Author(s): Brubacher JR, Mabie A, Ngo M, Abu-Laban RB, Buchanan J, et al.
Objective: For many patients with addiction and other substance problems, the emergency department (ED) is the sole provider of medical care. This study sought to determine the prevalence and characteristics of substance-related medical problems in ED patients, as defined by documentation in the medical record. We also sought to compare the ED resource use (length of ED stay and number of revisits) of patients with and without substance problems.
Methods: Trained evaluators using explicit criteria reviewed all ED charts during a 6-week period at a Canadian tertiary care teaching centre. Data was collected on demographics, documentation of problematic substance use and whether the ED visit was due to substance problems. Using a computerized database, we determined how many patients with and without substance problems had 1 or more subsequent ED visits during the 1-year period from Sept. 1, 2002, to Aug. 31, 2003.
Results: Of 6064 visits made by 5194 patients, 6026 visits (99.4%) representing 5188 patients (99.9%) were captured for review. Of those visits, 674 (11.2%, 95% confidence interval [CI] 10.4%-12.0%), made by 600 patients, had documentation of problematic substance use and 521 visits (8.6%, 95% CI 7.9%-9.4%) by 469 patients were caused by substance problems. The mean age of patients with a visit due to a substance problem was 39.2 years, compared with 48.5 years for those with other visits (p < 0.001). The admission rate for substance-related visits was 25.3%, compared with 17.6% for other visits (p < 0.001). For discharged patients, the median length of the ED visit owing to substance-related problems lasted 232 minutes (IQR [interquartile range] 267 min), compared with 164 minutes (IQR 167 min) for other visits (p < 0.001). In 1 year of follow-up, 161 of 600 patients (26.8%) with a substance problem made 466 revisits (mean 0.78 revisits/patient), compared with 975 of 4588 patients (21.3%) without a substance problem who made a total of 2150 revisits (mean 0.47 revisits/patient, p < 0.001).
Conclusion: Substance problems contribute significantly to ED visits, hospital admissions and duration of ED stay at a tertiary centre. It is likely that our methodology underestimates the scope of the problem and that a universal screening program would find a higher prevalence. The magnitude of this problem supports the need for an interdisciplinary identification and intervention program for ED patients with substance-related issues.
Referred From: https://www.ncbi.nlm.nih.gov/pubmed/19019269
Author(s): Hungerford DW, Williams JM, Furbee PM, Manley WG, Helmkamp JC, et al.
Author(s): Barros RE, Tung TC, Mari JJ
Author(s): Del-Ben CM, Tung TC
Author(s): Foli-Andersen NJ
Author(s): Kohler S, Hofmann A
Author(s): McCullumsmith C, Clark B, Blair C, Cropsey K, Shelton R
Author(s): Hungerford DW, Pollock DA, Todd KH
Author(s): Helmkamp JC, Hungerford DW, Williams JM, Manley WG, Furbee PM, et al.
Author(s): Cherpitel CJ, Ye Y
Author(s): Allen JP, Litten RZ, Fertig JB, Babor T
Author(s): Brown JM, Miller WR
Author(s): Booth RH, Corsi KF, Mikulich-Giberson SK
Author(s): Heffner JL, Tran GQ, Johnson CS, Barrett SW, Blom TJ, et al.
Author(s): Longabaugh R, Woolard RF, Nirenberg TD, Minugh AP, Becker B, et al.
Author(s): Chafetz ME, Blane HT, Abrams HS, Golner JH, Lacy E, et al.
Author(s): McCambridge J, Cunningham JA
Author(s): D’Onofrio G, Degutis LC
Author(s): Stange K, Flocke S, Goodwin M
Author(s): Wallace P
Author(s): Nordqvist C, Johansson K, Bendtsen P
Author(s): Segatto ML, Pinsky I, Laranjeira R, Rezende FF, Vilela TR
Author(s): Jayaram G, Triplett P
Author(s): Havard A, Shakeshaft A, Sanson-Fischer R
Author(s): Carr CJA, Xu J, Redko C, Lane DT, Rapp RC, et al.
Author(s): Xu J, Rapp RC, Carr CA, Lane DT, Wang J, et al.
Author(s): Allen K
Author(s): Allen K
Author(s): Rapp RC, Xu J, Carr CA, Lane DT, Wang J, et al.
Author(s): Breton AR, Taira DA, Burns E, O´Leary J, Chung RS
Author(s): Aseltine RH
Author(s): Babor TF, Higgins-Biddle, JC
Author(s): Brown RL, Saunders LA, Bobula JA, Mundt MP, Koch PE
Author(s): Daeppen JB, Gaume J, Bady P, Yersin B, Calmes JM, et al.
Author(s): Leontieva L, Kimberly HE, Helmkamp J, Furbee M, Jarrett T, et al.
Author(s): Wright S, Moran L, Meyrick M, O’Connor R, Touquet R
Author(s): Rockett IRH, Putnam SL, Jia H, Smith GS
Author(s): Curran GM, Sullivan G, Williams K, Han X, Allee E, et al.
Author(s): Pal HR, Yadav D, Mehta AS, Mohan I
Author(s): Blow FC, Walton MA, Murray R, Cunningham RM, Chermack ST, et al.
Author(s): Barros A, Hirakata V
Author(s): Stokes ME, Davis CS, Koch GG