National Drug and Alcohol Research Centre, 22-32 King St, Randwick NSW 2031, Australia; Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 7HB, UK.
National Drug and Alcohol Research Centre, 22-32 King St, Randwick NSW 2031, Australia.
Drug Alcohol Depend. 2020 Dec 1;217:108343. doi: 10.1016/j.drugalcdep.2020.108343. Epub 2020 Oct 12.
People who use illicit opioids have high rates of hospital admission. We aimed to measure the risk of discharge against medical advice among inpatients with a history of opioid agonist therapy (OAT), and test whether OAT is associated with lower risk of discharge against medical advice.
We conducted a cohort study of patients admitted to hospital in an emergency between 1 August 2001 and 30 April 2018 in New South Wales, Australia. All patients had a previous episode of OAT in the community. The main outcome was discharge against medical advice, and the main exposure was whether patients had an active OAT permit at the time of admission.
14,035/116,957 admissions (12 %) ended in discharge against medical advice. Admissions during periods of OAT had 0.79 (0.76-0.83; p < 0.001) times the risk of discharge against medical advice, corresponding to an absolute risk reduction of 3.0 percentage points. Risk of discharge against medical advice was higher among patients who were younger, male, identified as Aboriginal and/or Torres Strait Islander, and those admitted for accidents, drug-related reasons, or injecting-related injuries (such as cutaneous abscesses). In a subsample of 7793 patients included in a crossover-cohort analysis, OAT was associated with 0.84 (95 % CI 0.76-0.93; p < 0.001) times the risk of discharge against medical advice.
Among patients with a history of OAT, one in eight emergency hospital admissions ends in discharge against medical advice. OAT enrolment at the time of admission is associated with a reduction of this risk.
使用非法阿片类药物的人住院率很高。我们旨在衡量有阿片类药物激动剂治疗（OAT）史的住院患者提前出院的风险，并检验 OAT 是否与提前出院风险降低相关。
我们对澳大利亚新南威尔士州 2001 年 8 月 1 日至 2018 年 4 月 30 日期间急诊入院的患者进行了队列研究。所有患者在社区中均有过 OAT 治疗史。主要结局是提前出院，主要暴露因素是患者在入院时是否持有有效的 OAT 许可证。
14035/116957 例（12%）出院时提前出院。在 OAT 期间入院的患者提前出院的风险为 0.79（0.76-0.83；p<0.001），相应的绝对风险降低了 3.0 个百分点。年龄较小、男性、被认定为原住民和/或托雷斯海峡岛民、因事故、药物相关原因或与注射相关的损伤（如皮肤脓肿）入院的患者提前出院的风险更高。在一项交叉队列分析中包含的 7793 例患者的亚样本中，OAT 与提前出院的风险相关（0.84（95%CI 0.76-0.93；p<0.001）。
在有 OAT 治疗史的患者中，每 8 例急诊住院患者中就有 1 例提前出院。入院时接受 OAT 治疗与降低这种风险有关。
