Age differences in emergency department utilization and repeat visits among patients with opioid use disorder at an urban safety-net hospital: A focus on young adults
Age differences in emergency department utilization and repeat visits among patients with opioid use disorder at an urban safety-net hospital: A focus on young adults
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DOI：
10.1016/j.drugalcdep.2019.02.030
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发表时间：
2019-07-01
影响因子：
4.2
通讯作者：
Drainoni, Mari-Lynn
中科院分区：
文献类型：
--
作者：
Choi, Sugy;Biello, Katie B.;Drainoni, Mari-Lynn
背景：美国 18 至 25 岁的年轻人中阿片类药物使用障碍 (OUD) 正在增加。急诊科 (ED) 被认为是 OUD 患者的主要护理来源，但该人群中 ED 的使用情况仍然存在疑问。我们检查了城市安全网医院的人口统计和急诊室使用模式，重点关注年轻人，为干预措施的制定提供信息。方法：我们从 2013 年至 2017 年间诊断为 OUD 的 18 岁至 64 岁患者的电子病历中提取了人口统计和临床数据。评估了描述性统计数据，包括种族/族裔、性别、保险、其他物质使用障碍和心理健康诊断，以及按年龄组划分的急诊室使用模式。采用单变量和多变量逻辑回归来分析年龄和 ED 使用模式之间的关联。结果：在样本中的 12,025 名 OUD 患者中，30% 的患者在急诊就诊时初步诊断为 OUD。在接受过急诊科就诊的患者中，48% 的人在一年内至少再接受过一次急诊科就诊。与最大年龄组（56-64 岁）相比，年轻人（18-25 岁）去急诊室就诊的概率（调整后比值比 [AOR]：5.04；95% 置信区间 [CI]：4.14-6.13）和重复就诊（AOR：3.28；CI：2.53-4.26）显着更高。结论：与老年人相比，患有 OUD 的年轻人更有可能使用急诊室并重复就诊。在解决阿片类药物泛滥问题的更广泛努力中，确定急诊科针对青年的干预措施应该是当务之急。
Background: Opioid use disorder (OUD) among young adults from ages 18 to 25 years is increasing in the United States. Emergency departments (EDs) are recognized as major sources of care for patients with OUD, but questions remain about ED utilization among this population. We examined the demographics and ED utilization patterns at an urban safety-net hospital with a focus on young adults to inform intervention development.Methods: We extracted demographic and clinical data from electronic medical records of patients ages 18 to 64 years diagnosed with OUD between 2013 and 2017. Descriptive statistics were assessed, including race/ethnicity, sex, insurance, other substance use disorder and mental health diagnoses, and ED utilization patterns by age group. Univariable and multivariable logistic regressions were performed to analyze the associations between age and ED utilization patterns.Results: Among 12,025 OUD patients in the sample, 30% had an ED visit with a primary diagnosis of OUD. Among those who had an ED visit, 48% had at least one additional ED visit within a year. The probability of ED visits (adjusted odds ratio [AOR]:5.04; 95% confidence interval [CI]:4.14-6.13) and repeat ED visits (AOR:3.28; CI:2.53-4.26) were significantly higher among young adults (18-25 years) compared to the oldest age group (56-64 years).Conclusions: Compared to older adults, young adults with OUD are more likely to use the ED and to have repeat ED visits. The identification of youth-tailored interventions in the ED within broader efforts to address the opioid epidemic should be an urgent priority.