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Frequent emergency department use and mortality in patients with substance and opioid use in Alberta: A population-based retrospective cohort study

  • Jessica Moe (a1) (a2), Carlos A. Camargo (a3) (a4), Roger B. Davis (a5), Susan Jelinski (a6) (a7) and Brian H. Rowe (a6) (a8)...
Abstract
Objectives

In the current opioid epidemic, identifying high-risk patients among those with substance and opioid use may prevent deaths. The objective of this study was to determine whether frequent emergency department (ED) use and degree of frequent use are associated with mortality among ED patients with substance and opioid use.

Methods

This cohort study used linked population-based ED (National Ambulatory Care Reporting System) and mortality data from Alberta. All adults ≥ 18 years with substance or opioid use-related visits based on diagnostic codes from April 1, 2012, to March 31, 2013, were included (n = 16,389). Frequent use was defined by ≥ 5 visits in the previous year. Outcomes were unadjusted and adjusted (for age, sex, income) mortality within 90 days (primary), and 30 days, 365 days, and 2 years (secondary). To examine degree, frequent use was subcategorized into 5–10, 11–15, 16–20, and > 20 visits.

Results

Frequent users were older, lower income, and made lower acuity visits than non-frequent users. Frequent users with substance use had higher mortality at 365 days (hazard ratio [HR] 1.36 [1.04, 1.77]) and 2 years (HR 1.32 [1.04, 1.67]), but not at 90 or 30 days. Mortality did not differ for frequent users with opioid use overall. By degree, patients with substance use and > 20 visits/year and with opioid use and 16–20 visits/year demonstrated a higher 365-day and 2-year mortality.

Conclusions

Among patients with substance use, frequent ED use and extremely frequent use (> 20 visits/year) were associated with long-term but not short-term mortality. These findings suggest a role for targeted screening and preventive intervention.

Objectif

Dans le contexte actuel de l’épidémie de surdoses d'opioïdes, la détection des patients à risque élevé parmi ceux qui font usage d'opioïdes ou d'autres substances psychoactives peut avoir, pour effet, la prévention de la mort. L’étude visait donc à déterminer si les consultations fréquentes au service des urgences (SU) et le degré de fréquence étaient associés à la mortalité chez les patients faisant usage d'opioïdes ou d'autres substances psychoactives, traités au SU.

Méthode

Il s'agit d'une étude de cohortes fondée sur la population et reposant sur des bases de données liées en ce qui concerne les consultations au SU (Système national d'information sur les soins ambulatoires) et la mortalité, en Alberta. Ont été inclus dans l’étude tous les adultes ≥ 18 ans ayant consulté pour des troubles liés à l'usage d'opioïdes ou d'autres substances psychoactives, d'après les codes de diagnostic inscrits du 1er avril 2012 au 31 mars 2013 (n = 16 389). On entendait par « visites fréquentes » ≥ 5 consultations (cons.) au cours de l'année précédente. Les résultats recherchés consistaient en la mortalité brute et la mortalité rajustée selon l’âge, le sexe et les revenus au cours des 90 jours suivants (critère d’évaluation principal) ainsi qu'au bout de 30 jours, de 365 jours et de 2 ans (critères d’évaluation secondaires). Quant au degré de fréquence, le nombre de visites a été subdivisé en tranches de 5-10, 11-15, 16-20 et > 20 consultations.

Résultats

Les usagers fréquents étaient des personnes plus âgées, ayant des revenus plus faibles et consultant pour des troubles moins graves que les usagers non fréquents. Parmi les usagers fréquents, ceux qui utilisaient des substances psychoactives connaissaient une mortalité plus élevée au bout de 365 jours (rapport des risques instantanés [RRI] : 1,36 [1,04–1,77]) et de 2 ans (RRI : 1,32 [1,04–1,67]), mais pas au bout de 90 jours ou de 30 jours. Par contre, il n'y avait pas de différence de mortalité chez les usagers fréquents utilisant des opioïdes, dans l'ensemble. Enfin, la mortalité calculée en fonction du degré de fréquence chez les patients faisant usage de substances psychoactives et comptant > 20 cons./année ainsi que chez ceux faisant usage d'opioïdes et comptant 16-20 cons./année était plus élevée au bout de 365 jours et de 2 ans.

Conclusion

Une fréquence élevée et extrêmement élevée de consultations (> 20/année) au SU chez les patients faisant usage de substances psychoactives a été associée à la mortalité à long terme mais pas à court terme. Les résultats laissent donc croire à la pertinence d'un dépistage ciblé et d'interventions préventives.

Copyright
Corresponding author
Correspondence to: Dr. Jessica Moe, Vancouver General Hospital Emergency Department, Jim Pattison Pavilion 920 West 10th Avenue, Vancouver, BC V5Z 1M9; Email: jessica.moe@gmail.com
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