Canada
| | - Christopher R. Carpenter
- Department of Emergency Medicine Washington University in St. Louis School of Medicine Emergency Care Research Core St. Louis Missouri USA
| | - Fernanda Bellolio
- Department of Emergency Medicine Mayo Clinic Rochester Minnesota USA
| |
Collapse
|
17
|
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.
Collapse
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.
| |
Collapse
|
18
|
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: 16] [Impact Index Per Article: 5.3] [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.
Collapse
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.
| |
Collapse
|
19
|
von Allmen M, Grazioli VS, Kasztura M, Chastonay O, Moullin JC, Hugli O, Daeppen JB, Bodenmann P. Does Case Management Provide Support for Staff Facing Frequent Users of Emergency Departments? A Comparative Mixed-Method Evaluation of ED Staff Perception. BMC Emerg Med 2021; 21:92. [PMID: 34348645 PMCID: PMC8336392 DOI: 10.1186/s12873-021-00481-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 07/05/2021] [Indexed: 11/23/2022] Open
Abstract
Objective Frequent users of emergency departments (FUED) account for a disproportionate number of emergency department (ED) visits and contribute to a wide range of challenges for ED staff. While several research has documented that case management (CM) tailored to FUED leads to a reduction in ED visits and a better quality of life (QoL) among FUED, whether there is added value for ED staff remains to be explored. This study aimed to compare, among staff in two academic EDs in Switzerland (one with and one without CM), the FUED-related knowledge, perceptions of the extent of the FUED issue, FUED-related work challenges and FUEDs’ legitimacy to use ED. Method Mixed methods were employed. First, ED physicians and nurses (N = 253) of the two EDs completed an online survey assessing their knowledge and perceptions of FUEDs. Results between healthcare providers working in an ED with CM to those working in an ED without CM were compared using independent two-sided T-tests. Next, a sample of participants (n = 16) took part in a qualitative assessment via one-to-one interviews (n = 6) or focus groups (n = 10). Results Both quantitative and qualitative results documented that the FUED-related knowledge, the extent FUED were perceived as an issue and perceived FUEDs’ legitimacy to use ED were not different between groups. The level of perceived FUED-related challenges was also similar between groups. Quantitative results showed that nurses with CM experienced more challenges related to FUED. Qualitative exploration revealed that lack of psychiatric staff within the emergency team and lack of communication between ED staff and CM team were some of the explanations behind these counterintuitive findings. Conclusion Despite promising results on FUEDs’ QoL and frequency of ED visits, these preliminary findings suggest that CM may provide limited support to ED staff in its current form. Given the high burden of FUED-related challenges encountered by ED staff, improved communication and FUED-related knowledge transfer between ED staff and the CM team should be prioritized to increase the value of a FUED CM intervention for ED staff. Supplementary Information The online version contains supplementary material available at 10.1186/s12873-021-00481-9.
Collapse
Affiliation(s)
- Michael von Allmen
- Department of Vulnerabilities and Social Medicine, University Center for General Medicine and Public Health, Lausanne, Switzerland.
| | - Véronique S Grazioli
- Department of Vulnerabilities and Social Medicine, University Center for General Medicine and Public Health, Lausanne, Switzerland
| | - Miriam Kasztura
- Department of Vulnerabilities and Social Medicine, University Center for General Medicine and Public Health, Lausanne, Switzerland
| | - Oriane Chastonay
- Department of Vulnerabilities and Social Medicine, University Center for General Medicine and Public Health, Lausanne, Switzerland
| | | | - Olivier Hugli
- Emergency Department, University Hospital, Lausanne, Switzerland
| | - Jean-Bernard Daeppen
- Addiction Medicine, Department of Psychiatry, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Patrick Bodenmann
- Department of Vulnerabilities and Social Medicine, University Center for General Medicine and Public Health, Lausanne, Switzerland
| |
Collapse
|
20
|
Gentil L, Grenier G, Vasiliadis HM, Huỳnh C, Fleury MJ. Predictors of Recurrent High Emergency Department Use among Patients with Mental Disorders. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094559. [PMID: 33923112 PMCID: PMC8123505 DOI: 10.3390/ijerph18094559] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/16/2021] [Accepted: 04/17/2021] [Indexed: 11/23/2022]
Abstract
Few studies have examined predictors of recurrent high ED use. This study assessed predictors of recurrent high ED use over two and three consecutive years, compared with high one-year ED use. This five-year longitudinal study is based on a cohort of 3121 patients who visited one of six Quebec (Canada) ED at least three times in 2014–2015. Multinomial logistic regression was performed. Clinical, sociodemographic and service use variables were identified based on data extracted from health administrative databases for 2012–2013 to 2014–2015. Of the 3121 high ED users, 15% (n = 468) were recurrent high ED users for a two-year period and 12% (n = 364) over three years. Patients with three consecutive years of high ED use had more personality disorders, anxiety disorders, alcohol or drug related disorders, chronic physical illnesses, suicidal behaviors and violence or social issues. More resided in areas with high social deprivation, consulted frequently with psychiatrists, had more interventions in local community health service centers, more prior hospitalizations and lower continuity of medical care. Three consecutive years of high ED use may be a benchmark for identifying high users needing better ambulatory care. As most have multiple and complex health problems, higher continuity and adequacy of medical care should be prioritized.
Collapse
Affiliation(s)
- Lia Gentil
- Department of Psychiatry, McGill University, 1033, Pine Avenue West, Montreal, QC H3A 1A1, Canada;
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, 6875 LaSalle Blvd, Montreal, QC H4H 1R3, Canada;
- Centre Intégré Universitaire de Santé et des Services Sociaux du Centre-Sud-de-l’Île-de-Montréal, Institut Universitaire sur les Dépendances, 950 Louvain Est, Montréal, QC H2M 2E8, Canada;
| | - Guy Grenier
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, 6875 LaSalle Blvd, Montreal, QC H4H 1R3, Canada;
| | - Helen-Maria Vasiliadis
- Département Des Sciences de la Santé Communautaire, Université de Sherbrooke, Longueuil, QC J4K 0A8, Canada;
- Centre de Recherche Charles-Le Moyne-Saguenay–Lac-Saint-Jean sur les Innovations en Santé (CR-CSIS), Campus de Longueuil-Université de Sherbrooke, 150 Place Charles-Lemoyne, Longueuil, QC J4K 0A8, Canada
| | - Christophe Huỳnh
- Centre Intégré Universitaire de Santé et des Services Sociaux du Centre-Sud-de-l’Île-de-Montréal, Institut Universitaire sur les Dépendances, 950 Louvain Est, Montréal, QC H2M 2E8, Canada;
| | - Marie-Josée Fleury
- Department of Psychiatry, McGill University, 1033, Pine Avenue West, Montreal, QC H3A 1A1, Canada;
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, 6875 LaSalle Blvd, Montreal, QC H4H 1R3, Canada;
- Correspondence:
| |
Collapse
|
21
|
Chastonay OJ, Lemoine M, Grazioli VS, Canepa Allen M, Kasztura M, Moullin JC, Daeppen JB, Hugli O, Bodenmann P. Health care providers' perception of the frequent emergency department user issue and of targeted case management interventions: a cross-sectional national survey in Switzerland. BMC Emerg Med 2021; 21:4. [PMID: 33413163 PMCID: PMC7792123 DOI: 10.1186/s12873-020-00397-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 12/22/2020] [Indexed: 11/10/2022] Open
Abstract
Background Frequent users of emergency departments (FUEDs) (≥5 ED visits/year) represent a vulnerable population with complex needs accounting for a significant number of emergency department (ED) consultations, thus contributing to EDs overcrowding. Research exploring ED staff perceptions of FUEDs is scarce. Objectives The current study aimed to evaluate in ED staff a) the extent to which FUEDs are perceived as an issue; b) their perceived levels of knowledge and understanding of FUEDs; c) levels of perceived usefulness of case management (CM) and interest in implementing this intervention in their ED service. Methods Head physicians of the EDs at all public hospitals in Switzerland (of various level of specialization) were sent a 19-item web-based survey, pilot tested prior to its dissemination. The head physicians were asked to forward the survey to ED staff members from different health professional backgrounds. Results The hospital response rate was 81% (85/106). The exploitable hospital response rate was 71% (75/106 hospitals) including 208 responding health professionals. Issues and difficulties around FUEDs were perceived as important by 64% of respondents. The perceived frequency of being confronted with FUEDs was higher among nurses in more specialized EDs. In total, 64% of respondents felt poorly informed about FUEDs, nurses feeling less informed than physicians. The understanding of FUEDs was lower in the French-Italian-speaking parts (FISP) of Switzerland than in the German-speaking part. Eighty-one percent of respondents had no precise knowledge of FUED-related interventions. The perceived usefulness of CM interventions after receiving explanations about it was high (92%). However, the overall level of interest for CM implementation was 59%. The interest in CM by physicians was low across all regions and ED categories. Nurses, on the other hand, showed more interest, especially those in EDs of high specialization. Conclusions The majority of ED staff reported being confronted with FUEDs on a regular basis. Staff perceived FUEDs as a vulnerable population, yet, they felt poorly informed about how to manage the issue. The majority of ED staff thought a CM intervention would be useful for FUEDs, however there appears to be a gap in their desire or willingness to implement such interventions. Supplementary Information The online version contains supplementary material available at 10.1186/s12873-020-00397-w.
Collapse
Affiliation(s)
- Oriane J Chastonay
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland. .,Department of Vulnerabilities and Social Medicine, University Center for General Medicine and Public Health, Lausanne, Switzerland.
| | - Melissa Lemoine
- Department of Vulnerabilities and Social Medicine, University Center for General Medicine and Public Health, Lausanne, Switzerland
| | - Véronique S Grazioli
- Department of Vulnerabilities and Social Medicine, University Center for General Medicine and Public Health, Lausanne, Switzerland
| | - Marina Canepa Allen
- Department of Vulnerabilities and Social Medicine, University Center for General Medicine and Public Health, Lausanne, Switzerland
| | - Miriam Kasztura
- Department of Vulnerabilities and Social Medicine, University Center for General Medicine and Public Health, Lausanne, Switzerland
| | | | | | - Olivier Hugli
- Emergency Department, University Hospital, Lausanne, Switzerland
| | - Patrick Bodenmann
- Department of Vulnerabilities and Social Medicine, University Center for General Medicine and Public Health, Lausanne, Switzerland
| |
Collapse
|
22
|
Bodenmann P, Kasztura M, Graells M, Schmutz E, Chastonay O, Canepa-Allen M, Moullin J, von Allmen M, Lemoine M, Hugli O, Daeppen JB, Grazioli VS. Healthcare Providers' Perceptions of Challenges with Frequent Users of Emergency Department Care in Switzerland: A Qualitative Study. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2021; 58:469580211028173. [PMID: 34328025 PMCID: PMC8326990 DOI: 10.1177/00469580211028173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 05/19/2021] [Accepted: 06/07/2021] [Indexed: 11/17/2022]
Abstract
Frequent users of emergency departments (FUED; ≥ 5 ED visits/year) commonly cumulate medical, social, and substance use problems requiring complex and sustained care coordination often unavailable in ED. This study aimed to explore ED healthcare providers' challenges related to FUED care to gain insight into the support and resources required to address FUED complex needs. An online survey was sent to all general adult emergency services within Switzerland (N = 106). Participants were asked to indicate the extent to which they perceived that FUED represented a problem and to describe the main challenges encountered. In total, 208 physicians and nurses from 75 EDs (70.7%) completed the survey. Among the 208 participants, 134 (64%) reported that FUED represented a challenge and 133 described 1 to 5 challenges encountered. A conventional content analysis yielded 4 main categories of perceived challenges. Negative consequences in the ED secondary to FUED's presence (eg, ED overcrowding, staff helplessness, and fatigue) was the most frequently reported challenge, followed by challenges related to FUEDs' characteristics (eg, mental health and social problems) leading to healthcare complexity. The third most frequently encountered challenge was related to the ED inappropriateness and inefficiency to address FUEDs' needs. Finally, challenges related to the lack of FUED healthcare network were the least often mentioned. ED healthcare providers experience a wide range of challenges related to FUED care. These findings suggest that currently EDs nor their staff are equipped to address FUEDs' complex needs.
Collapse
Affiliation(s)
- Patrick Bodenmann
- Department of Vulnerabilities and
Social Medicine, Center for Primary Care and Public Health, Chair of Medicine for
Vulnerable Populations, University of Lausanne, Switzerland
| | - Miriam Kasztura
- Department of Vulnerabilities and
Social Medicine, Center for Primary Care and Public Health, Chair of Medicine for
Vulnerable Populations, University of Lausanne, Switzerland
| | - Madison Graells
- Department of Vulnerabilities and
Social Medicine, Center for Primary Care and Public Health, Chair of Medicine for
Vulnerable Populations, University of Lausanne, Switzerland
| | - Elodie Schmutz
- Department of Vulnerabilities and
Social Medicine, Center for Primary Care and Public Health, Chair of Medicine for
Vulnerable Populations, University of Lausanne, Switzerland
| | - Oriane Chastonay
- Department of Vulnerabilities and
Social Medicine, Center for Primary Care and Public Health, Chair of Medicine for
Vulnerable Populations, University of Lausanne, Switzerland
| | - Marina Canepa-Allen
- Department of Vulnerabilities and
Social Medicine, Center for Primary Care and Public Health, Chair of Medicine for
Vulnerable Populations, University of Lausanne, Switzerland
| | - Joanna Moullin
- Faculty Health Sciences, School of
Pharmacy and Biomedical Sciences, Curtin University, Western Australia
| | - Michael von Allmen
- Department of Vulnerabilities and
Social Medicine, Center for Primary Care and Public Health, Chair of Medicine for
Vulnerable Populations, University of Lausanne, Switzerland
| | - Melissa Lemoine
- Department of Vulnerabilities and
Social Medicine, Center for Primary Care and Public Health, Chair of Medicine for
Vulnerable Populations, University of Lausanne, Switzerland
| | - Olivier Hugli
- Emergency Department, Lausanne
University Hospital, University of Lausanne, Switzerland
| | - Jean-Bernard Daeppen
- Addiction Medicine, Department of
Psychiatry, University of Lausanne, Switzerland
| | - Véronique S. Grazioli
- Department of Vulnerabilities and
Social Medicine, Center for Primary Care and Public Health, Chair of Medicine for
Vulnerable Populations, University of Lausanne, Switzerland
| |
Collapse
|
23
|
Gentil L, Grenier G, Meng X, Fleury MJ. Impact of Co-occurring Mental Disorders and Chronic Physical Illnesses on Frequency of Emergency Department Use and Hospitalization for Mental Health Reasons. Front Psychiatry 2021; 12:735005. [PMID: 34880788 PMCID: PMC8645581 DOI: 10.3389/fpsyt.2021.735005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 11/01/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Patients with mental disorders (MD) are at high risk for a wide range of chronic physical illnesses (CPI), often resulting in greater use of acute care services. This study estimated risk of emergency department (ED) use and hospitalization for mental health (MH) reasons among 678 patients with MD and CPI compared to 1,999 patients with MD only. Methods: Patients visiting one of six Quebec (Canada) ED for MH reasons and at onset of a MD in 2014-15 (index year) were included. Negative binomial models comparing the two groups estimated risk of ED use and hospitalization at 12-month follow-up to index ED visit, controlling for clinical, sociodemographic, and service use variables. Results: Patients with MD, more severe overall clinical conditions and those who received more intensive specialized MH care had higher risks of frequent ED use and hospitalization. Continuity of medical care protected against both ED use and hospitalization, while general practitioner (GP) consultations protected against hospitalization only. Patients aged 65+ had lower risk of ED use, whereas risk of hospitalization was higher for the 45-64- vs. 12-24-year age groups, and for men vs. women. Conclusion: Strategies including assertive community treatment, intensive case management, integrated co-occurring treatment, home treatment, and shared care may improve adequacy of care for patients with MD-CPI, as well as those with MD only whose clinical profiles were severe. Prevention and outreach strategies may also be promoted, especially among men and older age groups.
Collapse
Affiliation(s)
- Lia Gentil
- Douglas Mental Health University Institute Research Centre, Montréal, QC, Canada.,Department of Psychiatry, McGill University, Montréal, QC, Canada
| | - Guy Grenier
- Douglas Mental Health University Institute Research Centre, Montréal, QC, Canada
| | - Xiangfei Meng
- Douglas Mental Health University Institute Research Centre, Montréal, QC, Canada.,Department of Psychiatry, McGill University, Montréal, QC, Canada
| | - Marie-Josée Fleury
- Douglas Mental Health University Institute Research Centre, Montréal, QC, Canada.,Department of Psychiatry, McGill University, Montréal, QC, Canada
| |
Collapse
|
24
|
Wang C, Cheng SF, Hung JL, Tang PL. Highly frequent utilization of outpatient services in a national health insurance system - analysis of associated factors and underlying co-morbidity. Curr Med Res Opin 2020; 36:1761-1767. [PMID: 33017273 DOI: 10.1080/03007995.2020.1832057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE We aimed to identify associated factors of highly frequent use of outpatient services and explore how they were impacted to provide policy references for government and medical institutes in their efforts to seek provision of reasonable medical services, continuous care and integrated outpatient services. METHODS The Taiwanese national health insurance database was used and 661,125 patients were identified in 2009. The patients with ≥100 internal medicine outpatient (IMO) visits were defined as the highly frequent group and they were matched at a ratio of 1:4 with patients of 1-99 IMO visits based on demographic characteristics. Multivariate logistic regression was used to estimate adjusted odds ratios with 95% confidence intervals. RESULTS Among 1 million patients in the outpatient department, 0.05% had at least 100 visits. These patients with highly frequent IMO visits had significantly higher rates of emergency department (ED) visits, hospitalization, psychiatric disorders and possession of a catastrophic illness card as well as a significantly lower level of continuity of care index (COCI). Multivariate analysis showed that ED visits (adjusted OR [AOR] = 1.63), psychiatric disorders (AOR = 7.13), low COCI (AOR = 1.69), and several comorbidities including peripheral vascular diseases (AOR = 4.33), dementia (AOR = 0.04), chronic pulmonary disease (AOR = 3.02), peptic ulcer diseases (AOR = 3.70), diabetes mellitus (AOR = 3.45) and renal disease (AOR = 2.43) were significant associated factors. CONCLUSIONS To rationalize use and distribution of medical resources, we suggest proper regular care and health education to those with mental disabilities and multiple chronic conditions, which may not only improve the situation of highly frequent hospital visits but also effectively control incidence of acute conditions and reduce their ED visits. In addition, improving the continuity of care is vital, and the best way to do this is to promote family medicine as the primary form of healthcare.
Collapse
Affiliation(s)
- Chi Wang
- Department of Nursing, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
- Department of Nursing, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan, ROC
| | - Su-Fen Cheng
- Department of Nursing, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Jui-Lan Hung
- Department of Nursing, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Pei-Ling Tang
- Research Center of Medical Informatics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
- Department of Health-Business Administration, Fooyin University, Kaohsiung, Taiwan, ROC
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
| |
Collapse
|
25
|
Treating Post-traumatic Stress Disorder with a Prolonged Exposure Protocol Within Primary Care Behavioral Health: A Case Example. J Clin Psychol Med Settings 2020; 28:575-583. [PMID: 33090302 DOI: 10.1007/s10880-020-09747-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2020] [Indexed: 10/23/2022]
Abstract
Posttraumatic stress disorder (PTSD) is a debilitating condition that impacts anywhere from 2 to 39% of primary care patients. Research suggests overall health, instances of hospitalizations, emergency room visits, and utilization of primary care services are impacted by a diagnosis of PTSD. Evidenced based treatments such as cognitive process therapy and prolonged exposure (PE) are available in specialty mental health but pose many barriers to treatment and implementation into primary care. This case study serves as the first known case example with an ethnic minority civilian, examining the treatment of PTSD within the Primary Care Behavioral Health Model using the brief (5 visits), PE protocol for primary care (PE-PC). PTSD was assessed using the PCL-5. Additional variables were assessed and tracked with the following tools: PHQ-9 (depressive symptoms), GAD-7 (anxiety symptoms), QLES-SF (quality of life), and the AAQ-2 (psychological flexibility) pre/post treatment, 6 months post-treatment and 9 months post-treatment. The patient reported clinically significant decreases in symptoms of PTSD, depression, and anxiety symptoms. Additionally, the patient's scores on quality of life and psychological flexibility improved. Brief, exposure-based treatment for PTSD can be delivered within the PCBH model. This treatment may result in improved quality of life and has the potential to reduce health care costs. This case encourages the treatment of PTSD within primary care, increasing access to care for patients. Future research is needed to further investigate this protocol in primary care with underserved, civilian populations and to explore patient attitudes toward brief treatment for PTSD in a primary care setting.
Collapse
|
26
|
Richards JR, Placone TW, Wang CG, van der Linden MC, Derlet RW, Laurin EG. Methamphetamine, Amphetamine, and MDMA Use and Emergency Department Recidivism. J Emerg Med 2020; 59:320-328. [PMID: 32546441 DOI: 10.1016/j.jemermed.2020.04.051] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 04/23/2020] [Accepted: 04/28/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Emergency department (ED) recidivism and the use of amphetamine and associated derivatives such as methamphetamine and MDMA (MAE), are intersecting public health concerns. OBJECTIVE This study aims to determine the frequency of ED recidivism of patients who use MAE and associated factors. METHODS The study was a retrospective 6-year electronic medical record review of patients with MAE-positive toxicology screens and single and multiple ED visits in the span of 12 months. RESULTS There were 7844 ED visits by 5568 MAE-positive patients. Average age was 42 ± 13 years. The majority were male (65%), white (46%), tobacco smokers (55%), and in the psychiatric discharge diagnostic-related group (41%), followed by blunt trauma (20%). Admission rate was 35%, with another 17% transferred to inpatient psychiatric treatment facilities. Occasional (2-5 visits/year), heavy (6-11 visits/year), and super users (≥12 visits/year) altogether accounted for 20% of patients and 43% of visits. Heavy and super users combined represented 2% of patients and 10% of visits, with significant differences for race/ethnicity, health insurance, tobacco smoking, and psychiatric/cardiovascular/trauma discharge diagnostic-related groups. Heavy and super users were less likely to be admitted and more likely to be discharged to an inpatient psychiatric treatment facility. Regression analysis revealed racial/ethnic differences, female gender, and tobacco smoking to be associated with super and heavy use. Heavy users were more likely to have cardiovascular-related discharge diagnoses. CONCLUSIONS The prevalence of ED recidivism in patients who use MAE is similar to published ranges for general ED users. Significant differences in demographics, discharge diagnoses, insurance, smoking, and disposition exist between nonfrequent and frequent ED users.
Collapse
Affiliation(s)
- John R Richards
- Department of Emergency Medicine, University of California Davis Medical Center, Sacramento, California
| | - Taylaur W Placone
- Department of Emergency Medicine, University of California Davis Medical Center, Sacramento, California
| | - Colin G Wang
- Department of Emergency Medicine, University of California Davis Medical Center, Sacramento, California
| | | | - Robert W Derlet
- Department of Emergency Medicine, University of California Davis Medical Center, Sacramento, California
| | - Erik G Laurin
- Department of Emergency Medicine, University of California Davis Medical Center, Sacramento, California
| |
Collapse
|
27
|
Fleury MJ, Grenier G, Bamvita JM, Ferland F. Typology of patients who use emergency departments for mental and substance use disorders. BJPsych Open 2020; 6:e59. [PMID: 32489163 PMCID: PMC7345525 DOI: 10.1192/bjo.2020.39] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Identifying profiles of people with mental and substance use disorders who use emergency departments may help guide the development of interventions more appropriate to their particular characteristics and needs. AIMS To develop a typology for the frequency of visits to the emergency department for mental health reasons based on the Andersen model. METHOD Questionnaires were completed by patients who attended an emergency department (n = 320), recruited in Quebec (Canada), and administrative data were obtained related to sociodemographic/socioeconomic characteristics, mental health diagnoses including alcohol and drug use, and emergency department and mental health service utilization. A cluster analysis was performed, identifying needs, predisposing and enabling factors that differentiated subclasses of participants according to frequency of emergency department visits for mental health reasons. RESULTS Four classes were identified. Class 1 comprised individuals with moderate emergency department use and low use of other health services; mostly young, economically disadvantaged males with substance use disorders. Class 2 comprised individuals with high emergency department and specialized health service use, with multiple mental and substance use disorders. Class 3 comprised middle-aged, economically advantaged females with common mental disorders, who made moderate use of emergency departments but consulted general practitioners. Class 4 comprised older individuals with multiple chronic physical illnesses co-occurring with mental disorders, who made moderate use of the emergency department, but mainly consulted general practitioners. CONCLUSIONS The study found heterogeneity in emergency department use for mental health reasons, as each of the four classes represented distinct needs, predisposing and enabling factors. As such, interventions should be tailored to different classes of patients who use emergency departments, based on their characteristics.
Collapse
Affiliation(s)
- Marie-Josée Fleury
- Department of Psychiatry, McGill University; and Douglas Mental Health University Institute Research Centre, Quebec, Canada
| | - Guy Grenier
- Douglas Mental Health University Institute Research Centre, Quebec, Canada
| | - Jean-Marie Bamvita
- Douglas Mental Health University Institute Research Centre, Quebec, Canada
| | - Francine Ferland
- School of Social Work, Laval University; and Addiction Rehabilitation Centre, University Integrated Health and Social Services Centre - Capitale-Nationale, Quebec, Canada
| |
Collapse
|
28
|
Maruster L, van der Zee DJ, Hatenboer J, Buskens E. Tracing frequent users of regional care services using emergency medical services data: a networked approach. BMJ Open 2020; 10:e036139. [PMID: 32467254 PMCID: PMC7259845 DOI: 10.1136/bmjopen-2019-036139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES This study shows how a networked approach relying on 'real-world' emergency medical services (EMS) records might contribute to tracing frequent users of care services on a regional scale. Their tracing is considered of importance for policy-makers and clinicians, since they represent a considerable workload and use of scarce resources. While existing approaches for data collection on frequent users tend to limit scope to individual or associated care providers, the proposed approach exploits the role of EMS as the network's 'ferryman' overseeing and recording patient calls made to an entire network of care providers. DESIGN A retrospective study was performed analysing 2012-2017 EMS calls in the province of Drenthe, the Netherlands. Using EMS data, benefits of the networked approach versus existing approaches are assessed by quantifying the number of frequent users and their associated calls for various categories of care providers. Main categories considered are hospitals, nursing homes and EMS. SETTING EMS in the province of Drenthe, the Netherlands, serving a population of 491 867. PARTICIPANTS Analyses are based on secondary patient data from EMS records, entailing 212 967 transports and 126 758 patients, over 6 years (2012-2017). RESULTS Use of the networked approach for analysing calls made to hospitals in Drenthe resulted in a 20% average increase of frequent users traced. Extending the analysis by including hospitals outside Drenthe increased ascertainment by 28%. Extending to all categories of care providers, inside Drenthe, and subsequently, irrespective of their location, resulted in an average increase of 132% and 152% of frequent users identified, respectively. CONCLUSIONS Many frequent users of care services are network users relying on multiple regional care providers, possibly representing inefficient use of scarce resources. Network users are effectively and efficiently traced by using EMS records offering high coverage of calls made to regional care providers.
Collapse
Affiliation(s)
- Laura Maruster
- Innovation Management & Strategy, Faculty of Economics and Business, University of Groningen, Groningen, The Netherlands
| | - Durk-Jouke van der Zee
- Operations, Faculty of Economics and Business, University of Groningen, Groningen, The Netherlands
| | - Jaap Hatenboer
- Ambulancezorg, UMCG, Tynaarlo, Groningen, The Netherlands
| | - Erik Buskens
- Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| |
Collapse
|
29
|
Gaulin M, Simard M, Candas B, Lesage A, Sirois C. Combined impacts of multimorbidity and mental disorders on frequent emergency department visits: a retrospective cohort study in Quebec, Canada. CMAJ 2020; 191:E724-E732. [PMID: 31266786 DOI: 10.1503/cmaj.181712] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Multimorbidity and mental disorders are independently associated with frequent visits to the emergency department (≥ 3 visits/yr), but their interaction has been little studied. We aimed to measure the interaction between mental disorders and physical multimorbidity with respect to frequent visits to the emergency department. METHODS We conducted a population-based cohort study of adults in Quebec from 2012 to 2016, using the Quebec Integrated Chronic Disease Surveillance System. We assessed multimorbidity as the number of physical illnesses and mental disorders as serious (psychotic or bipolar disorders), common or absent, using data from 2012 to 2014. We counted emergency department visits from 2014 to 2015. We used logistic regression to estimate interaction on frequent visits to the emergency department from 2 perspectives: of public health (additive scale as differences in risk) and of individual patients (multiplicative scale as odds ratios). RESULTS Each additional physical illness was associated with a greater increase in the absolute risk of frequent visits to the emergency department for people with mental disorders. Between 0 and ≥ 4 physical conditions, the absolute risk increased more for individuals with serious mental disorders (16.2%) than common (15.3%) or no disorders (11.4%). On the relative scale, for people with no mental disorders and ≥ 4 physical conditions, odds of frequent visits to the emergency department were 6.2 (95% confidence interval [CI] 6.08-6.35) times the odds for people with no physical conditions. For individuals with common and serious mental illnesses, corresponding odds ratios were 4.75 (95% CI 4.60-4.90) and 3.7 (95% CI 3.18-3.57), respectively. INTERPRETATION Mental disorders interact with physical multimorbidity to increase the odds of frequent visits to the emergency department. More research is needed on interventions that promote high-quality care for mental illness, especially in the context of physical multimorbidity.
Collapse
Affiliation(s)
- Myles Gaulin
- Département de médecine sociale et préventive (Gaulin, Candas, Sirois), Faculté de médecine, Université Laval, Québec, Que.; Institut national de santé publique du Québec (INSPQ) (Gaulin, Simard, Lesage, Sirois), Montréal, Que.; Institut national d'excellence en santé et services sociaux (INESSS) (Candas), Québec, Que.; Département de psychiatrie (Lesage), Université de Montréal, Montréal, Que
| | - Marc Simard
- Département de médecine sociale et préventive (Gaulin, Candas, Sirois), Faculté de médecine, Université Laval, Québec, Que.; Institut national de santé publique du Québec (INSPQ) (Gaulin, Simard, Lesage, Sirois), Montréal, Que.; Institut national d'excellence en santé et services sociaux (INESSS) (Candas), Québec, Que.; Département de psychiatrie (Lesage), Université de Montréal, Montréal, Que.
| | - Bernard Candas
- Département de médecine sociale et préventive (Gaulin, Candas, Sirois), Faculté de médecine, Université Laval, Québec, Que.; Institut national de santé publique du Québec (INSPQ) (Gaulin, Simard, Lesage, Sirois), Montréal, Que.; Institut national d'excellence en santé et services sociaux (INESSS) (Candas), Québec, Que.; Département de psychiatrie (Lesage), Université de Montréal, Montréal, Que
| | - Alain Lesage
- Département de médecine sociale et préventive (Gaulin, Candas, Sirois), Faculté de médecine, Université Laval, Québec, Que.; Institut national de santé publique du Québec (INSPQ) (Gaulin, Simard, Lesage, Sirois), Montréal, Que.; Institut national d'excellence en santé et services sociaux (INESSS) (Candas), Québec, Que.; Département de psychiatrie (Lesage), Université de Montréal, Montréal, Que
| | - Caroline Sirois
- Département de médecine sociale et préventive (Gaulin, Candas, Sirois), Faculté de médecine, Université Laval, Québec, Que.; Institut national de santé publique du Québec (INSPQ) (Gaulin, Simard, Lesage, Sirois), Montréal, Que.; Institut national d'excellence en santé et services sociaux (INESSS) (Candas), Québec, Que.; Département de psychiatrie (Lesage), Université de Montréal, Montréal, Que
| |
Collapse
|
30
|
Breuer F, Pommerenke C, Wollenhaupt L, Brettschneider P, Poloczek S. Vorkommen von Frequent Usern und Frequent Callern in einem großstädtischen Rettungsdienst: Indikatoren eines unzureichenden Gesundheits- und Sozialsystems? Notf Rett Med 2020. [DOI: 10.1007/s10049-019-0600-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
31
|
Further Utilization of Emergency Department and Inpatient Psychiatric Services Among Young Adults Admitted at the Emergency Department With Clinical Alcohol Intoxication. J Addict Med 2020; 14:32-38. [PMID: 32012139 DOI: 10.1097/adm.0000000000000529] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To assess in a cohort of young adults admitted with alcohol intoxication (AI) to the Emergency Department (ED): how many patients are readmitted to the ED or to a Psychiatric Department (PD) inpatient unit; and which characteristics are associated with further ED and PD inpatient admissions. METHODS In 630 patients aged 18 to 30 years admitted for AI in 2006 to 2007 to the ED of a Swiss tertiary hospital, further ED and PD inpatient admissions through 2013 were assessed. Patient characteristics at the index (initial) ED visit were assessed using administrative and medical records. MEASUREMENTS Proportion of subjects with at least 1 further ED admission, 1 further ED admission with AI, and any PD admission over the study period.Associations between patients' characteristics at index visit and readmissions were assessed using backward selection multivariate regression analyses. RESULTS Mean age was 24, 66% were male, 60% had any ED/PD admissions during the study period, 17.9% a PD admission, and 13.8% were re-admitted to ED with AI. Disruptive behavior at the index visit was associated with further ED (odds ratio [OR] 1.69 [1.13; 2.54]) and PD admissions (OR 2.41 [1.44; 4.05]). Psychiatric diagnosis was associated with any further ED admission (OR 2.07 [1.41; 3.05]), with further ED admission with AI (OR 4.56 [2.36; 8.81]) and with PD admission (OR 3.92 [2.40; 6.41]). Female sex predicted any further ED admission (OR 1.65 [1.14; 2.39]). CONCLUSIONS Young adults presenting with alcohol intoxication have high rates of subsequent inpatient emergency and psychiatric admissions. Being female, presenting with disruptive behavior, and having a psychiatric diagnosis at the ED visit were predictors of further admissions.
Collapse
|
32
|
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.
Collapse
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.
| |
Collapse
|
33
|
Butler A, Love AD, Young JT, Kinner SA. Frequent Attendance to the Emergency Department after Release from Prison: a Prospective Data Linkage Study. J Behav Health Serv Res 2019; 47:544-559. [PMID: 31820327 PMCID: PMC7578130 DOI: 10.1007/s11414-019-09685-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of this paper was to identify characteristics and predictors of frequent emergency department (ED) use among people released from prisons in Queensland, Australia. Baseline interview data from a sample of sentenced adults were linked to ED and hospital records. The association between baseline characteristics and frequent ED attendance was modelled by fitting multivariate logistic regression models. Participants who had ≥ 4 visits to the ED in any 365-day period of community follow-up were defined as frequent attenders (FA). The analyses included 1307 people and mean follow-up time in the community was 1063 days. After adjusting for covariates, those with a dual diagnoses of mental illness and substance use (RR = 2.42, 95% CI 1.47–3.99) and those with mental illness alone (RR = 2.47, 95% CI 1.29–4.73) were at higher risk of frequent ED attendance, compared with those with no disorder. Future research should assess whether individually tailored transition supports from prison to community reduce the frequency of ED use among this population.
Collapse
Affiliation(s)
- Amanda Butler
- Faculty of Health Sciences, Simon Fraser University, 313-1286 14th Avenue West, Vancouver, BC, V6H 1P9, Canada.
| | - Alexander D Love
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
- Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Jesse T Young
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
- Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Stuart A Kinner
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
- Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| |
Collapse
|
34
|
Fleury MJ, Grenier G, Farand L, Ferland F. Reasons for Emergency Department Use among Patients with Mental Disorders. Psychiatr Q 2019; 90:703-716. [PMID: 31342253 DOI: 10.1007/s11126-019-09657-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Disproportionate use of emergency departments (EDs) by patients with mental disorders suggests the need to evaluate factors associated with ED use. Based on the Andersen Behavioral model, this mixed-method study identified the contributions of predisposing, enabling and needs factors in ED use among 328 patients with mental disorders. We hypothesised that ED use for mental health (MH) reasons would be most strongly associated with need factors. The study was conducted in four EDs located in different territories of Quebec (Canada). ED teams assisted with patient recruitment. Participants completed a questionnaire including a qualitative component on reasons for using the ED and assessments of ED and MH services. Data were organised according to the Andersen model, and analysed thematically. ED users were generally single, with low socioeconomic status and inadequate knowledge of MH services (predisposing factors). Most had a regular source of care which facilitated ED referrals (enabling factors); although inadequate access to outpatient care contributed to ED use. Needs factors were the primary motivators in ED use among patients with mental disorders, especially self-rated importance of problems, and MH diagnoses including suicidal ideation/attempts, depression, anxiety, and substance use disorders. Results confirmed our hypothesis that ED visits were more strongly related to needs factors. The mixed methodology reinforced the importance of predisposing and enabling factors in ED use, particularly in more complex cases. Various strategies (e.g. shared care, recruitment of addiction liaison nurses for SUD screening) are suggested for improving access to other resources and reducing non-urgent ED use.
Collapse
Affiliation(s)
- Marie-Josée Fleury
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada. .,Douglas Mental Health University Institute Research Centre, Montreal, Quebec, Canada. .,Douglas Hospital Research Centre, 6875 LaSalle Blvd. Montreal, Quebec, H4H 1R3, Canada.
| | - Guy Grenier
- Douglas Mental Health University Institute Research Centre, Montreal, Quebec, Canada
| | - Lambert Farand
- Department of Health Administration, Policy and Evaluation, School of Public Health, University of Montreal, Montreal, Quebec, Canada
| | - Francine Ferland
- School of Social Work, Addiction Rehabilitation Center, National Capital University Integrated Health and Social Services Center, Laval University, Quebec City, Quebec, Canada
| |
Collapse
|
35
|
Bushnell GA, Gaynes BN, Compton SN, Dusetzina SB, Olfson M, Stürmer T. Incident Substance Use Disorder Following Anxiety Disorder in Privately Insured Youth. J Adolesc Health 2019; 65:536-542. [PMID: 31326248 PMCID: PMC6755043 DOI: 10.1016/j.jadohealth.2019.05.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 05/09/2019] [Accepted: 05/09/2019] [Indexed: 01/12/2023]
Abstract
PURPOSE Anxiety disorders in childhood might be associated with an increased risk of substance use disorders. Incident substance use-related diagnoses were quantified in the 2 years after youth were newly diagnosed with an anxiety disorder and in a similar cohort of youth without diagnosed anxiety. METHODS Privately insured youth (10-17 years) were identified in a commercial claims database who were newly diagnosed with an anxiety disorder (2005-2014), treatment naïve, and without baseline substance-related disorder diagnoses. The comparison cohort included age, sex, region, and date matched youth with equivalent baseline exclusions. We used Kaplan-Meier estimator to calculate 2-year cumulative incidence of substance use disorder diagnosis following a new office-based anxiety disorder diagnosis (or match date for comparison cohort). RESULTS In 131,271 youth with a new anxiety disorder diagnosis (male = 41%, median age = 14 years), 1.5% (95% confidence interval = 1.5-1.6) had an incident substance use disorder diagnosis 1 year after their anxiety diagnosis, 2.9% (95% confidence interval = 2.8-3.0) by 2 years. Over the same period, .5% and 1.1% of the comparison cohort had incident substance use disorder diagnoses (n = 1,321,701). In the anxiety cohort, 2-year incidence was higher in youth aged 14-17 years (4.6%) versus 10-13 years (.7%). Incidence of substance use diagnosis varied by anxiety disorder (e.g., 2-year incidence: 4.3% for post-traumatic stress disorder, 3.0% for generalized anxiety disorder). CONCLUSION Approximately 3% of youth newly diagnosed with anxiety received an incident substance use disorder diagnosis within 2 years, almost threefold the incidence in youth without an anxiety diagnosis, emphasizing the need for increased awareness and prevention of substance-related disorders in pediatric anxiety.
Collapse
Affiliation(s)
- Greta A Bushnell
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York.
| | - Bradley N Gaynes
- Department of Psychiatry, University of North Carolina at
Chapel Hill School of Medicine, 101 Manning Drive, Chapel Hill, NC 27514, USA
| | - Scott N Compton
- Department of Psychiatry and Behavioral Sciences, Duke
University School of Medicine, 2608 Erwin Road, Durham, NC 27705, USA
| | - Stacie B Dusetzina
- Department of Health Policy, Vanderbilt University School
of Medicine, 2525 West End Avenue, Nashville, TN, 37203, USA
| | - Mark Olfson
- Department of Epidemiology, Columbia University Mailman
School of Public Health, 722 W. 168 Street, New York, NY 10032,
USA,Department of Psychiatry, Columbia University Irving
Medical Center, 1051 Riverside Drive, New York, NY 10032, USA
| | - Til Stürmer
- Department of Epidemiology, University of North Carolina at
Chapel Hill Gillings School of Global Public Health, 170 Rosenau Hall, Chapel Hill,
NC 27599, USA
| |
Collapse
|
36
|
Klenk L, von Rütte C, Henssler JF, Sauter TC, Hautz WE, Exadaktylos AK, Müller M. Resource consumption of multi-substance users in the emergency room: A neglected patient group. PLoS One 2019; 14:e0223118. [PMID: 31557239 PMCID: PMC6763017 DOI: 10.1371/journal.pone.0223118] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 09/15/2019] [Indexed: 11/18/2022] Open
Abstract
Background Multi-substance use is accompanied by increased morbidity and mortality and responsible for a large number of emergency department (ED) consultations. To improve the treatment for this vulnerable group of patients, it is important to quantify and break down in detail the ED resources used during the ED treatment of multi-substance users. Methods This retrospective single centre case-control study included all ED consultations of multi-substance users over a three-year study period at a university hospital in Switzerland. Resource consumption of these patients was compared to an age-matched control group of non-multi-substance users. Results The analysis includes 867 ED consultations of multi-substance users compared to 4,335 age-matched controls (5:1). Multi-substance users needed more total resources (median tax points [medical currency] (IQR): 762 (459–1226) vs. 462 (196–833), p<0.001), especially physician, radiology, and laboratory resources. This difference persisted in multivariable analysis (geometric mean ratio (GMR) 1.2, 95% CI: 1.1–1.3, p = 0.001) adjusted for sociodemographic parameters, consultation characteristics, and patient comorbidity; the GMR was highest in ED laboratory and radiology resource consumption. Among multi-substance user, indirect and non-drug-related consultations had higher ED resource consumption compared to drug-related consultations. Furthermore, leading discipline as well as urgency were predictors of ED resource consumption. Moreover, multi-substance users had more revisits (55.2% vs. 24.9%, p<0.001) as well as longer ED and in-hospital stays (both: GMR 1.2, 95% CI: 1.1–1.3, p<0.001). Conclusion ED consultations of multi-substance users are expensive and resource intensive. Multi-substance users visited the ED more often and stayed longer at the ED and in-hospital. The findings of our study underline the importance of this patient group. Additional efforts should be made to improve their ED care. Special interventions should target this patient group in order to decrease the high frequency and costs of emergency consultations caused by multi-substance users.
Collapse
Affiliation(s)
- Laurence Klenk
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christina von Rütte
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jonathan F. Henssler
- Department of Psychiatry and Psychotherapy, St. Hedwig Hospital Berlin, Charité University Medicine, Berlin, Germany
| | - Thomas C. Sauter
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Medical Skills Lab, Charité Medical School Berlin, Berlin, Germany
| | - Wolf E. Hautz
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Aristomenis K. Exadaktylos
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Martin Müller
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Health Economics and Clinical Epidemiology, Cologne University Hospital, Cologne, Germany
- * E-mail:
| |
Collapse
|
37
|
Fleury MJ, Rochette L, Grenier G, Huỳnh C, Vasiliadis HM, Pelletier É, Lesage A. Factors associated with emergency department use for mental health reasons among low, moderate and high users. Gen Hosp Psychiatry 2019; 60:111-119. [PMID: 31404825 DOI: 10.1016/j.genhosppsych.2019.07.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 07/05/2019] [Accepted: 07/08/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVES This study identified factors associated with frequency of emergency department (ED) use for mental health (MH) reasons in Quebec during 2015-2016. METHODS Participants (n = 115,066) were categorized as: 1) low (1 visit/year; 76%); 2) moderate (2 visits/year; 14%); and 3) high (3+ visits/year; 10%) ED users. Independent variables included predisposing, enabling and needs factors based on the Andersen Behavioral Model. Variables significantly associated with frequency of ED use were entered into a multinomial logistic regression. RESULTS Patients with mental illness (MI), especially substance-related disorders (SRD) and schizophrenia spectrum disorders; bipolar, depressive, anxiety or personality disorders; and those with severe chronic physical illness (needs factors) were more likely to use ED for MH reasons, as were male participants 18-64 years old, and those living in metropolitan areas with high social or material deprivation (predisposing factors). Regarding enabling factors, consultations with outpatient psychiatrists and not seeing a general practitioner (GP) in the year prior to ED visit were associated with high ED use. CONCLUSION The severity of MI/SRD contributed most to frequent ED use, while social and material deprivation in metropolitan areas, and intensity of medical care also influenced ED use for MH reasons.
Collapse
Affiliation(s)
- Marie-Josée Fleury
- Department of Psychiatry, McGill University, Montreal, QC, Canada; Douglas Mental Health University Institute, Montréal, QC, Canada.
| | - Louis Rochette
- Insitut national de santé publique du Québec, Québec, QC, Canada
| | - Guy Grenier
- Douglas Mental Health University Institute, Montréal, QC, Canada
| | - Christophe Huỳnh
- University Institute on Addictions, Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal, Montréal, QC, Canada; Department of Psychiatry, University of Montreal, Montréal, QC, Canada; School of Psychoeducation, University of Montreal, Montréal, QC, Canada
| | - Helen-Maria Vasiliadis
- Département des sciences de la santé communautaire, Université de Sherbrooke, Sherbrooke, QC, Canada; Centre de recherche Charles LeMoyne - Saguenay-Lac-Saint-Jean sur les innovations en santé, Longueuil, QC, Canada
| | - Éric Pelletier
- Insitut national de santé publique du Québec, Québec, QC, Canada
| | - Alain Lesage
- Department of Psychiatry, University of Montreal, Montréal, QC, Canada; Centre de recherche Fernand-Séguin, Institut universitaire en santé mentale de Montréal, Montréal, QC, Canada
| |
Collapse
|
38
|
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.
Collapse
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
| |
Collapse
|
39
|
Hotzy F, Marty S, Moetteli S, Theodoridou A, Hoff P, Jaeger M. Involuntary admission for psychiatric treatment: Compliance with the law and legal considerations in referring physicians with different professional backgrounds. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2019; 64:142-149. [PMID: 31122624 DOI: 10.1016/j.ijlp.2019.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 03/21/2019] [Accepted: 03/25/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Involuntary admission (IA) for psychiatric treatment is a massive restriction of human rights. Therefore, its execution is regulated by law. During executing IAs referring physicians find themselves in a dual role: support of patients in the recovery process but also safe-keeper of society. In Zurich, Switzerland the law stipulates that physicians regardless of their medical specialization may admit patients who suffer from a mental disorder, mental disability or severe neglect involuntarily if care cannot be provided otherwise, regardless of their decision-making capacity. The referring physician is obliged to examine the patients, hear their views on the IA, inform them about the following steps and about their right of appeal at the civil court. We aimed to assess whether referring physicians can comply with those legal requirements for an IA. Additionally, we examined whether legal considerations differed according to the physicians` professional backgrounds and attitudes towards coercion in general. METHODS We invited physicians from different in- and outpatient settings who executed IAs to the University Hospital of Psychiatry Zurich to participate in a newly developed online survey. We used correlation analysis, chi-square and t-tests to analyze the responses of 43 psychiatrists with those of 64 other physicians. RESULTS In about 1/3 of the IAs referring physicians were not able to hear the patients' views on the IA, to inform the patients about the following steps and about their right of appeal. Psychiatrists felt more certain with the legal basis of IA compared to physicians other than psychiatrists. Nevertheless, the latter stated that the assessment of the risk for suicide and danger should not be restricted only to psychiatrists. Both groups differed in their attitudes towards coercion with psychiatrists being more critical. CONCLUSIONS Interventions should be developed to facilitate a compliance with legal requirements during IA. Physicians who execute IAs must have a thorough knowledge of the clinical and legal basis for their actions. We recommend specialized consultation teams for the assessment of PES and regular training including ethical discussions, especially for physicians other than psychiatrists.
Collapse
Affiliation(s)
- Florian Hotzy
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Lenggstrasse 31, Postfach 1931, 8032 Zürich, Switzerland.
| | - Silvan Marty
- University of Zurich, Rämistrasse 71, 8006 Zürich, Switzerland.
| | - Sonja Moetteli
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Lenggstrasse 31, Postfach 1931, 8032 Zürich, Switzerland.
| | - Anastasia Theodoridou
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Lenggstrasse 31, Postfach 1931, 8032 Zürich, Switzerland.
| | - Paul Hoff
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Lenggstrasse 31, Postfach 1931, 8032 Zürich, Switzerland.
| | - Matthias Jaeger
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Lenggstrasse 31, Postfach 1931, 8032 Zürich, Switzerland; Psychiatrie Baselland, Bienentalstrasse 7, 4410 Liestal, Switzerland.
| |
Collapse
|
40
|
Marco CA, Mann D, Daahir C, Savarese H, Detherage JP, McGlone C. Lack of associations of substance use and mental health with self-reported pain scores among emergency department patients. Am J Emerg Med 2019; 37:1790-1792. [PMID: 30797608 DOI: 10.1016/j.ajem.2019.02.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Accepted: 02/18/2019] [Indexed: 12/01/2022] Open
Affiliation(s)
- Catherine A Marco
- Department of Emergency Medicine, Wright State University Boonshoft School of Medicine, Dayton, OH, United States of America.
| | - Dennis Mann
- Department of Emergency Medicine, Wright State University Boonshoft School of Medicine, Dayton, OH, United States of America
| | - Christian Daahir
- Wright State University Boonshoft School of Medicine, Dayton, OH, United States of America
| | | | - John Paul Detherage
- Wright State University Boonshoft School of Medicine, Dayton, OH, United States of America
| | - Cameron McGlone
- Wright State University Boonshoft School of Medicine, Dayton, OH, United States of America
| |
Collapse
|
41
|
Grazioli VS, Moullin JC, Kasztura M, Canepa-Allen M, Hugli O, Griffin J, Vu F, Hudon C, Jackson Y, Wolff H, Burnand B, Daeppen JB, Bodenmann P. Implementing a case management intervention for frequent users of the emergency department (I-CaM): an effectiveness-implementation hybrid trial study protocol. BMC Health Serv Res 2019; 19:28. [PMID: 30634955 PMCID: PMC6330435 DOI: 10.1186/s12913-018-3852-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 12/20/2018] [Indexed: 12/01/2022] Open
Abstract
Background ED overcrowding represents a significant public health problem in developed countries. Frequent users of the emergency departments (FUEDs; reporting 5 or more ED visits in the past year) are often affected by medical, psychological, social, and substance use problems and account for a disproportionately high number of ED visits. Past research indicates that case management (CM) interventions are a promising way to reduce ED overcrowding and improve FUEDs’ quality of life. There is, however, very limited knowledge about how to disseminate and implement this intervention on a large scale to diverse clinical settings, including community hospitals and non-academic centers. This paper describes the protocol of a research project aiming to implement a CM intervention tailored to FUEDs in the public hospitals with ED in the French-speaking region of Switzerland and evaluate both the implementation process and effectiveness of the CM intervention. Methods This research project uses a hybrid study design assessing both implementation and clinical outcomes. The implementation part of the study uses mixed methods a) to describe quantitatively and qualitatively factors that influence the implementation process, and b) to examine implementation effectiveness. The clinical part of the study uses a within-subject design (pre-post intervention) to evaluate participants’ trajectories on clinical variables (e.g., quality of life, ED use) after receiving the CM intervention. We designed the study based on two implementation science frameworks. The Generic Implementation Framework guided the overall research protocol design, whereas the RE-AIM (reach, efficacy, adoption, implementation and maintenance) framework guided the implementation and effectiveness evaluations. Discussion This research project will contribute to implementation science by providing key insights into the processes of implementing CM into broader practice. This research project is also likely to have both clinical and public health implications. Trial registration NCT03641274, Registered 20 August 2018.
Collapse
Affiliation(s)
- Véronique S Grazioli
- Department of Ambulatory Care and Community Medicine, Vulnerable Populations Center, Lausanne University Hospital, Rue du Bugnon 44, 1011, Lausanne, Switzerland.
| | | | - Miriam Kasztura
- Department of Ambulatory Care and Community Medicine, Vulnerable Populations Center, Lausanne University Hospital, Rue du Bugnon 44, 1011, Lausanne, Switzerland
| | - Marina Canepa-Allen
- Department of Ambulatory Care and Community Medicine, Vulnerable Populations Center, Lausanne University Hospital, Rue du Bugnon 44, 1011, Lausanne, Switzerland
| | - Olivier Hugli
- Emergency Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Judy Griffin
- Department of Medicine, Well Cornell College Of Medicine, New York, USA
| | - Francis Vu
- Department of Ambulatory Care and Community Medicine, Vulnerable Populations Center, Lausanne University Hospital, Rue du Bugnon 44, 1011, Lausanne, Switzerland
| | - Catherine Hudon
- Department of Family and Emergency Medicine, University of Sherbrooke, Sherbrooke, Canada
| | - Yves Jackson
- Division of primary care medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Hans Wolff
- Division of Prison Health, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Bernard Burnand
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Patrick Bodenmann
- Department of Ambulatory Care and Community Medicine, Vulnerable Populations Center, Lausanne University Hospital, Rue du Bugnon 44, 1011, Lausanne, Switzerland
| |
Collapse
|
42
|
Virk P, Stenstrom R, Doan Q. Reliability testing of the HEARTSMAP psychosocial assessment tool for multidisciplinary use and in diverse emergency settings. Paediatr Child Health 2018; 23:503-508. [PMID: 30842695 DOI: 10.1093/pch/pxy017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Objective HEARTSMAP is a tool developed to facilitate assessment and management of paediatric mental health (MH) patients by emergency department (ED) clinicians. We evaluate the inter-rater reliability of HEARTSMAP when administered by clinicians of various backgrounds. Methods In a cross-sectional study initiated in 2016, collaborating clinician evaluators (n=16) applied the HEARTSMAP tool to evaluate a set of 50 fictional clinical vignettes, digitally in an approach consistent with the anticipated tool's access and usage in clinical settings. Evaluators came from different types of health centres from across the province of British Columbia (Canada), including remote/rural, regional and urban academic health centres. Results We report moderate to near excellent agreement, overall among clinicians for all 10 of the tool's psychosocial sections (κ=0.43 to 0.93) and domain scores (κ=0.75 to 0.90), with acceptable agreement across all tool-triggered service recommendations (κ=0.36 to 0.65). Conclusions Our findings show that HEARTSMAP may be reliably used by ED clinicians in assessing MH issues among youth. Results from this study will assist in informing the wider clinical implementation of HEARTSMAP as a standard assessment tool, in diverse emergency care settings.
Collapse
Affiliation(s)
- Punit Virk
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia.,BC Children's Hospital Research Institute, Vancouver, British Columbia
| | - Rob Stenstrom
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia.,Department of Emergency Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia
| | - Quynh Doan
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia.,BC Children's Hospital Research Institute, Vancouver, British Columbia.,Department of Emergency Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia
| |
Collapse
|
43
|
Zhang L, Norena M, Gadermann A, Hubley A, Russell L, Aubry T, To MJ, Farrell S, Hwang S, Palepu A. Concurrent Disorders and Health Care Utilization Among Homeless and Vulnerably Housed Persons in Canada. J Dual Diagn 2018; 14:21-31. [PMID: 29494795 DOI: 10.1080/15504263.2017.1392055] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Individuals who are homeless or vulnerably housed have a higher prevalence of concurrent disorders, defined as having a mental health diagnosis and problematic substance use, compared to the general housed population. The study objective was to investigate the effect of having concurrent disorders on health care utilization among homeless or vulnerably housed individuals, using longitudinal data from the Health and Housing in Transition Study. METHODS In 2009, 1190 homeless or vulnerably housed adults were recruited in Ottawa, Toronto, and Vancouver, Canada. Participants completed baseline interviews and four annual follow-up interviews, providing data on sociodemographics, housing history, mental health diagnoses, problematic drug use with the Drug Abuse Screening Test (DAST-10), problematic alcohol use with the Alcohol Use Disorders Identification Test (AUDIT), chronic health conditions, and utilization of the following health care services: emergency department (ED), hospitalization, and primary care. Concurrent disorders were defined as the participant having ever received a mental health diagnosis at baseline and having problematic substance use (i.e., DAST-10 ≥ 6 and/or AUDIT ≥ 20) at any time during the study period. Three generalized mixed effects logistic regression models were used to examine the independent association of having concurrent disorders and reporting ED use, hospitalization, or primary care visits in the past 12 months. RESULTS Among our sample of adults who were homeless or vulnerably housed, 22.6% (n = 261) reported having concurrent disorders at baseline. Individuals with concurrent disorders had significantly higher odds of ED use (adjusted odds ratio [AOR] = 1.71; 95% confidence interval [CI], 1.4-2.11), hospitalization (AOR = 1.45; 95% CI, 1.16-1.81), and primary care visits (AOR = 1.34; 95% CI, 1.05-1.71) in the past 12 months over the four-year follow-up period, after adjusting for potential confounders. CONCLUSIONS Concurrent disorders were associated with higher rates of health care utilization when compared to those without concurrent disorders among homeless and vulnerably housed individuals. Comprehensive programs that integrate mental health and addiction services with primary care as well as community-based outreach may better address the unmet health care needs of individuals living with concurrent disorders who are vulnerable to poor health outcomes.
Collapse
Affiliation(s)
- Linda Zhang
- a Division of General Internal Medicine , Department of Medicine, University of British Columbia , Vancouver , British Columbia , Canada
| | - Monica Norena
- b Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital , Vancouver , British Columbia , Canada
| | - Anne Gadermann
- b Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital , Vancouver , British Columbia , Canada.,c School of Population and Public Health, University of British Columbia , Vancouver , British Columbia , Canada
| | - Anita Hubley
- d Department of Education Counselling Psychology and Special Education , University of British Columbia , Vancouver , British Columbia , Canada
| | - Lara Russell
- b Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital , Vancouver , British Columbia , Canada
| | - Tim Aubry
- e School of Psychology, University of Ottawa , Ottawa , Ontario , Canada
| | - Matthew J To
- f Centre for Urban Health Solutions, St. Michael's Hospital , Toronto , Ontario , Canada
| | - Susan Farrell
- g Royal Ottawa Health Care Group , Ottawa , Ontario , Canada
| | - Stephen Hwang
- f Centre for Urban Health Solutions, St. Michael's Hospital , Toronto , Ontario , Canada.,h Division of General Internal Medicine, Department of Medicine , University of Toronto , Toronto , Ontario , Canada
| | - Anita Palepu
- a Division of General Internal Medicine , Department of Medicine, University of British Columbia , Vancouver , British Columbia , Canada.,b Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital , Vancouver , British Columbia , Canada
| |
Collapse
|
44
|
Baggio S, Dupuis M, Richard JB, Beck F. Addictive behaviors and healthcare renunciation for economic reasons in a French population-based sample. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 49:1-7. [PMID: 28818639 DOI: 10.1016/j.drugpo.2017.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 04/22/2017] [Accepted: 07/10/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Healthcare renunciation for economic reasons is a major health concern, but it has been scarcely investigated among drug users, even if drug users constitute a vulnerable population in need of medical care. This study investigated associations of healthcare renunciation for economic reasons and addictive behaviors (alcohol, tobacco, cannabis, illicit drug use, and gambling) in a population-based sample of adults living in France, a country with universal health coverage. METHODS Data were collected using the 2014 Health Barometer, a French cross-sectional survey conducted among a random representative sample of the general population aged 18-64 (n=12,852). Measures included healthcare renunciation, substance use (alcohol, tobacco, cannabis, and other illicit drugs) and gambling. Experimental/recreational and heavy/chronic use were assessed. Logistic regressions were used to test the relationship between healthcare renunciation and addictive behaviors, controlling for relevant covariates. RESULTS A total of 25% of the participants had renounced care at least once in the previous twelve months. Most variables of drug use were significantly associated with increased healthcare renunciation. This was the case for heavy/hazardous use and experimental/recreational use. Regular gambling was not associated with healthcare renunciation, but disordered gambling was. CONCLUSION This study showed that addictive behaviors, including substance use and gambling, were part of the burden of vulnerability of people who forgo care. Therefore, drug use and gambling patterns should be a focus in the development of policies to reduce health inequalities, not only for heavy and chronic drug users.
Collapse
Affiliation(s)
- Stéphanie Baggio
- Life Course and Social Inequality Research Centre, University of Lausanne, Switzerland; Division of Correctional Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland.
| | - Marc Dupuis
- Institute of Psychology, University of Lausanne, Switzerland.
| | | | - François Beck
- Observatoire Français des Drogues et des Toxicomanies (OFDT), The French Monitoring Center for Drugs and Drug Addiction, France; ERES, Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, UMRS, 1136 Paris, France.
| |
Collapse
|
45
|
Meng X, Muggli T, Baetz M, D'Arcy C. Disordered lives: Life circumstances and clinical characteristics of very frequent users of emergency departments for primary mental health complaints. Psychiatry Res 2017; 252:9-15. [PMID: 28237761 DOI: 10.1016/j.psychres.2017.02.044] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 01/03/2017] [Accepted: 02/19/2017] [Indexed: 10/20/2022]
Abstract
This study explored the life circumstances and clinical characteristics of very frequent users of emergency departments (EDs) presenting with a primary mental health complaint. Patients with 10 or more EDs visits in 2012 with a primary psychiatric diagnosis in a Canadian regional health authority were identified from electronic administrative files. The hospital charts for these patients were thoroughly reviewed for a three-year period, from 2011 to 2013. A retrospective thematic analysis was undertaken. Very frequent users of EDs were generally young to early middle aged, unemployed, living in transient accommodations, having substance abuse diagnoses, and self-referred to EDs for a variety of psychiatric and health symptoms and/or unmet needs. Four themes were identified: 1) substance abuse and associated health and social problems; 2) common mental disorders, which may include suicidality; 3) social and personal stressors with additional common mental disorders and somatic complaints; 4) cognitive impairment with concurrent psychiatric disorders. Traditional mental health services are ineffective in dealing with patients with complex psychiatric and social problems/needs. Efforts should focus on early detection, intervention, reducing mental and behavior problems, and developing appropriate case management and treatment options. Personalized care models are needed to meet their diverse needs.
Collapse
Affiliation(s)
- Xiangfei Meng
- Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, Quebec, Canada; Douglas Mental Health University Institute, Montreal, Quebec, Canada.
| | - Tracy Muggli
- Mental Health and Addition Services, Saskatoon Health Region, Saskatoon, Saskatchewan, Canada
| | - Marilyn Baetz
- Department of Psychiatry, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Carl D'Arcy
- Department of Psychiatry, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada; School of Public Health, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| |
Collapse
|
46
|
Bodenmann P, Velonaki VS, Griffin JL, Baggio S, Iglesias K, Moschetti K, Ruggeri O, Burnand B, Wasserfallen JB, Vu F, Schupbach J, Hugli O, Daeppen JB. Case Management may Reduce Emergency Department Frequent use in a Universal Health Coverage System: a Randomized Controlled Trial. J Gen Intern Med 2017; 32:508-515. [PMID: 27400922 PMCID: PMC5400747 DOI: 10.1007/s11606-016-3789-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 05/04/2016] [Accepted: 06/21/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Frequent emergency department (ED) users account for a disproportionately high number of ED visits. Studies on case management (CM) interventions to reduce frequent ED use have shown mixed results, and few studies have been conducted within a universal health coverage system. OBJECTIVE To determine whether a CM intervention-compared to standard emergency care-reduces ED attendance. DESIGN Randomized controlled trial. PARTICIPANTS Two hundred fifty frequent ED users (5 or more visits in the prior 12 months) who visited a public urban ED at the Lausanne University Hospital between May 2012 and July 2013 were allocated to either an intervention (n = 125) or control (n = 125) group, and monitored for 12 months. INTERVENTIONS An individualized CM intervention consisting of concrete assistance in obtaining income entitlements, referral to primary or specialty medical care, access to mental health care or substance abuse treatment, and counseling on at-risk behaviors and health care utilization (in addition to standard care) at baseline and 1, 3, and 5 months. MAIN MEASURES We used a generalized linear model for count data (negative binomial distribution) to compare the number of ED visits during the 12-month follow-up between CM and usual care, from an intention-to-treat perspective. KEY RESULTS At 12 months, there were 2.71 (±0.23) ED visits in the intervention group versus 3.35 (±0.32) visits among controls (ratio = 0.81, 95 % CI = 0.63; 1.02). In the multivariate model, the effect of the CM intervention on the number of ED visits approached statistical significance (b = -0.219, p = 0.075). The presence of poor social determinants of health was a significant predictor of ED use in the multivariate model (b = 0.280, p = 0.048). CONCLUSIONS CM may reduce ED use by frequent users through an improved orientation to the health care system. Poor social determinants of health significantly increase use of the ED by frequent users.
Collapse
Affiliation(s)
- Patrick Bodenmann
- Vulnerable Populations Center, Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland.
| | - Venetia-Sofia Velonaki
- Institute of Higher Education and Research in Healthcare, Department of Community Medicine and Public Health, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Judith L Griffin
- Vulnerable Populations Center, Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland
| | - Stéphanie Baggio
- Life Course and Social Inequality Research Center, Faculty of Social and Political Sciences, University of Lausanne, Lausanne, Switzerland
| | - Katia Iglesias
- Center for the Understanding of Social Processes, University of Neuchâtel, Neuchâtel, Switzerland.,Institute of social and preventive medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Karine Moschetti
- Institute of social and preventive medicine, Lausanne University Hospital, Lausanne, Switzerland.,Technology Assessment Unit, Lausanne University Hospital, Lausanne, Switzerland.,IEMS - Plateforme interfacultaire en économie et management de la santé, University of Lausanne, Lausanne, Switzerland
| | - Ornella Ruggeri
- Department of Community Medicine and Public Health, Lausanne University Hospital, Lausanne, Switzerland
| | - Bernard Burnand
- Institute of social and preventive medicine, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Francis Vu
- Vulnerable Populations Center, Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland
| | - Joelle Schupbach
- Vulnerable Populations Center, Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland
| | - Olivier Hugli
- Emergency Department, Lausanne University Hospital, Lausanne, Switzerland
| | | |
Collapse
|
47
|
Ng SV, Rosenheck RA. Severe mental illness and emergency department service use nationally in the Veterans Health Administration. Gen Hosp Psychiatry 2017; 44:61-66. [PMID: 28041578 DOI: 10.1016/j.genhosppsych.2016.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 11/14/2016] [Accepted: 11/15/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Stephanie V Ng
- Yale University School of Medicine, 300 George St, Suite 901, New Haven, CT, USA 06510.
| | - Robert A Rosenheck
- VA New England Mental Illness, Research, Education, and Clinical Center, Yale University School of Medicine, VA Connecticut Health Care System, 950 Campbell Ave. Building 35, West Haven, CT, USA 06516.
| |
Collapse
|
48
|
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.
Collapse
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
| |
Collapse
|