Research paperFrequent emergency department presentations among people who inject drugs: A record linkage study
Introduction
Overcrowding at emergency departments (EDs) is a problem documented in Australia and internationally (Dent, Phillips, Chenhall, & McGregor, 2003; Geelhoed and de Klerk, 2012, Zuckerman and Shen, 2004). One reported driver of overcrowding is frequent ED use by population sub-groups with chronic pain and mental health conditions, and those who may have limited access to primary health care (Pines et al., 2011), such as people with substance use issues (Billings and Raven, 2013, Fuda and Immekus, 2006).
Previous reports show people who inject drugs (PWID) frequently use EDs (Aitken et al., 2012, Kerr et al., 2005; Nambiar, Spelman, Stoove, & Dietze, 2017), typically for injecting-related harms, injuries and mental health conditions (Kerr et al., 2005, Marks et al., 2013; Nambiar et al., submitted). While acute events such as drug overdose and trauma typically require ED services, soft-tissue infections and some mental health conditions can be managed in low acuity settings such as primary health care. Delays in attending primary health care at the onset of some medical conditions may result in ED presentations once the condition has festered. However PWID face a range of barriers to accessing primary health care such as out-of-pocket expenses, inconvenient service opening hours and the stigma associated with injecting drug use (Drumm et al., 2003, Islam et al., 2012; Nambiar, Stoove, & Dietze, 2014). These barriers may encourage the use of relatively anonymous and low threshold services, such as those provided in EDs (Chitwood, McBride, French, & Comerford, 1999).
In a previous study using a cohort of PWID we reported rates of ED utilisation among Australian PWID over three times higher than the general population (Nambiar et al., submitted). This finding was evident despite the availability of free primary health care targeted to PWID that we have shown in a separate study to be widely used by the this cohort (Nambiar et al., 2014). Taken together these findings suggest that there may be sub-populations of PWID whose needs are not met by the targeted primary health care services and may be at greater risk of acute harm and frequent ED presentations. It is therefore important to understand the relationship between use of other health services and ED utilisation, as well as the effect of personal characteristics and patterns of substance use on ED use among PWID to help develop tailored interventions or refine existing targeted services. In the current study we use prospective data from a cohort of PWID to identify longitudinal correlates of cumulative and frequent ED use.
Section snippets
Study population
The study population is drawn from the Melbourne injecting drug user cohort study (MIX), an ongoing community-based cohort of PWID recruited from urban locations in Melbourne, Australia, between 2008 and 2010. Eligible participants had to be residing in Melbourne, aged 18 years or over, reported injecting heroin or amphetamines regularly (at least once a month in the six months prior to baseline) and were able to present a valid Medicare number (used to access the universal healthcare system in
Participants
A total of 688 cohort members from the MIX study were linked to the VEMD. Of these, 76 had incomplete exposure data and so were excluded. There were no significant differences between the excluded and remaining cohort members across demographics and drug use characteristics, although 127 ED presentations and 14 frequent presentation episodes were lost.
At baseline, the remaining 612 participants in the cohort had a median age of 28 years (interquartile range (IQR): 24–29), and 67% were male.
Discussion/Conclusion
We examined the relationship between self-reported exposures in a cohort of PWID and administrative ED data to describe longitudinal correlates of state-wide ED presentations. These findings demonstrate that individual-level factors such as substance use preferences and residing in unstable accommodation, as well as the use of other health services such as mental health and outpatient services, influence patterns of ED presentations among PWID. Accessing primary health care was not associated
Acknowledgements
The authors wish to thank study participants, and community organizations who assisted with recruitment. We would also like to thank the MIX study team who assisted with recruitment, follow-up and interviews. We thank Simon Brown, Katy Greenland, Ying Chen, Likhesh Mahajan and Pradeep Wijayaratne from the Department of Health and Human Services for the VEMD record linkage.
The MIX study is funded by The Colonial Foundation Trust and the National Health and Medical Research Council (NHMRC Grant
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Emergency department presentations in the first weeks following release from prison among men with a history of injecting drug use in Victoria, Australia: A prospective cohort study
2022, International Journal of Drug PolicyCitation Excerpt :In Australia, primary care centres that cater specifically for the needs of PWID (e.g., Kirketon Road Clinic in Sydney and North Richmond Community Health in Melbourne) are options for tertiary to primary health care referral pathways. Referrals or diversion to specialist primary care services from EDs may help to address specific and ongoing clinical and social needs for PWID, such as substance use treatment, to reduce high levels of ED presentations (Nambiar et al., 2017). The implementation of these supported health care linkages (from ED to primary care) would be especially effective for non-urgent ED presentations during service operational hours, with over half of ED presentations in this study occurring within service operational hours.
Acceptability of, and barriers and facilitators to, a pilot physical health service for people who inject drugs: A qualitative study with service users and providers
2022, International Journal of Drug PolicyCitation Excerpt :This is problematic from PWIDs’ perspectives in terms of unmet needs and worse health outcomes (Ahern et al., 2007). It is also challenging from a healthcare perspective due to increased inequity, pressure on healthcare services from frequent and/or avoidable admissions, and increased financial challenges for health (and particularly drug) services (Harris et al., 2018; Hope et al., 2015; Islam, Topp, Day, Dawson, & Conigrave, 2012; Nambiar et al., 2017). Healthcare programmes may be tailored specifically to the needs of service users in order to overcome challenges with provision and use.
Commentary
2017, Annals of Emergency Medicine