糖尿病高危高需求患者中的物质使用障碍和共病情况。
Substance use disorders and medical comorbidities among high-need, high-risk patients with diabetes.
机构信息
Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA; Department of Medicine, Division of General Internal Medicine, Duke University Medical Center, Durham, NC, USA; Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA; Center for Child and Family Policy, Sanford School of Public Policy, Duke University, Durham, NC, USA.
National Institute on Drug Abuse, Bethesda, MD, USA.
出版信息
Drug Alcohol Depend. 2018 May 1;186:86-93. doi: 10.1016/j.drugalcdep.2018.01.008. Epub 2018 Mar 3.
BACKGROUND
The majority of the U.S. healthcare resources are utilized by a small population characterized as high-risk, high-need persons with complex care needs (e.g., adults with multiple chronic conditions). Substance use disorders (SUDs) and mental health disorders (MHDs) are a driver of poor health and additional healthcare costs, but they are understudied among high-need patients.
OBJECTIVE
We examine the prevalence and correlates of SUDs and MHDs among adults with high-risk diabetes, who are patients at the top 10% risk score for developing poor outcomes (hospital admission or death).
METHODS
A risk algorithm developed from Duke University Health System electronic health records (EHRs) data was used to identify patients with high-risk diabetes for targeting home-based primary care. The EHR data of the 263 patients with high-risk diabetes were analyzed to understand patterns of SUDs and MHDs to inform care-coordinating efforts.
RESULTS
Both SUDs (any SUD 48.3%, alcohol 12.5%, tobacco 38.8%, drug 23.2%) and MHDs (any MHD 74.9%, mood 53.2%, sleep 37.3%, anxiety 32.7%, schizophrenia/psychotics/delusional 14.8%, dementia/delirium/amnestic/cognitive 14.4%, adjustment 9.1%) were prevalent. Overall, 81.7% of the sample had SUD or MHD. Elevated odds of SUD were noted among men (tobacco, alcohol) and those who were never-married (alcohol, cannabis). African-American race (vs. other race/ethnicity) was associated with lower odds of anxiety disorders.
CONCLUSION
While data are limited to one large academic health system, they provide clinical evidence revealing that 82% of patients with high-risk diabetes had SUD and/or MHD recorded in their EHRs, highlighting a need for developing service models to optimize high-risk care.
背景
大多数美国医疗保健资源都被一小部分人群利用，这些人群被认为是高风险、高需求的人，他们有复杂的医疗需求（例如，患有多种慢性疾病的成年人）。物质使用障碍（SUDs）和精神健康障碍（MHDs）是导致健康状况不佳和额外医疗费用的原因，但在高需求患者中研究不足。
目的
我们研究了患有高危糖尿病的成年人中 SUDs 和 MHDs 的患病率和相关因素，这些成年人的风险评分处于发展不良结局（住院或死亡）的前 10%。
方法
使用来自杜克大学健康系统电子健康记录（EHRs）数据的风险算法来识别高危糖尿病患者，以便针对这些患者开展家庭为基础的初级保健。分析了 263 名高危糖尿病患者的 EHR 数据，以了解 SUDs 和 MHDs 的模式，为协调护理工作提供信息。
结果
SUDs（任何 SUD 占 48.3%，酒精 12.5%，烟草 38.8%，药物 23.2%）和 MHDs（任何 MHD 占 74.9%，情绪障碍 53.2%，睡眠障碍 37.3%，焦虑障碍 32.7%，精神分裂症/精神病/妄想症 14.8%，痴呆/谵妄/遗忘症/认知障碍 14.4%，适应障碍 9.1%）都很常见。总体而言，81.7%的样本患有 SUD 或 MHD。男性（吸烟、饮酒）和未婚者（饮酒、大麻）SUD 的患病风险较高。非裔美国人种族（与其他种族/族裔相比）与焦虑障碍的低患病风险相关。
结论
尽管数据仅限于一个大型学术医疗系统，但它们提供了临床证据，表明 82%的高危糖尿病患者在其 EHRs 中记录了 SUD 和/或 MHD，这凸显了开发服务模式以优化高危护理的必要性。
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