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加拿大萨德伯里 2018 年至 2022 年的一项回顾性队列研究：基于医院的物质使用支持与急诊科复诊的关联。

Association of hospital-based substance use supports on emergency department revisits: a retrospective cohort study in Sudbury, Canada from 2018 to 2022.

机构信息

Health Science North, Sudbury, ON, Canada.

ICES North, Sudbury, ON, Canada.

出版信息

Harm Reduct J. 2024 Mar 28;21(1):71. doi: 10.1186/s12954-024-00985-0.

DOI:10.1186/s12954-024-00985-0

PMID:38549074

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10976798/

Abstract

BACKGROUND

This study compares emergency department (ED) revisits for patients receiving hospital-based substance-use support compared to those who did not receive specialized addiction services at Health Sciences North in Sudbury, Ontario, Canada.

METHODS

The study is a retrospective observational study using administrative data from all patients presenting with substance use disorder (SUD) at Health Sciences North from January 1, 2018, and August 31, 2022 with ICD-10 codes from the Discharge Abstract Database (DAD) and the National Ambulatory Care Database (NACRS). There were two interventions under study: addiction medicine consult services (AMCS group), and specialized addiction medicine unit (AMU group). The AMCS is a consult service offered for patients in the ED and those who are admitted to the hospital. The AMU is a specialized inpatient medical unit designed to offer addiction support to stabilize patients that operates under a harm-reduction philosophy. The primary outcome was all cause ED revisit within 30 days of the index ED or hospital visit. The secondary outcome was all observed ED revisits in the study period. Kaplan-Meier curves were used to measure the proportion of 30-day revisits by exposure group. Odds ratios and Hazard Ratios were calculated using logistic regression models with random effects and Cox-proportional hazard model respectively.

RESULTS

A total of 5,367 patients with 10,871 ED index visits, and 2,127 revisits between 2018 and 2022 are included in the study. 45% (2,340/5,367) of patient were not admitted to hospital. 30-day revisits were less likely among the intervention group: Addiction Medicine Consult Services (AMCS) in the ED significantly reduced the odds of revisits (OR 0.53, 95% CI 0.39-0.71, p < 0.01) and first revisits (OR 0.42, 95% CI 0.33-0.53, p < 0.01). The AMU group was associated with lower revisits odds (OR 0.80, 95% CI 0.66-0.98, p = 0.03). For every additional year of age, the odds of revisits slightly decreased (OR 0.99, 95% CI 0.98-1.00, p = 0.01) and males were found to have an increased risk compared to females (OR 1.50, 95% CI 1.35-1.67, p < 0.01).

INTERPRETATION

We observe statistically significant differences in ED revisits for patients receiving hospital-based substance-use support at Health Sciences North. Hospital-based substance-use supports could be applied to other hospitals to reduce 30-day revisits.

摘要

背景

本研究比较了在安大略省萨德伯里的健康科学北方医院接受医院为基础的物质使用支持的急诊科（ED）复诊患者与未接受专门成瘾服务的患者。

方法

这是一项使用来自所有在 2018 年 1 月 1 日至 2022 年 8 月 31 日期间在健康科学北方医院就诊的有物质使用障碍（SUD）患者的行政数据的回顾性观察性研究，使用来自 Discharge Abstract Database（DAD）和 National Ambulatory Care Database（NACRS）的 ICD-10 代码。有两个研究干预措施：成瘾医学咨询服务（AMCS 组）和专门的成瘾医学单位（AMU 组）。AMCS 是为急诊科和住院患者提供的咨询服务。AMU 是一个专门的住院医疗单位，旨在通过减少伤害的理念为稳定患者提供成瘾支持。主要结局是在指数 ED 或医院就诊后的 30 天内所有原因的 ED 复诊。次要结局是研究期间所有观察到的 ED 复诊。使用 Kaplan-Meier 曲线来衡量按暴露组计算的 30 天复诊比例。使用具有随机效应的逻辑回归模型和 Cox 比例风险模型分别计算优势比和危险比。

结果

在 2018 年至 2022 年间，共有 5367 名患者有 10871 次 ED 索引就诊，2127 次在研究期间复诊。45%（2340/5367）的患者未住院。干预组的 30 天复诊率较低：在急诊科接受成瘾医学咨询服务（AMCS）显著降低了复诊的几率（OR 0.53，95% CI 0.39-0.71，p<0.01）和首次复诊的几率（OR 0.42，95% CI 0.33-0.53，p<0.01）。AMU 组的复诊几率较低（OR 0.80，95% CI 0.66-0.98，p=0.03）。每增加一岁，复诊的几率略有下降（OR 0.99，95% CI 0.98-1.00，p=0.01），与女性相比，男性的风险增加（OR 1.50，95% CI 1.35-1.67，p<0.01）。