Observational Study

. 2017 May 12;14(1):16.

doi: 10.1186/s12954-017-0143-4.

A cohort study examining emergency department visits and hospital admissions among people who use drugs in Ottawa, Canada

Claire E Kendall¹, Lisa M Boucher², Amy E Mark³, Alana Martin⁴, Zack Marshall⁵, Rob Boyd⁶, Pam Oickle⁷, Nicola Diliso⁸, Dave Pineau⁸, Brad Renaud⁸, Tiffany Rose⁸, Sean LeBlanc^{8

9}, Mark Tyndall¹⁰, Olivia M Lee¹¹, Ahmed M Bayoumi^{3

12

13}

Affiliations

¹ Bruyère Research Institute, 43 Bruyère Street (Annex E), Ottawa, ON, K1N 5C8, Canada. ckendall@uottawa.ca.
² Bruyère Research Institute, 43 Bruyère Street (Annex E), Ottawa, ON, K1N 5C8, Canada.
³ Institute for Clinical Evaluative Sciences, Ottawa Hospital, Civic Campus, 1053 Carling Avenue, Box 684, Administrative Services Building, 1st Floor, Ottawa, ON, K1Y 4E9, Canada.
⁴ Ottawa Hospital Research Institute, 1053 Carling Avenue, Ottawa, Ontario, K1Y 4E9, Canada.
⁵ Social Development Studies and School of Social Work, Renison University College-University of Waterloo, 240 Westmount Road North, Waterloo, ON, N2L 3G4, Canada.
⁶ Sandy Hill Community Health Centre, 221 Nelson Street, Ottawa, ON, K1N 1C7, Canada.
⁷ Ottawa Public Health, 179 Clarence St, Ottawa, ON, K1N 5P7, Canada.
⁸ PROUD Community Advisory Committee, Ottawa, ON, Canada.
⁹ Drug Users Advocacy League, Ottawa, ON, Canada.
¹⁰ BC Centre for Disease Control, 655W 12th Avenue, Vancouver, BC, V5Z 4R4, Canada.
¹¹ Faculty of Medicine, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8 L1, Canada.
¹² Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute and Division of General Internal Medicine, St. Michael's Hospital, Toronto, Canada.
¹³ Department of Medicine and Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto ON 30 Bond St, Toronto, ON, M5B 1 W8, Canada.

PMID: 28494791
PMCID: PMC5427560
DOI: 10.1186/s12954-017-0143-4

Observational Study

A cohort study examining emergency department visits and hospital admissions among people who use drugs in Ottawa, Canada

Claire E Kendall et al. Harm Reduct J. 2017.

. 2017 May 12;14(1):16.

doi: 10.1186/s12954-017-0143-4.

Authors

Affiliations

¹ Bruyère Research Institute, 43 Bruyère Street (Annex E), Ottawa, ON, K1N 5C8, Canada. ckendall@uottawa.ca.
² Bruyère Research Institute, 43 Bruyère Street (Annex E), Ottawa, ON, K1N 5C8, Canada.
³ Institute for Clinical Evaluative Sciences, Ottawa Hospital, Civic Campus, 1053 Carling Avenue, Box 684, Administrative Services Building, 1st Floor, Ottawa, ON, K1Y 4E9, Canada.
⁴ Ottawa Hospital Research Institute, 1053 Carling Avenue, Ottawa, Ontario, K1Y 4E9, Canada.
⁵ Social Development Studies and School of Social Work, Renison University College-University of Waterloo, 240 Westmount Road North, Waterloo, ON, N2L 3G4, Canada.
⁶ Sandy Hill Community Health Centre, 221 Nelson Street, Ottawa, ON, K1N 1C7, Canada.
⁷ Ottawa Public Health, 179 Clarence St, Ottawa, ON, K1N 5P7, Canada.
⁸ PROUD Community Advisory Committee, Ottawa, ON, Canada.
⁹ Drug Users Advocacy League, Ottawa, ON, Canada.
¹⁰ BC Centre for Disease Control, 655W 12th Avenue, Vancouver, BC, V5Z 4R4, Canada.
¹¹ Faculty of Medicine, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8 L1, Canada.
¹² Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute and Division of General Internal Medicine, St. Michael's Hospital, Toronto, Canada.
¹³ Department of Medicine and Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto ON 30 Bond St, Toronto, ON, M5B 1 W8, Canada.

PMID: 28494791
PMCID: PMC5427560
DOI: 10.1186/s12954-017-0143-4

Erratum in

Erratum to: A cohort study examining emergency department visits and hospital admissions among people who use drugs in Ottawa, Canada.
Kendall CE, Boucher LM, Mark AE, Martin A, Marshall Z, Boyd R, Oickle P, Diliso N, Pineau D, Renaud B, Rose T, LeBlanc S, Tyndall M, Lee OM, Bayoumi AM. Kendall CE, et al. Harm Reduct J. 2017 Jul 3;14(1):42. doi: 10.1186/s12954-017-0169-7. Harm Reduct J. 2017. PMID: 28673291 Free PMC article. No abstract available.

Abstract

Background: The health of people who use drugs (PWUD) is characterized by multimorbidity and chronicity of health conditions, necessitating an understanding of their health care utilization. The objective of this study was to evaluate emergency department (ED) visits and hospital admissions among a cohort of PWUD.

Methods: We used a retrospective observational design between 2012 and 2013. The population was a marginalized cohort of PWUD (the PROUD study) for whom survey data was linked (n = 663) to provincial health administrative data housed at the Institute for Clinical Evaluative Sciences. We constructed a 5:1 comparison group matched by age, sex, income quintile, and region. The main outcomes were defined as having two or more ED visits, or one or more hospital admissions, in the year prior to survey completion. We used multivariable logistic regression analyses to identify factors associated with these outcomes.

Results: Compared to the matched cohort, PWUD had higher rates of ED visits (rate ratio [RR] 7.0; 95% confidence interval [95% CI] 6.5-7.6) and hospitalization (RR 7.7; 95% CI 5.9-10.0). After adjustment, factors predicting more ED visits were receiving disability (adjusted odds ratio [AOR] 3.0; 95% CI 1.7-5.5) or income assistance (AOR 2.7; 95% CI 1.5-5.0), injection drug use (AOR 2.1; 95% CI 1.3-3.4), incarceration within 12 months (AOR 1.6; 95% CI 1.1-2.4), mental health comorbidity (AOR 2.1; 95% CI 1.4-3.1), and a suicide attempt within 12 months (AOR 2.1; 95% CI 1.1-3.4). Receiving methadone (AOR 0.5; 95% CI 0.3-0.9) and having a regular family physician (AOR 0.5; 95% CI 0.2-0.9) were associated with lower odds of having more ED visits. Factors associated with more hospital admissions included Aboriginal identity (AOR 2.4; 95% CI 1.4-4.1), receiving disability (AOR 2.4; 95% CI 1.1-5.4), non-injection drug use (opioids and non-opioids) (AOR 2.2; 95% CI 1.1-4.4), comorbid HIV (AOR 2.4; 95% CI 1.2-5.6), mental health comorbidity (AOR 2.4; 95% CI 1.3-4.2), and unstable housing (AOR 1.9; 95% CI 1.0-3.4); there were no protective factors for hospitalization.

Conclusions: Improved post-incarceration support, housing services, and access to integrated primary care services including opioid replacement therapy may be effective interventions to decrease acute care use among PWUD, including targeted approaches for people receiving social assistance or with mental health concerns.

Keywords: Emergency department visits; Health administrative data; Hospital admissions; Matched control group; Multimorbidity; Opioid replacement therapy; People who use drugs; Prescription drug benefits; Primary care; Self-reported data.

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A cohort study examining emergency department visits and hospital admissions among people who use drugs in Ottawa, Canada

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A cohort study examining emergency department visits and hospital admissions among people who use drugs in Ottawa, Canada

Authors

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