Skip to main content

Advertisement

Log in

Factors Influencing the Frequency of Emergency Department Utilization by Individuals with Substance Use Disorders

  • Original Paper
  • Published:
Psychiatric Quarterly Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Meier F, Maas R, Sonst A, Patapovas A, Muller F, Plank-Kiegele B et al.: Adverse drug events in patients admitted to an emergency department: An analysis of direct costs. Pharmacoepidemiol Drug Safety 2014. doi:10.1002/pds.3663.

    Google Scholar 

  2. Dehours E, Bounes V, Bagheri H, Valle B, Ducasse JL, Montastruc JL: Adverse drug reactions in an emergency medical dispatching centre. Eur J Clin Pharmacology 70(7):881–887, 2014. doi:10.1007/s00228-014-1685-y.

    Article  CAS  Google Scholar 

  3. Macias Konstantopoulos WL, Dreifuss JA, McDermott KA, Parry BA, Howell ML, Mandler RN et al.: Identifying patients with problematic drug use in the emergency department: Results of a multisite study. Annals of Emergency Medicine. 64(5):516–525, 2014. doi:10.1016/j.annemergmed.2014.05.012.

    Article  PubMed  Google Scholar 

  4. Kinner SA, Alati R, Watt K, Najman JM, Fowler G, Green D: Substance misuse, anxiety and depression and urgency of presentation to a public emergency department in Australia. Emergency Medicine Australasia. 17(4):363–370, 2005. doi:10.1111/j.1742-6723.2005.00758.x.

    Article  PubMed  Google Scholar 

  5. Brubacher JR, Mabie A, Ngo M, Abu-Laban RB, Buchanan J, Shenton T et al.: Substance-related problems in patients visiting an urban Canadian emergency department. CJEM. 10(3):198–204, 2008.

    Article  PubMed  Google Scholar 

  6. Rockett IR, Putnam SL, Jia H, Smith GS: Assessing substance abuse treatment need: A statewide hospital emergency department study. Annals of emergency medicine. 41(6):802–813, 2003. doi:10.1067/mem.2003.189.

    Article  PubMed  Google Scholar 

  7. Gourevitch MN, Chatterji P, Deb N, Schoenbaum EE, Turner BJ. On-site medical care in methadone maintenance: Associations with health care use and expenditures. Journal of Substance Abuse Treatment. 32(2):143–151, 2007. doi:10.1016/j.jsat.2006.07.008.

    Article  PubMed  Google Scholar 

  8. Parthasarathy S, Weisner C, Hu TW, Moore C: Association of outpatient alcohol and drug treatment with health care utilization and cost: Revisiting the offset hypothesis. Journal of Studies on Alcohol. 62(1):89–97, 2001.

    Article  CAS  PubMed  Google Scholar 

  9. Ireys HT, Barrett AL, Buck JA, Croghan TW, Au M, Teich JL: Medicaid beneficiaries using mental health or substance abuse services in fee-for-service plans in 13 states, 2003. Psychiatric Services. 61(9):871–877, 2010. doi:10.1176/appi.ps.61.9.871.

    Article  PubMed  Google Scholar 

  10. Parthasarathy S, Weisner CM: Five-year trajectories of health care utilization and cost in a drug and alcohol treatment sample. Drug Alcohol Dependence. 80(2):231–240, 2005. doi:10.1016/j.drugalcdep.2005.04.004.

    Article  PubMed  Google Scholar 

  11. Cherpitel CJ, Soghikian K, Hurley LB: Alcohol-related health services use and identification of patients in the emergency department. Annals of Emergency Medicine. 28(4):418–423, 1996. doi:http://dx.doi.org/10.1016/S0196-0644(96)70008-2.

    Article  CAS  PubMed  Google Scholar 

  12. Simonet D: Cost reduction strategies for emergency services: insurance role, practice changes and patients accountability. Health Care Analysis. 17:1–19, 2009.

    Article  PubMed  Google Scholar 

  13. Smith MW, Stocks C, Santora PB: Hospital readmission rates and emergency department visits for mental health and substance abuse conditions. Community Mental Health Journal. 51(2):190–197, 2015. doi:10.1007/s10597-014-9784-x.

    Article  PubMed  Google Scholar 

  14. Larson MJ, Saitz R, Horton NJ, Lloyd-Travaglini C, Samet JH: Emergency department and hospital utilization among alcohol and drug-dependent detoxification patients without primary medical care. The American Journal of Drug and Alcohol Abuse. 32(3):435–452, 2006. doi:10.1080/00952990600753958.

    Article  PubMed  Google Scholar 

  15. Pope D, Fernandes CMB, Bouthillette F, Etherington J: Frequent users of the emergency department: A program to improve care and reduce visits. Canadian Medical Association Journal. 162(7):1017–1020, 2000.

    CAS  PubMed  PubMed Central  Google Scholar 

  16. Palmer E, Leblanc-Duchin D, Murray J, Atkinson P: Emergency department use: is frequent use associated with a lack of primary care provider? Canadian Family Physician. 60(4):e223–e229, 2014.

    PubMed  PubMed Central  Google Scholar 

  17. Ngamini-Ngui A, Fleury MJ, Moisan J, Gregoire JP, Lesage A, Vanasse A. High users of emergency departments in quebec among patients with both schizophrenia and a substance use disorder. Psychiatric services. 65:1389–1391, 2014. doi:10.1176/appi.ps.201300474

    Article  PubMed  Google Scholar 

  18. O’Toole TP, Pollini R, Gray P, Jones T, Bigelow G, Ford DE: Factors identifying high-frequency and low-frequency health service utilization among substance-using adults. Journal of Substance Abuse Treatment. 33(1):51–59, 2007.

    Article  PubMed  Google Scholar 

  19. Vu F, Daeppen JB, Hugli O, Iglesias K, Stucki S, Paroz S et al.: Screening of mental health and substance users in frequent users of a general Swiss emergency department. BMC Emergency Medicine. 15:27, 2015. doi:10.1186/s12873-015-0053-2.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Vanstone NA, Belanger P, Moore K, Caudle JM. Socioeconomic composition of low-acuity emergency department users in Ontario. Canadian Family Physician. 60(4):355–362, 2014.

    PubMed  PubMed Central  Google Scholar 

  21. Gordon JA, Chudnofsky CR, Hayward RA: Where health and welfare meet: social deprivation among patients in the emergency department. Journal of Urban Health : Bulletin of the New York Academy of Medicine. 78(1):104–111, 2001. doi:10.1093/jurban/78.1.104.

    Article  CAS  Google Scholar 

  22. Institut de la statistique du Québec. Regions and RCMS at a glance: Montreal. 2015. http://www.stat.gouv.qc.ca/statistiques/profils/region_06/region_06_00_an.htm. Accessed August 28, 2015.

  23. Andersen RM: Revisiting the behavioral model and access to medical care: Does it matter? Journal of Health and Social Behavior. 36(1):1–10, 1995.

    Article  CAS  PubMed  Google Scholar 

  24. Andersen RM: Families’ use of health services: A behavioral model of predisposing, enabling, and need Components. Michigan, Purdue University, 1968.

    Google Scholar 

  25. Quan H, Sundararajan V, Halfon P, Fong A, Burnand B, Luthi JC et al.: Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Medical Care. 43(11):1130–1139, 2005.

    Article  PubMed  Google Scholar 

  26. Pampalon R, Hamel D, Gamache P, Philibert MD, Raymond G, Simpson A: An area-based material and social deprivation index for public health in Quebec and Canada. Canadian Journal of Public Health. 103(8 Suppl 2):S17–S22, 2012.

    PubMed  Google Scholar 

  27. Allardyce J, Gilmour H, Atkinson J, Rapson T, Bishop J, McCreadie RG: Social fragmentation, deprivation and urbanicity: relation to first-admission rates for psychoses. The British Journal of Psychiatry. 187:401–406, 2005. doi:10.1192/bjp.187.5.401.

    Article  PubMed  Google Scholar 

  28. Zeger SL, Liang KY: Longitudinal data analysis for discrete and continuous outcomes. Biometrics. 42(1):121–130, 1986

    Article  CAS  PubMed  Google Scholar 

  29. Zeger SL, Liang KY, Albert PS: Models for longitudinal data: A generalized estimating equation approach. Biometrics. 44(4):1049–1060, 1988

    Article  CAS  PubMed  Google Scholar 

  30. Gardner W, Mulvey EP, Shaw EC: Regression analyses of counts and rates: Poisson, overdispersed Poisson, and negative binomial models. Psychological bulletin. 118(3):392–404, 1995

    Article  CAS  PubMed  Google Scholar 

  31. LaCalle E, Rabin E: Frequent users of emergency departments: The myths, the data, and the policy implications. Annals of Emergency Medicine. 56(1):42–48, 2010

    Article  PubMed  Google Scholar 

  32. Castillo EM, Brennan JJ, Killeen JP, Chan TC: Identifying frequent users of emergency department resources. The Journal of Emergency Medicine. 47(3):343–347, 2014. doi:10.1016/j.jemermed.2014.03.014.

    Article  PubMed  Google Scholar 

  33. McGovern MP, Lambert-Harris C, Gotham HJ, Claus RE, Xie H: Dual diagnosis capability in mental health and addiction treatment services: An assessment of programs across multiple state systems. Administration and Policy in Mental Health. 41(2):205–214, 2014. doi:10.1007/s10488-012-0449-1.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Di Lorenzo R, Galliani A, Guicciardi A, Landi G, Ferri P: A retrospective analysis focusing on a group of patients with dual diagnosis treated by both mental health and substance use services. Neuropsychiatric Disease and Treatment. 10:1479–1488, 2014. doi:10.2147/NDT.S65896.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Bohnert KM, Pfeiffer PN, Szymanski BR, McCarthy JF: Continuation of care following an initial primary care visit with a mental health diagnosis: differences by receipt of VHA Primary Care-Mental Health Integration services. General Hospital Psychiatry. 35(1):66–70, 2013. doi:10.1016/j.genhosppsych.2012.09.002.

    Article  PubMed  Google Scholar 

  36. Chaput YJ, Lebel MJ: Demographic and clinical profiles of patients who make multiple visits to psychiatric emergency services. Psychiatric Services. 58(3):335–341, 2007. doi:10.1176/appi.ps.58.3.335.

    Article  PubMed  Google Scholar 

  37. Larkin GL, Claassen CA, Emond JA, Pelletier AJ, Camargo CA: Trends in U.S. emergency department visits for mental health conditions, 1992 to 2001. Psychiatric Services. 56(6):671–677, 2005. doi:10.1176/appi.ps.56.6.671.

    Article  PubMed  Google Scholar 

  38. McCormack RP, Gallagher T, Goldfrank LR, Caplan AL: Including frequent emergency department users with severe alcohol use disorders in research: assessing capacity. Annals of Emergency Medicine. 2015;65(2):172–177e1. doi:10.1016/j.annemergmed.2014.09.027.

  39. Gilchrist G, Moskalewicz J, Slezakova S, Okruhlica L, Torrens M, Vajd R et al.: Staff regard towards working with substance users: A European multi-centre study. Addiction. 106(6):1114–1125, 2011. doi:10.1111/j.1360-0443.2011.03407.x.

    Article  PubMed  Google Scholar 

  40. van Boekel LC, Brouwers EP, van Weeghel J, Garretsen HF: Healthcare professionals’ regard towards working with patients with substance use disorders: Comparison of primary care, general psychiatry and specialist addiction services. Drug Alcohol Dependence. 134:92–98, 2014. doi:10.1016/j.drugalcdep.2013.09.012.

    Article  PubMed  Google Scholar 

  41. van Boekel LC, Brouwers EP, van Weeghel J, Garretsen HF: Comparing stigmatising attitudes towards people with substance use disorders between the general public, GPs, mental health and addiction specialists and clients. International Journal of Social Psychiatry. 2014. doi:10.1177/0020764014562051.

    PubMed  Google Scholar 

  42. Danda MC: Attitudes of health care professionals towards addictions clients accessing mental health services: What do we know and how can this be used to improve care? JEMH. 7:1–5, 2012.

    Google Scholar 

  43. Happell B, Carta B, Pinikahana J: Nurses’ knowledge, attitudes and beliefs regarding substance use: a questionnaire survey. Nursing Health Science. 4(4):193–200, 2002.

    Article  PubMed  Google Scholar 

  44. Bogenschutz MP, Donovan DM, Mandler RN, Perl HI, Forcehimes AA, Crandall C et al.: Brief intervention for patients with problematic drug use presenting in emergency departments: a randomized clinical trial. JAMA Internal Medicine. 174(11):1736–1745, 2014. doi:10.1001/jamainternmed.2014.4052.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Curran GM, Sullivan G, Williams K, Han X, Collins K, Keys J et al.: Emergency department use of persons with comorbid psychiatric and substance abuse disorders. Annals of Emergency Medicine. 41(5):659–667, 2003.

    Article  PubMed  Google Scholar 

  46. Fleury MJ. Primary mental healthcare reform in Quebec and the role and coordination strategies of general practitioners. Sante mentale au Quebec. 39(1):25–45, 2014.

    Article  PubMed  Google Scholar 

  47. Gotham HJ, Claus RE, Selig K, Homer AL: Increasing program capability to provide treatment for co-occurring substance use and mental disorders: Organizational characteristics. Journal of Substance Abuse Treatment. 38(2):160–169, 2010. doi:10.1016/j.jsat.2009.07.005.

    Article  PubMed  Google Scholar 

  48. McGovern MP, Xie H, Segal SR, Siembab L, Drake RE: Addiction treatment services and co-occurring disorders: Prevalence estimates, treatment practices, and barriers. Journal of Substance Abuse Treatment. 31(3):267–75, 2006. doi:10.1016/j.jsat.2006.05.003.

    Article  PubMed  Google Scholar 

  49. Baumann LC, Dang TT: Helping patients with chronic conditions overcome barriers to self-care. The Nurse Practitioner. 37(3):32–38, 2012.

    Article  PubMed  Google Scholar 

  50. Stjarne MK, Ponce de Leon A, Hallqvist J: Contextual effects of social fragmentation and material deprivation on risk of myocardial infarction–results from the Stockholm Heart Epidemiology Program (SHEEP). International Journal of Epidemiology. 33(4):732–741, 2004. doi:10.1093/ije/dyh087.

    Article  PubMed  Google Scholar 

  51. Omer S, Kirkbride JB, Pringle DG, Russell V, O’Callaghan E, Waddington JL: Neighbourhood-level socio-environmental factors and incidence of first episode psychosis by place at onset in rural Ireland: the Cavan-Monaghan First Episode Psychosis Study [CAMFEPS]. Schizophrenia research. 152(1):152–157, 2014. doi:10.1016/j.schres.2013.11.019.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Silver E, Mulvey EP, Swanson JW: Neighborhood structural characteristics and mental disorder: Faris and Dunham revisited. Social Science and Medicine. 55(8):1457–1470, 2002.

    Article  PubMed  Google Scholar 

  53. Whitley E, Gunnell D, Dorling D, Smith GD: Ecological study of social fragmentation, poverty, and suicide. BMJ. 319(7216):1034–1037, 1999.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  54. Hansagi H, Olsson M, Sjöberg S, Tomson Y, Göransson S: Frequent use of the hospital emergency department is indicative of high use of other health care services. Annals of Emergency Medicine. 37(6):561–567, 2001. doi:http://dx.doi.org/10.1067/mem.2001.111762.

    Article  CAS  PubMed  Google Scholar 

  55. Blank FS, Li H, Henneman PL, Smithline HA, Santoro JS, Provost D et al.: A descriptive study of heavy emergency department users at an academic emergency department reveals heavy ED users have better access to care than average users. Journal of Emergency Nursing. 31(2):139–144, 2005.

    Article  PubMed  Google Scholar 

  56. Doupe MB, Palatnick W, Day S, Chateau D, Soodeen R-A, Burchill C et al. Frequent users of emergency departments: developing standard definitions and defining prominent risk factors. Annals of Emergency Medicine. 60(1):24–32, 2012. doi:http://dx.doi.org/10.1016/j.annemergmed.2011.11.036.

    Article  PubMed  Google Scholar 

  57. Suzman R, Beard J. Global Health and Aging: World Health Organization 2011 Contract No.: NIH Publication no. 11-7737.

  58. Frishman WH, Del Vecchio A, Sanal S, Ismail A: Cardiovascular manifestations of substance abuse: part 2: alcohol, amphetamines, heroin, cannabis, and caffeine. Heart Disease. 5(4):253–271, 2003. doi:10.1097/01.hdx.0000080713.09303.a6.

    Article  PubMed  Google Scholar 

  59. Stein MD: Medical consequences of substance abuse. The Psychiatric Clinics of North America. 22(2):351–370, 1999.

    Article  CAS  PubMed  Google Scholar 

  60. Chase V, Neild R, Sadler CW, Batey RG: The medical complications of alcohol use: understanding mechanisms to improve management. Drug and Alcohol Review. 24(3):253–265, 2005. doi:10.1080/09595230500167510.

    Article  PubMed  Google Scholar 

  61. Rehm J, Allamani A, Vedova RD, Elekes Z, Jakubczyk A, Landsmane I et al.: General practitioners recognizing alcohol dependence: a large cross-sectional study in 6 European countries. The Annals of Family Medicine. 13(1):28–32, 2015. doi:10.1370/afm.1742

    Article  PubMed  PubMed Central  Google Scholar 

  62. Rehm J, Shield KD, Gmel G, Rehm MX, Frick U: Modeling the impact of alcohol dependence on mortality burden and the effect of available treatment interventions in the European Union. European Neuropsychopharmacology: The Journal of the European College of Neuropsychopharmacology. 23(2):89–97, 2013. doi:10.1016/j.euroneuro.2012.08.001.

    Article  CAS  Google Scholar 

  63. Gill KJ, Campbell E, Gauthier G, Xenocostas S, Charney D, Macaulay AC: From policy to practice: implementing frontline community health services for substance dependence-study protocol. Implement Science. 9:108, 2014. doi:10.1186/s13012-014-0108-x.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Hser YI, Evans E: Cross-system data linkage for treatment outcome evaluation: lessons learned from the California Treatment Outcome Project. Evaluation & Program Planning. 31(2):125–135, 2008.

    Article  Google Scholar 

Download references

Acknowledgments

The authors thank André Ngamini Ngui for his work on this research project and Judith Sabetti for the English editing of this manuscript. This study was funded by Mitacs-Accelerate (Fund Number # 240,577).

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Christophe Huynh.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Huynh, C., Ferland, F., Blanchette-Martin, N. et al. Factors Influencing the Frequency of Emergency Department Utilization by Individuals with Substance Use Disorders. Psychiatr Q 87, 713–728 (2016). https://doi.org/10.1007/s11126-016-9422-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11126-016-9422-6

Keywords

Navigation