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. 2022 Jul 14;22(1):127.
doi: 10.1186/s12873-022-00673-x.

Characterizing people with frequent emergency department visits and substance use: a retrospective cohort study of linked administrative data in Ontario, Alberta, and B.C., Canada

Jessica Moe  1   2   3 , Yueqiao Elle Wang  4 , Michael J Schull  5   6 , Kathryn Dong  7 , Margaret J McGregor  8 , Corinne M Hohl  4   9 , Brian R Holroyd  7   10 , Kimberlyn M McGrail  11
Affiliations

Characterizing people with frequent emergency department visits and substance use: a retrospective cohort study of linked administrative data in Ontario, Alberta, and B.C., Canada

Jessica Moe et al. BMC Emerg Med. .

Abstract

Background: Substance use is common among people who visit emergency departments (EDs) frequently. We aimed to characterize subgroups within this cohort to better understand care needs/gaps, and generalizability of characteristics in three Canadian provinces.

Methods: This was a retrospective cohort study (April 1st, 2013 to March 31st, 2016) of ED patients in Ontario, Alberta, and British Columbia (B.C.) We included patients ≥ 18 years with substance use-related healthcare contact during the study period and frequent ED visits, defined as those in the top 10% of ED utilization when all patients were ordered by annual ED visit number. We used linked administrative databases including ED visits and hospitalizations (all provinces); mental heath-related hospitalizations (Ontario and Alberta); and prescriptions, physician services, and mortality (B.C.). We compared to cohorts of people with (1) frequent ED visits and no substance use, and (2) non-frequent ED visits and substance use. We employed cluster analysis to identify subgroups with distinct visit patterns and clinical characteristics during index year, April 1st, 2014 to March 31st, 2015.

Results: In 2014/15, we identified 19,604, 7,706, and 9,404 people with frequent ED visits and substance use in Ontario, Alberta, and B.C (median 37-43 years; 60.9-63.0% male), whose ED visits and hospitalizations were higher than comparison groups. In all provinces, cluster analyses identified subgroups with "extreme" and "moderate" frequent visits (median 13-19 versus 4-6 visits/year). "Extreme" versus "moderate" subgroups had more hospitalizations, mental health-related ED visits, general practitioner visits but less continuity with one provider, more commonly left against medical advice, and had higher 365-day mortality in B.C. (9.3% versus 6.6%; versus 10.4% among people with frequent ED visits and no substance use, and 4.3% among people with non-frequent ED visits and substance use). The most common ED diagnosis was acute alcohol intoxication in all subgroups.

Conclusions: Subgroups of people with "extreme" (13-19 visits/year) and "moderate" (4-6 visits/year) frequent ED visits and substance use had similar utilization patterns and characteristics in Ontario, Alberta, and B.C., and the "extreme" subgroup had high mortality. Our findings suggest a need for improved evidence-based substance use disorder management, and strengthened continuity with primary and mental healthcare.

Keywords: Emergency medicine; Epidemiology; Frequent Users; Health policy; Health services research; High Service Users; Substance-Related Disorders.

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Conflict of interest statement

KD discloses the following potential competing interests: grant from the Canadian Research Initiative in Substance Misuse; committee honoraria from the College of Physicians and Surgeons of Alberta and the Edmonton Zone Medical Staff Association; receipt of funding for travel from the Royal College of Physicians and Surgeons of Canada to chair the AFC Addiction Medicine Committee; receipt of funding from the Canadian Association of Emergency Physicians for conference registration as a track chair; receipt of a Medical Leadership Salary from Alberta Health Services. JM discloses the following potential competing interests: receipt of research grants from the Canadian Institutes of Health Research, Health Canada Substance Use and Addictions Program, Vancouver Coastal Health Research Institute, Vancouver Foundation, Vancouver Physician Staff Association, UBC Department of Family Practice & Community Geriatrics, Vancouver General Hospital Complex Pain and Addictions Service, BCCDC Foundation for Public Health, and UBC Faculty of Medicine. No other authors declare that they have competing interests.

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