Department of Psychiatry, McGill University, Montreal, Canada.
Douglas Hospital Research Centre, Douglas Mental Health University Institute, Montreal, Canada.
Drug Alcohol Rev. 2022 Jul;41(5):1136-1151. doi: 10.1111/dar.13451. Epub 2022 Mar 10.
Patients with substance-related disorders and mental disorders (MD) contribute substantially to emergency department (ED) overcrowding. Few studies have identified predictors of ED use integrating service use correlates, particularly among patients with cannabis-related disorders (CRD). This study compared predictors of low (1-2 visits/year) or frequent (3+ visits/year) ED use with no ED use for a cohort of 9836 patients with CRD registered at Quebec (Canada) addiction treatment centres in 2012-2013.
This longitudinal study used multinomial logistic regression to evaluate clinical, sociodemographic and service use variables from various databases as predictors of the frequency of ED use for any medical reason in 2015-2016 among patients with CRD.
Compared to non-ED users with CRD, frequent ED users included more women, rural residents, patients with serious MD and chronic CRD, dropouts from programs in addiction treatment centres and with less continuity of physician care. Compared with non-users, low ED users had more common MD and there more workers than students.
Multimorbidity, including MD, chronic physical illnesses and other substance-related disorders than CRD, predicted more ED use and explained frequent use of outpatient services and prior specialised acute care, as did being 12-29 years, after controlling for all other covariates. Better continuity of physician care and reinforcement of programs like assertive community or integrated treatment, and chronic primary care models may protect against frequent ED use. Strategies like screening, brief intervention and treatment referral, including motivational therapy for preventing treatment dropout may also be expanded to decrease ED use.
患有物质相关障碍和精神障碍（MD）的患者会大量导致急诊部门（ED）过度拥挤。很少有研究将服务使用相关性综合起来，确定与 ED 使用相关的预测因素，特别是在与大麻相关障碍（CRD）患者中。本研究比较了 2012-2013 年在魁北克（加拿大）成瘾治疗中心登记的 9836 名 CRD 患者中，低（1-2 次/年）或高（3+次/年）ED 使用与无 ED 使用的预测因素。
本纵向研究使用多项逻辑回归来评估来自各种数据库的临床、社会人口统计学和服务使用变量，作为 2015-2016 年 CRD 患者因任何医疗原因使用 ED 频率的预测因素。
与非 ED 使用的 CRD 患者相比，频繁使用 ED 的患者中女性、农村居民、有严重 MD 和慢性 CRD 的患者、从成瘾治疗中心的项目中辍学的患者以及医生护理连续性较差的患者比例更高。与非使用者相比，低 ED 用户更常见 MD，且工人多于学生。
多种合并症，包括 MD、慢性身体疾病和其他与 CRD 相关的物质相关障碍，预测了更多的 ED 使用，并解释了频繁使用门诊服务和之前专门的急性护理，这也与 12-29 岁有关，在控制了所有其他协变量后。更好的医生护理连续性和强化社区或综合治疗等项目，以及慢性初级保健模式可能有助于预防频繁使用 ED。筛查、简短干预和治疗转介策略，包括预防治疗中断的动机治疗，也可能会扩大以减少 ED 使用。
