Predictors of Recurrent High Emergency Department Use among Patients with Mental Disorders
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Setting and Data Collection
2.2. Variables
2.3. Analysis
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
List of Abbreviations
BDCU | Emergency department database (Banque de données commune des urgences) |
CLSC | Local community health service centers |
ED | Emergency departments |
GP | General practitioners |
ICC | Intraclass correlation coefficient |
ICD | International Classification of Diseases |
I-CLSC | Public primary care database (Système d’information clinique et administrative des centres locaux de services communautaires) |
MED-ÉCHO | Hospitalization database (Maintenance et exploitation des données pour l’étude de la clientèle hospitalière) |
MD | Mental disorders |
SRD | Substance-related disorders |
RAMQ | Quebec Health Insurance Regime (Régie de l’assurance maladie du Québec) |
VIF | Variance inflation factors |
References
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Diagnoses | International Classification of Diseases, Ninth Revision (ICD-9) | International Classification of Diseases, Tenth Revision, Canada (ICD-10-CA) |
---|---|---|
Schizophrenia spectrum and other psychotic disorders | 295, 297, 298 | F20, F21, F22, F23, F24, F25, F28, F29, F32.3, F33.3, F44.89 |
Bipolar disorders | 296.0–296.6, 296.8, 296.9 | F30.0–F30.2, F30.8, F30.9, F31.0–F31.9 |
Depressive disorders | 300.4, 311.9 | F32.0- F32.3, F32.8, F32.9, F33.0–F33.3, F33.8, F33.9, F34.8, F34.9, F38.0, F38.1, F38.8, F39, F41.2 |
Anxiety disorders | 300 (except 300.4) | F40–F48, F68 |
Personality disorders | 301 | F60, F07.0, F34.0, F341, F48.8, F61 |
Adjustment disorders | 309.0–309.4, 309.8, 309.9 | F43.0–F43.2, F43.8, F43.9 |
Alcohol-related disorders | 303.0, 303.9, 305.0 (alcohol abuse or dependence); 291, 357.5, 425.5, 535.3, 571.0–571.3 (alcohol-induced disorders); 980.0, 980.1, 980,8, 980.9 (alcohol intoxication) | F10.1, F10.2 (alcohol abuse or dependence); F10.3–F10.9, K70.0–K70.4, K70.9, G62.1, I42.6, K29.2, K85.2, K86.0, E24.4, G31.2, G72.1, O35.4 (alcohol-induced disorders); F10.0, T51.0, T51.1, T51.8, T51.9 (alcohol intoxication) |
Drug-related disorders | 304.0–304.9, 305.2–305.7, 305.9 (drug abuse or dependence); 292 (drug-induced disorders); 965.0, 965.8, 967.0, 967.6, 967.8, 967.9, 969.4–969.9, 970.8, 982.0, 982.8 (drug intoxication) | F11.1, F12.1, F13.1, F14.1, F15.1, F16.1, F18.1, F19.1, F11.2, F12.2, F13.2, F14.2, F15.2, F16.2, F18.2, F19.2, F55 (drug abuse or dependence); F11.3–F11.9, F12.3–F12.9, F13.3–F13.9, F14.3–F14.9, F15.3–F15.9, F16.3–F16.9, F18.3–F18.9, F19.3–F19.9 (drug-induced MD); F11.0, F12.0, F13.0, F14.0, F15.0, F16.0, F18.0, F19.0, T40.0–T40.9, T42.3, T42.4, T42.6, T42.7, T43.5, T43.6, T43.8, T43.9, T50.9, T52.8, T52.9 (drug intoxication) |
Characteristics Overall | Total High ED Users in 2014–2015 (Index Year) | High One-Year ED Users | Recurrent High ED Users for Two Consecutive Years (2014–2015 and 2015–2016) | Recurrent High ED Users for Three Consecutive Years (2014–2015 to 2016–2017) | p-Value |
---|---|---|---|---|---|
N (%) | N (%) | N (%) | N (%) | ||
3121 (100) | 2289 (100) | 468 (100) | 364 (100) | ||
Clinical variables (2012–2013 to third ED visit in 2014–2015) or other, as specified | |||||
Mental disorders (MD) a | |||||
Common MD | |||||
Depressive disorders | 1510 (48.4) | 1114 (48.7) | 220 (47.0) | 176 (48.4) | 0.807 |
Anxiety disorders | 1740 (55.8) | 1239 (54.1) 3 | 260 (55.6) 3 | 241 (66.2) 1,2 | 0.000 |
Adjustment disorders | 1347 (43.2) | 983 (42.9) | 207 (44.2) | 157 (43.1) | 0.877 |
Serious MD | |||||
Schizophrenia spectrum and other psychotic disorders | 1292 (41.4) | 926 (40.5) | 209 (44.7) | 157 (43.1) | 0.188 |
Bipolar disorders | 1169 (37.5) | 850 (37.1) | 168 (35.9) | 151 (41.5) | 0.212 |
Personality disorders | 913 (29.3) | 600 (26.2) 2,3 | 161 (34.4) 1,3 | 152 (41.8) 1,2 | 0.000 |
Substance-related disorders (SRD) | |||||
Alcohol-related disorders | 715 (22.9) | 478 (20.9) 3 | 116 (24.8) 3 | 121 (33.2) 1,2 | 0.000 |
Drug-related disorders | 573 (18.4) | 373 (16.3) 2,3 | 94 (20.1) 1,3 | 106 (29.1) 1,2 | 0.000 |
Chronic physical illnesses | 1563 (50.1) | 1089 (47.6) 3 | 244 (52.1) 3 | 230 (63.2) 1,2 | 0.000 |
Elixhauser Comorbidity Index b | 0.025 | ||||
0 | 2331 (74.7) | 1738 (75.9)3 | 350 (74.8) | 243 (66.8) 1 | |
1 | 315 (10.1) | 222 (9.7) | 44 (9.4) | 49 (13.5) | |
2 | 200 (6.4) | 138 (6.0) | 32 (6.8) | 30 (8.2) | |
3+ | 275 (8.8) | 191 (8.3) | 42 (9.0) | 42 (11.5) | |
Reasons for emergency department (ED) visits | |||||
Suicidal behaviors (ideation or attempts) | 1401 (45.0) | 973 (42.6) 3 | 216 (46.2) 3 | 212 (58.4) 1,2 | 0.000 |
Violence or social issues | 168 (5.4) | 109 (4.8) 3 | 21 (4.5) 3 | 38 (10.4) 1,2 | 0.000 |
Illness acuity (triage priority levels) c | 0.154 | ||||
Level 1–2 (immediate or very urgent care) | 525 (16.8) | 403 (17.6) | 66 (14.1) | 56 (15.4) | |
Level 3 (urgent care) | 1000 (32.0) | 742 (32.4) | 141 (30.1) | 117 (32.1) | |
Level 4–5 (less urgent or non-urgent care) | 1596 (51.1) | 1144 (50.0) | 261 (55.8) | 191 (52.5) | |
ED patients on stretchers c | 1780 (57.0) | 1332 (58.2) 3 | 258 (55.1) | 190 (52.2) 1 | 0.067 |
Sociodemographic variables (2014–2015) | |||||
Age | 0.750 | ||||
12–24 years | 665 (21.3) | 478 (20.9) | 98 (20.9) | 89 (24.5) | |
25–44 years | 1166 (37.4) | 852 (37.2) | 182 (38.9) | 132 (36.3) | |
45–64 years | 887 (28.4) | 661 (28.9) | 131 (28.0) | 95 (26.1) | |
65+ years | 403 (12.9) | 298 (13.0) | 57 (12.2) | 48 (13.2) | |
Sex | 0.174 | ||||
Male | 1683 (53.9) | 1221 (53.3) | 249 (53.2) | 151 (41.5) | |
Female | 1438 (46.1) | 1068 (46.7) | 219 (46.8) | 213 (58.5) | |
Material Deprivation Index | 0.666 | ||||
1–2: least deprived | 1060 (34.0) | 788 (34.4) | 151 (32.3) | 121 (33.2) | |
3 | 570 (18.3) | 426 (18.6) | 82 (17.5) | 62 (17.0) | |
4–5: most deprived or not assigned d | 1491 (47.8) | 1075 (47.0) | 235 (50.2) | 181 (49.8) | |
Social Deprivation Index | 0.039 | ||||
1–2: least deprived | 615 (19.7) | 469 (20.5) 3 | 92 (19.7) | 54 (14.8) 1 | |
3 | 409 (13.1) | 312 (13.6) | 56 (12.0) | 92 (19.7) | |
4–5: most deprived or not assigned d | 2097 (67.2) | 1508 (65.9)3 | 320 (68.4) | 269 (73.9) 1 | |
Service use variables (12 months prior to third ED visit in 2014–2015) | |||||
Having a family physician | 1469 (47.1) | 1067 (46.7) | 223 (47.6) | 179 (49.3) | 0.632 |
Number of consultations with general practitioner (GP) most frequently consulted e | 0.894 | ||||
0 consultations | 634 (20.3) | 464 (20.3) | 97 (20.7) | 73 (20.1) | |
1–2 consultations | 731 (23.4) | 538 (23.5) | 114 (24.4) | 79 (21.7) | |
3+ consultations | 1756 (56.3) | 1287 (56.2) | 257 (54.9) | 212 (58.2) | |
Number of consultations with psychiatrist most frequently consulted f | 0.002 | ||||
0 consultations | 1193 (38.2) | 913 (39.9) 3 | 174 (37.2) | 120 (33.0) 1 | |
1–2 consultations | 374 (12.0) | 274 (12.0) | 57 (12.2) | 43 (11.8) | |
3+ consultations | 1554 (49.8) | 1102 (48.1) 3 | 237 (50.6) | 201 (55.2) 1 | |
Usual Provider Continuity Index integrating GP and psychiatrist g | |||||
≥0.80 | 580 (18.6) | 451 (19.7) 3 | 87 (18.6) 3 | 42 (11.5) 1,2 | 0.001 |
Number of interventions in local community health service centers (excluding GP interventions) | 0.001 | ||||
0 interventions | 1784 (57.2) | 1337 (58.4) 3 | 272 (58.1) 3 | 175 (48.1) 1,2 | |
1–2 interventions | 600 (19.2) | 444 (19.4) | 79 (16.9) | 77 (21.2) | |
3+ interventions | 737 (23.6) | 508 (22.2) 3 | 117 (25.0) | 112 (30.8) 1 | |
Prior hospitalizations (any medical reason) | 2082 (66.7) | 1479 (64.6) 3 | 321 (68.6) 3 | 282 (77.5) 1,2 | 0.000 |
Recurrent High ED Use for Two Consecutive Years (2014–2015 and 2015–2016) | Recurrent High ED Use for Three Consecutive Years (2014–2015 to 2016–2017) | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
Variables | β | p-Value | OR | 95% CI | β | p-Value | OR | 95% CI | ||
Clinical variables (2012–2013 to third ED visit in 2014–2015, or other as specified) a,b | ||||||||||
Mental disorders (MD) | ||||||||||
Common MD | ||||||||||
Anxiety disorders | 0.020 | 0.845 | 1.021 | 0.833 | 1.251 | 0.326 | 0.009 | 1.385 | 1.085 | 1.768 |
Serious MD | ||||||||||
Personality disorders | 0.367 | 0.001 | 1.443 | 1.153 | 1.805 | 0.352 | 0.006 | 1.422 | 1.107 | 1.827 |
Substance-related disorders (SRD) | ||||||||||
Alcohol-related disorders | 0.155 | 0.221 | 1.167 | 0.911 | 1.495 | 0.542 | 0.000 | 1.720 | 1.326 | 2.230 |
Drug-related disorders | 0.170 | 0.214 | 1.186 | 0.906 | 1.551 | 0.596 | 0.000 | 1.814 | 1.379 | 2.387 |
Chronic physical illnesses | 0.168 | 0.124 | 1.182 | 0.955 | 1.463 | 0.549 | 0.000 | 1.731 | 1.347 | 2.223 |
Reasons for emergency department (ED) visits | ||||||||||
Suicidal behaviors (ideation or attempts) | 0.120 | 0.263 | 1.128 | 0.914 | 1.392 | 0.604 | 0.000 | 1.826 | 1.433 | 2.335 |
Violence or social issues | −0.047 | 0.852 | 0.955 | 0.586 | 1.555 | 0.837 | 0.000 | 2.310 | 1.505 | 3.544 |
ED patients on stretchers c | −0.181 | 0.217 | 0.835 | 0.627 | 1.112 | −0.177 | 0.357 | 0.838 | 0.575 | 1.221 |
Sociodemographic variables (2014–2015) | ||||||||||
Social Deprivation Index (ref. 1–2: least deprived) | ||||||||||
3 | −0.076 | 0.682 | 0.927 | 0.644 | 1.334 | 0.154 | 0.498 | 1.167 | 0.747 | 1.823 |
4–5: most deprived or not assigned d | 0.098 | 0.458 | 1.102 | 0.852 | 1.426 | 0.468 | 0.005 | 1.597 | 1.155 | 2.208 |
Service use variables (12 months prior to third ED visit) | ||||||||||
Number of outpatient psychiatric consultations with usual medical provider; (ref.: 0 consultations) e | ||||||||||
1–2 consultations | 0.037 | 0.834 | 1.036 | 0.742 | 1.448 | 0.134 | 0.514 | 1.143 | 0.765 | 1.707 |
3+ consultations | 0.036 | 0.748 | 1.038 | 0.827 | 1.303 | 0.377 | 0.006 | 1.458 | 1.114 | 1.908 |
Continuity of medical care: Usual Provider Continuity Index integrating GP and psychiatrist (≥0.8) f | −0.045 | 0.738 | 0.956 | 0.735 | 1.243 | −0.550 | 0.002 | 0.577 | 0.405 | 0.821 |
Number of interventions in local community health service centers, excluding GP consultations; (ref.: 0) | ||||||||||
1–2 interventions | −0.242 | 0.109 | 0.785 | 0.584 | 1.055 | 0.027 | 0.872 | 1.027 | 0.743 | 1.419 |
3+ interventions | 0.048 | 0.639 | 1.049 | 0.828 | 1.328 | 0.298 | 0.028 | 1.347 | 1.033 | 1.757 |
Prior hospitalizations (for any medical reason) | 0.134 | 0.267 | 1.144 | 0.902 | 1.450 | 0.309 | 0.037 | 1.362 | 1.018 | 1.823 |
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Gentil, L.; Grenier, G.; Vasiliadis, H.-M.; Huỳnh, C.; Fleury, M.-J. Predictors of Recurrent High Emergency Department Use among Patients with Mental Disorders. Int. J. Environ. Res. Public Health 2021, 18, 4559. https://doi.org/10.3390/ijerph18094559
Gentil L, Grenier G, Vasiliadis H-M, Huỳnh C, Fleury M-J. Predictors of Recurrent High Emergency Department Use among Patients with Mental Disorders. International Journal of Environmental Research and Public Health. 2021; 18(9):4559. https://doi.org/10.3390/ijerph18094559
Chicago/Turabian StyleGentil, Lia, Guy Grenier, Helen-Maria Vasiliadis, Christophe Huỳnh, and Marie-Josée Fleury. 2021. "Predictors of Recurrent High Emergency Department Use among Patients with Mental Disorders" International Journal of Environmental Research and Public Health 18, no. 9: 4559. https://doi.org/10.3390/ijerph18094559