Frequent emergency department presentations among people who inject drugs: A record linkage study
Frequent emergency department presentations among people who inject drugs: A record linkage study
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DOI：
10.1016/j.drugpo.2017.03.010
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发表时间：
2017-06-01
影响因子：
4.4
通讯作者：
Dietze, Paul
中科院分区：
文献类型：
--
作者：
Nambiar, Dhanya;Stoove, Mark;Dietze, Paul
背景：注射吸毒者 (PWID) 被描述为急诊室 (ED) 等医疗服务的频繁使用者，但很少有研究描述与该人群中经常使用 ED 相关的人口统计因素、物质使用模式和既往医疗服务使用情况。方法：结合使用 PWID 队列的自我报告数据和通过记录链接获得的行政 ED 数据，我们确定了与 ED 服务使用相关的纵向因素。使用负二项式回归进行双变量和多变量分析，以确定与累积 ED 就诊相关的暴露，并使用逻辑回归来确定频繁 ED 就诊（定义为每年三次或以上）的暴露。结果：在 612 名注射吸毒者中，超过一半 (58%) 至少就诊一次，超过三分之一 (36%) 在 2008 年 1 月至 2013 年 6 月期间经常就诊。频繁和累积 ED 就诊与报告相关主要药物选择为大麻（分别为 AOR：1.42、95%CI：1.07-1.89 和 AIRR：2.96、95%CI：1.44-6.07）或甲基苯丙胺（分别为 AOR：1.62、95%C1：1.17-2.2 和 AIRR：2.42、95%C1：1.08-5.46）海洛因使用情况、过去一个月的心理健康（AOR：1.42、95% CI：1.08-1.85 和 AIRR：3.32、95%0：1.69-6.53）和门诊服务（AOR：1.47、95% CI：1.00-2.16 和 AIRR：0.95、95% CI 1.52-10.28结论：经常使用 ED 的 PW1D 可能有复杂的健康和物质使用相关需求。急诊室应积极将大麻和甲基苯丙胺依赖者转介至减少伤害服务机构。减少危害服务应确保从急诊室转介的人员接受同时发生的心理健康状况筛查并获得足够的支持。 (C) 2017 Elsevier B.V. 保留所有权利。
Background: People who inject drugs (PWID) have been described as frequent users of health services such as emergency departments (EDs), however few studies have described demographic factors, patterns of substance use and previous health service use associated with frequent use of EDs in this population.Methods: Using a combination of self -reported data from a cohort of PWID and administrative ED data obtained through record linkage, we identified longitudinal factors associated with the use of ED services. Bivariate and multivariate analyses were conducted using negative binomial regression to identify exposures associated with both cumulative ED presentations, and logistic regression to identify exposures of frequent ED presentations (defined as three or more annual presentations).Results: Among 612 PWID, over half (58%) presented to EDs at least once and over a third (36%) presented frequently between January 2008 and June 2013. Frequent and cumulative ED presentations were associated with reporting the main drug of choice as cannabis (AOR:1.42, 95%CI:1.07-1.89 and AIRR:2.96, 95%CI:1.44-6.07 respectively) or methamphetamine (AOR:1.62, 95%C1:1.17-2.2 and AIRR:2.42, 95% C1:1.08-5.46 respectively) compared to heroin, and past month use of mental health (AOR:1.42, 95% CI:1.08-1.85 and AIRR:3.32, 95%0:1.69-6.53 respectively) and outpatient services (AOR:1.47, 95%CI: 1.00-2.16 and AIRR:0.95, 95%Cl 1.52-10.28 respectively).Conclusion: PW1D who are frequent users of EDs are likely to have complex health and substance use related needs. EDs should actively refer people who present with cannabis and methamphetamine dependence to harm reduction services. Harm reduction services should ensure people referred from EDs are screened for co-occurring mental health conditions and receive adequate support. (C) 2017 Elsevier B.V. All rights reserved.