St. John's University Department of Psychology, Queens, NY, USA; Jamaica Hospital Medical Center (JHMC), Queens, NY, USA.
Douglas Research Center, McGill University Department of Psychiatry, Montreal, Quebec, Canada.
Drug Alcohol Depend. 2023 May 1;246:109825. doi: 10.1016/j.drugalcdep.2023.109825. Epub 2023 Mar 1.
Patients with alcohol-use disorders (AUDs) are highly heterogenous and account for an increasing proportion of general medical hospital visits. However, many patients with AUDs do not present with severe medical or psychiatric needs requiring immediate attention. There may be a mismatch between some patients' needs and the available services, potentially driving re-admissions and re-encounters. The current study aims to identify subgroups of AUD patients and predict differences in patterns of healthcare service use (HSU) over time.
Latent class analysis (LCA) was conducted using hospital data incorporating sociodemographic, health behavior, clinical, and service use variables to identify subtypes of AUD patients, then class membership was used to predict patterns of HSU.
Four classes were identified with the following characteristics: (1) Patients with acute medical injuries (30 %); (2) Patients with socioeconomic and psychiatric risk factors, (11 %); (3) Patients with chronic AUD with primarily non-psychiatric medical needs (18 %); and (4) Patients with primary AUDs with low medical-treatment complexity (40 %). Negative binomial models showed that Class 4 patients accounted for the highest frequency of service use, including significantly higher rates of emergency department reencounters at 30 days and 12 months.
The profile and patterns of HSU exhibited by patients in class 4 suggest that these patients have needs which are not currently being addressed in the emergency department. These have implications for how resources are allocated to meet the needs of patients with AUDs, including those who make frequent visits to the emergency department without high acuity medical needs.
患有酒精使用障碍（AUD）的患者高度异质，占综合医院就诊人数的比例不断增加。然而，许多 AUD 患者并没有出现需要立即关注的严重医疗或精神需求。一些患者的需求与现有服务之间可能存在不匹配的情况，这可能会导致再次入院和再次就诊。本研究旨在确定 AUD 患者亚组，并预测随着时间的推移医疗服务使用（HSU）模式的差异。
使用包含社会人口统计学、健康行为、临床和服务使用变量的医院数据进行潜在类别分析（LCA），以确定 AUD 患者的亚组类型，然后使用类别成员身份预测 HSU 模式。
确定了四个具有以下特征的类别：（1）急性医疗损伤患者（30%）；（2）具有社会经济和精神风险因素的患者（11%）；（3）患有慢性 AUD 且主要有非精神科医疗需求的患者（18%）；和（4）具有原发性 AUD 且医疗治疗复杂性低的患者（40%）。负二项式模型显示，第 4 类患者的服务使用频率最高，包括在 30 天和 12 个月时急诊部门再次就诊的比率显著更高。
第 4 类患者的 HSU 特征和模式表明，这些患者的需求在急诊部门尚未得到满足。这对如何分配资源以满足 AUD 患者的需求产生影响，包括那些没有高急症医疗需求但频繁到急诊部门就诊的患者。
