The association of psychiatric comorbidity and use of the emergency department among persons with substance use disorders: an observational cohort studyReportar como inadecuado




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BMC Emergency Medicine

, 8:17

First Online: 03 December 2008Received: 14 March 2008Accepted: 03 December 2008DOI: 10.1186-1471-227X-8-17

Cite this article as: Curran, G.M., Sullivan, G., Williams, K. et al. BMC Emerg Med 2008 8: 17. doi:10.1186-1471-227X-8-17

Abstract

BackgroundPsychiatric and substance use problems are commonly found to be contributing factors to frequent Emergency Department ED use, yet little research has focused on the association between substance use and psychiatric comorbidity. This study assesses the association of a psychiatric comorbidity on ED use among patients with substance use disorders SUDs.

MethodsThe study focuses on 6,865 patients who were diagnosed with SUDs in the ED of a large urban hospital in the southern United States from January 1994 – June 1998. Patients were grouped by type of substance use disorder. After examining frequency of visits by diagnosis, the sample was assigned to the following groups–alcohol dependence ICD9 = 303, alcohol abuse ICD9 = 305.0, cocaine dependence-abuse ICD9 = 304.2, 305.6, and polysubstance-mixed use ICD9 = 305.9. A patient was classified with psychiatric comorbidity if a psychiatric diagnosis appeared during any of the patient-s visits. The following psychiatric diagnoses were included–schizophrenia-psychoses, bipolar disorder, depression, anxiety, and dementia ICD-9 codes available upon request.

ResultsPatients with SUDs and psychiatric comorbidity had significantly higher mean number of ER visits mean = 5.2 SD = 8.7 than SUD patients without psychiatric comorbidity mean = 2.5, SD = 3.7. In logistic regressions predicting several categorizations of heavier use of the ED either 4+, 8+, 12+, 16+, or 20+ visits over the span of the study SUD patients with psychiatric comorbidity had adjusted odds ratios of 3.0 to 5.6 reference group = patients with SUDs but no psychiatric comorbidity. This association was found across all substance use diagnostic categories studied, with the strongest relationship observed among patients with cocaine disorders or alcohol dependence.

ConclusionThe results provide further support for the notion that the ED could and should serve as an important identification site for cost-effective intervention.

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Autor: Geoffrey M Curran - Greer Sullivan - Keith Williams - Xiaotong Han - Elise Allee - Kathryn J Kotrla

Fuente: https://link.springer.com/







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