Are People Who Inject Drugs Frequent Users of Emergency Department Services? A Cohort Study (2008-2013)
Are People Who Inject Drugs Frequent Users of Emergency Department Services? A Cohort Study (2008-2013)
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DOI：
10.1080/10826084.2017.1341921
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发表时间：
2018-01-01
影响因子：
2
通讯作者：
Dietze, Paul
中科院分区：
文献类型：
--
作者：
Nambiar, Dhanya;Spelman, Tim;Dietze, Paul
背景资料：虽然注射毒品的人（PWID）被描述为急诊服务的频繁使用者，但大多数研究是横断面的，涉及单个急诊科（艾德）的记录。目的：我们描述了一个PWID队列中全州范围内艾德表现的特征，并将表现率与普通人群进行比较。我们还研究了与频繁使用艾德相关的特征。方法：我们使用了2008年1月至2013年6月期间678名PWID队列的公开艾德演示回顾性链接数据。常见的主要诊断使用国际疾病分类第十修订版澳大利亚修订版（ICD-10-AM）章节标题进行描述。使用负二项回归估计艾德表现趋势。使用广义估计方程（GEE）确定与频繁使用ED相关的特征。结果如下：在4163.5人-年（PY）中有3437例报告，最常见的主要诊断是损伤、中毒和其他外部性（19%）。艾德表现每6个月增加4%（95%置信区间（CI）0.1%-0.8%），是一般人群的3倍。四分之一（24%）的队列经常出现，他们更有可能有非损伤相关的诊断，年龄在30岁以下，不太可能有非紧急的表现和男性。结论：PWID使用ED的比率高于一般人群，通常存在损伤和精神和行为障碍。转介药物治疗，心理健康和社会支持服务可以改善患者护理，减轻ED的负担。
Background: Although people who inject drugs (PWID) have been described as frequent users of emergency services, the majority of research is cross-sectional and involves records from a single emergency department (ED). Objectives: We describe characteristics of state-wide ED presentations in a cohort of PWID, and compare presentation rates to the general population. We also examine characteristics associated with frequent ED use. Methods: We used data from a retrospective linkage of public ED presentations from a cohort of 678 PWID between January 2008 and June 2013. Common principal diagnoses were described using the International Classification of Diseases, Tenth Revision, Australian Modification (ICD-10-AM) chapter headings. The ED presentation trend was estimated using negative-binomial regression. Characteristics associated with frequent use of EDs were identified using generalized estimating equations (GEEs). Results: There were 3437 presentations over 4163.5 person-years (PY) and the most common principal diagnosis was injury, poisoning and other externalities (19%). ED presentations increased by 4% every six months (95% confidence interval (CI) 0.1%-0.8%) and were three times greater than the general population. A quarter (24%) of the cohort presented frequently, and they were more likely to have noninjury-related diagnoses and be aged below 30years, and less likely to have nonurgent presentations and be male. Conclusions: PWID use EDs at a higher rate than the general population, and typically present with injuries and mental and behavioral disorders. Referrals to drug treatment, mental health, and social support services can improve patient care and reduce the burden on EDs.