scholarly journals P106: Healthcare utilization among homeless and/or substance using adults presenting to the ED

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S114-S114
Author(s):  
V.V. Puri ◽  
K. Dong ◽  
B.H. Rowe ◽  
S.W. Kirkland ◽  
C. Vandenberghe ◽  
...  
Keyword(s):  
Substance Use ◽  
Risk Factor ◽  
High Risk ◽  
Drug Use ◽  
Acute Care ◽  
Unstable Housing ◽  
Alcohol And Drug Use ◽  
Ed Visits ◽  
The Impact

Introduction: Substance use and unstable housing are associated with heavy use of the Emergency Department (ED). This study examined the impact of substance use and unstable housing on the probability of future ED use. Methods: Case-control study of patients presenting to an urban ED. Patients were eligible if they were unstably housed for the past 30 days, and/or if their chief complaint was related to substance use. Following written informed consent, patients completed a baseline survey and health care use was tracked via electronic medical records for the next six months. Controls were enrolled in a 1:4 ratio. More than 2 ED visits during the follow-up was pre-specified as a measure of excess ED use. Descriptive analyses included proportions and medians with interquartile ranges (IQR). Binomial logistic regression models were used to estimate the impact of housing status, high-risk alcohol use (AUDIT) and drug use (DUDIT), and combinations of these factors on subsequent acute care system contacts (ED visits + admissions). We controlled for age, gender, comorbidities at baseline, and baseline presenting acuity. Results: 41 controls, 46 substance using, 91 unstably housed, and 31 both unstably housed and substance using patients were enrolled (n = 209). Median ED visits during follow up were 0 (IQR: 0-1.0) for controls, 1.0 (IQR: 0-3.3) for substance using, 1.0 (IQR: 0-4.0) for unstably housed and 4 (IQR: 2-12.3) for unstably housed and substance using patients. The median acute care system contacts over the same period was 1.0 (IQR 0-2.0) for controls, 1.0 (IQR: 0-4.0) for substance using, 1.0 (IQR: 0-5.0) for unstably housed and 4.5 (IQR: 2.8-14.3) for unstably housed and substance using patients. Being unstably housed was the factor most strongly associated with having > 2 ED visits (b=3.288, p<0.005) followed by high-risk alcohol and drug use (b=2.149, p<0.08); high risk alcohol use alone was not significantly associated with ED visits (b=1.939, p<0.1). The number of comorbidities present at baseline was a small but statistically significant additional risk factor (b=0.478, p<0.05). The model correctly predicted 70.1% of patients’ ED utilization status. Conclusion: Unstable housing is a substantial risk factor for ED use; high-risk alcohol and drug use, and comorbidities at baseline increased this risk. The intensity of excess ED use was greatest in patients who were unstably housed and substance using.

scholarly journals The Impact of Abuse Trauma on Alcohol and Drug Use: a Study of High-Risk Incarcerated Girls

2016 ◽  
Vol 25 (3) ◽  
pp. 194-205 ◽  
Author(s):  
S. Lynne Rich ◽  
Janet K. Wilson ◽  
Angela A. Robertson
Keyword(s):  
High Risk ◽  
Drug Use ◽  
Alcohol And Drug Use ◽  
The Impact

Do Stimulants Reduce the Risk for Alcohol and Substance Use in Youth With ADHD? A Secondary Analysis of a Prospective, 24-Month Open-Label Study of Osmotic-Release Methylphenidate

2016 ◽  
Vol 21 (1) ◽  
pp. 71-77 ◽  
Author(s):  
Paul Hammerness ◽  
Carter Petty ◽  
Stephen V. Faraone ◽  
Joseph Biederman
Keyword(s):  
Clinical Trial ◽  
Substance Use ◽  
Drug Use ◽  
Secondary Analysis ◽  
Self Report ◽  
Open Label ◽  
Stimulant Treatment ◽  
Alcohol And Drug Use ◽  
The Impact ◽  
Youth With Adhd

Objective: The purpose of this study was to examine the impact of stimulant treatment on risk for alcohol and illicit drug use in adolescents with ADHD. Method: Analysis of data derived from a prospective open-label treatment study of adolescent ADHD ( n = 115, 76% male), and a historical, naturalistic sample of ADHD ( n = 44, 68% male) and non-ADHD youth ( n = 52, 73% male) of similar age and sex. Treatment consisted of extended-release methylphenidate in the clinical trial or naturalistic stimulant treatment. Self-report of alcohol and drug use was derived from a modified version of the Drug Use Screening Inventory. Results: Rates of alcohol and drug use in the past year were significantly lower in the clinical trial compared with untreated and treated naturalistic ADHD comparators, and similar to rates in non-ADHD comparators. Conclusion: Well-monitored stimulant treatment may reduce the risk for alcohol and substance use in adolescent ADHD.

A multicenter quality improvement initiative on the impact of pharmacists’ postdischarge follow-up to reduce medication-related acute care episodes

2020 ◽  
Vol 77 (12) ◽  
pp. 938-942
Author(s):  
Lydia Noh ◽  
Kristina Heimerl ◽  
Rita Shane
Keyword(s):  
Quality Improvement ◽  
High Risk ◽  
Acute Care ◽  
Academic Medical Centers ◽  
Quality Improvement Initiative ◽  
Medical Centers ◽  
Academic Medical ◽  
Risk Patients ◽  
The Impact

Abstract Purpose This multicenter quality improvement initiative aims to measure and quantify pharmacists’ impact on reducing medication-related acute care episodes (MACEs) for high-risk patients at an increased risk for readmission due to drug-related problems (DRPs). Methods This was a prospective, multicenter quality improvement initiative conducted at 9 academic medical centers. Each participant implemented a standardized methodology for evaluating MACE likelihood to demonstrate the impact of pharmacist postdischarge follow-up (PDFU). The primary outcome was MACEs prevented, and the secondary outcome was DRPs identified and resolved by pharmacists. During PDFU, pharmacists were responsible for identification and resolution of DRPs, and cases were reviewed by physicians to confirm whether potential MACEs were prevented. Results A total of 840 patients were contacted by 9 participating academic medical centers during a 6-week data collection period. Of these, 328 cases were identified as MACEs prevented during PDFU by pharmacists, and physician reviewers confirmed that pharmacist identification of DRPs during PDFU prevented 27.9% of readmissions. Pharmacist identified 959 DRPs, 2.8% (27) of which were identified as potentially life threatening. Potentially serious or significant DRPs made up 56.6% (543) of the DRPs, and 40.6% (389) were identified as having a low capacity for harm. Conclusion The results demonstrate that PDFU of high-risk patients reduces DRPs and prevents MACEs based on physician confirmation. Implementation of MACE methodology provides health-system pharmacy departments the ability to demonstrate pharmacists’ value in transitions of care and assist in expanding pharmacist services.

Early Substance Use and School Achievement: An Examination of Latino, White, and African American Youth

2002 ◽  
Vol 32 (3) ◽  
pp. 921-943 ◽  
Author(s):  
Cynthia Perez McCluskey ◽  
Marvin D. Krohn ◽  
Alan J. Lizotte ◽  
Monica L. Rodriguez
Keyword(s):  
High School ◽  
Substance Use ◽  
African American ◽  
Drug Use ◽  
African American Males ◽  
Life Course Perspective ◽  
Alcohol And Drug Use ◽  
School Completion ◽  
The Impact ◽  
The Relationship

This study examines the impact of early substance use on school completion. From a life-course perspective, early deviance can interrupt adolescent development, including education. Studies have cited substance use in early adolescence as a risk factor for school dropout; however, few studies examine the relationship with diverse samples. Using longitudinal data from the Rochester Youth Development Study, we examine the impact of early alcohol and drug use on high school completion relative to other risk factors for Latino, White, and African American males. Once family, school, and life events are considered, early alcohol and drug use exerts an independent influence on the failure to complete high school for White and African American males. Among Latino males, the relationship between early use and school completion appears to be mediated by impregnating a partner

scholarly journals Biomarkers-based personalized follow-up in chronic heart failure improves patient’s outcomes and reduces care associate cost

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Antonio Leon-Justel ◽  
Jose I. Morgado Garcia-Polavieja ◽  
Ana Isabel Alvarez-Rios ◽  
Francisco Jose Caro Fernandez ◽  
Pedro Agustin Pajaro Merino ◽  
...  
Keyword(s):  
Heart Failure ◽  
Hospital Admissions ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Secondary Outcome ◽  
Ventricular Ejection Fraction ◽  
Number Of Patients ◽  
Ed Visits ◽  
The Impact

Abstract Background Heart failure (HF) is a major and growing medical and economic problem, with high prevalence and incidence rates worldwide. Cardiac Biomarker is emerging as a novel tool for improving management of patients with HF with a reduced left ventricular ejection fraction (HFrEF). Methods This is a before and after interventional study, that assesses the impact of a personalized follow-up procedure for HF on patient’s outcomes and care associated cost, based on a clinical model of risk stratification and personalized management according to that risk. A total of 192 patients were enrolled and studied before the intervention and again after the intervention. The primary objective was the rate of readmissions, due to a HF. Secondary outcome compared the rate of ED visits and quality of life improvement assessed by the number of patients who had reduced NYHA score. A cost-analysis was also performed on these data. Results Admission rates significantly decreased by 19.8% after the intervention (from 30.2 to 10.4), the total hospital admissions were reduced by 32 (from 78 to 46) and the total length of stay was reduced by 7 days (from 15 to 9 days). The rate of ED visits was reduced by 44% (from 64 to 20). Thirty-one percent of patients had an improved functional class score after the intervention, whereas only 7.8% got worse. The overall cost saving associated with the intervention was € 72,769 per patient (from € 201,189 to € 128,420) and €139,717.65 for the whole group over 1 year. Conclusions A personalized follow-up of HF patients led to important outcome benefits and resulted in cost savings, mainly due to the reduction of patient hospitalization readmissions and a significant reduction of care-associated costs, suggesting that greater attention should be given to this high-risk cohort to minimize the risk of hospitalization readmissions.

Improvement in psychological wellbeing among adolescents with a substance use disorder attending an outpatient treatment programme

2021 ◽  
pp. 1-8
Author(s):  
N.M. Gamage ◽  
C. Darker ◽  
B.P. Smyth
Keyword(s):  
Substance Use ◽  
Psychological Symptoms ◽  
Significant Proportion ◽  
Cannabis Use ◽  
Psychological Wellbeing ◽  
Substance Use Treatment ◽  
Disruptive Behaviour ◽  
Treatment Programme ◽  
The Impact

Objectives: Adolescents with substance use disorders (SUDs) exhibit high rates of comorbid psychological problems. This study aimed to examine the impact of an outpatient substance use treatment programme upon the psychological wellbeing of adolescents. Methods: A prospective study was carried out examining psychological symptoms in a group of adolescents attending the Youth Drug and Alcohol (YoDA) Addiction Service in Dublin. Participants were treated with evidenced based psychological models such as cognitive behavioural therapy, motivational interviewing and systemic family therapy. The Becks Youth Inventory was utilised to assess psychological symptoms at treatment entry and repeated three months later at follow up. Results: Among 36 adolescents who were included in this study, poly-substance misuse was the norm. Almost three-quarter had a cannabis use disorder (CUD). There were significant reductions in mean subscale scores of depression (56.0 to 50.8, p = 0.003), anger (55.2 to 49.5, p < 0.001) and disruptive behaviour (61.6 to 56.5, p = 0.002) at follow up. Although there wasn’t a statistically significant reduction in mean scores for anxiety, we observed a significant proportion of participants (p = 0.008) improving and moving out of a moderate to severe symptom range when examined by category. This was also the case for self-concept (p = 0.04). Furthermore this study revealed a positive correlation between the reduction in days of cannabis use and reduction in depressive scores (Pearson correlation 0.49, p = 0.01) among those with a CUD. Conclusion: The findings indicate that substance use treatment for adolescents is associated with important psychological and behavioural improvements.

scholarly journals Does parental permissiveness toward cigarette smoking and alcohol use influence illicit drug use among adolescents? A longitudinal study in seven European countries

2021 ◽  
Author(s):  
Emina Mehanović ◽  
Federica Vigna-Taglianti ◽  
Fabrizio Faggiano ◽  
Maria Rosaria Galanti ◽  
Barbara Zunino ◽  
...  
Keyword(s):  
Alcohol Use ◽  
Drug Use ◽  
Cigarette Smoking ◽  
Longitudinal Data ◽  
Illicit Drug ◽  
Large Population ◽  
Illicit Drug Use ◽  
European Countries ◽  
The Impact

Abstract Purpose Adolescents’ perceptions of parental norms may influence their substance use. The relationship between parental norms toward cigarette and alcohol use, and the use of illicit substances among their adolescent children is not sufficiently investigated. The purpose of this study was to analyze this relationship, including gender differences, using longitudinal data from a large population-based study. Methods The present study analyzed longitudinal data from 3171 12- to 14-year-old students in 7 European countries allocated to the control arm of the European Drug Addiction Prevention trial. The impact of parental permissiveness toward cigarettes and alcohol use reported by the students at baseline on illicit drug use at 6-month follow-up was analyzed through multilevel logistic regression models, stratified by gender. Whether adolescents’ own use of cigarette and alcohol mediated the association between parental norms and illicit drug use was tested through mediation models. Results Parental permissive norms toward cigarette smoking and alcohol use at baseline predicted adolescents’ illicit drug use at follow-up. The association was stronger among boys than among girls and was mediated by adolescents’ own cigarette and alcohol use. Conclusion Perceived parental permissiveness toward the use of legal drugs predicted adolescents’ use of illicit drugs, especially among boys. Parents should be made aware of the importance of norm setting, and supported in conveying clear messages of disapproval of all substances.

scholarly journals A longitudinal study over 40 years to study the metabolic syndrome as a risk factor for cardiovascular diseases

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Lars Lind ◽  
Johan Sundström ◽  
Johan Ärnlöv ◽  
Ulf Risérus ◽  
Erik Lampa
Keyword(s):  
Metabolic Syndrome ◽  
Risk Factor ◽  
Longitudinal Study ◽  
Clinical Intervention ◽  
The Elderly ◽  
Adult Men ◽  
The Metabolic Syndrome ◽  
The Impact ◽  
Over 40 Years

AbstractThe impact of most, but not all, cardiovascular risk factors decline by age. We investigated how the metabolic syndrome (MetS) was related to cardiovascular disease (CVD) during 40 years follow-up in the Uppsala Longitudinal Study of Adult Men (ULSAM, 2,123 men all aged 50 at baseline with reinvestigations at age 60, 70, 77 and 82). The strength of MetS as a risk factor of incident combined end-point of three outcomes (CVD) declined with ageing, as well as for myocardial infarction, ischemic stroke and heart failure when analysed separately. For CVD, the risk ratio declined from 2.77 (95% CI 1.90–4.05) at age 50 to 1.30 (95% CI 1.05–1.60) at age 82. In conclusion, the strength of MetS as a risk factor of incident CVD declined with age. Since MetS was significantly related to incident CVD also at old age, our findings suggest that the occurrence of MetS in the elderly should not be regarded as innocent. However, since our data were derived in an observational study, any impact of MetS in the elderly needs to be verified in a randomized clinical intervention trial.

scholarly journals Associations between History of Hospitalization for Violence Victimization and Substance-Use Patterns among Adolescents: A 2017 Korean National Representative Survey

2018 ◽  
Vol 15 (7) ◽  
pp. 1543
Author(s):  
Yeji Lee ◽  
Kang-Sook Lee
Keyword(s):  
Substance Use ◽  
Drug Use ◽  
Secondary Data ◽  
Web Based ◽  
Alcohol And Drug Use ◽  
Violence Victimization ◽  
Use Patterns ◽  
Chi Squared ◽  
History Of ◽  
Victimization Experience

Violence victimization can adversely affect adolescents’ long-term health. Existing research has mainly focused on the link between victimization and substance use; however, the evidence obtained to date has been inconsistent. This study, using a Korean national representative sample, examined the association between violence victimization and substance-use patterns (including tobacco, alcohol, and drug use) in terms of sex and number of violence victimization experiences. We analyzed secondary data from the 2017 Korean Youth Risk Behavior Web-based Survey. Chi-squared test analyses and logistic regression analysis were used to examine substance use in terms of violence victimization; additionally, p-values for trends were calculated to reveal the dose-response relationship per number of violence victimization experiences. We consequently found that participants’ rates of tobacco, alcohol, and drug use were higher among those who experienced violence victimization than among those who did not. For each substance-use-related variable, the greater the violence victimization experience, the higher the odds of substance use (p for trend < 0.001). Early intervention may help prevent the development of substance use, especially among adolescents who have experienced violence victimization. Prevention efforts regarding substance abuse and violence prevention should be included in school curricula to effectively prevent adverse health consequences among adolescents.

Sign in / Sign up

Export Citation Format

Share Document