scholarly journals Clearing the air: A study of cannabis-related presentations to urban Alberta emergency departments following legalization

CJEM ◽  
2020 ◽  
Vol 22 (6) ◽  
pp. 776-783
Author(s):  
Matthew E. M. Yeung ◽  
Colin G. Weaver ◽  
Kevin Janz ◽  
Rebecca Haines-Saah ◽  
Eddy Lang
Keyword(s):  
Emergency Departments ◽  
Interrupted Time Series ◽  
Poison Control ◽  
Medical Cannabis ◽  
Interrupted Time Series Analysis ◽  
Absolute Level ◽  
Level Change ◽  
Control Centre ◽  
Ed Visits ◽  
Pre Treatment

ABSTRACTObjectivesNon-medical cannabis recently became legal for adults in Canada. Legalization provides opportunity to investigate the public health effects of national cannabis legalization on presentations to emergency departments (EDs). Our study aimed to explore association between cannabis-related ED presentations, poison control and telemedicine calls, and cannabis legalization.MethodsData were collected from the National Ambulatory Care Reporting System from October 1, 2013, to July 31, 2019, for 14 urban Alberta EDs, from Alberta poison control, and from HealthLink, a public telehealth service covering all of Alberta. Visitation data were obtained to compare pre- and post-legalization periods. An interrupted time-series analysis accounting for existing trends was completed, in addition to the incidence rate ratio (IRR) and relative risk calculation (to evaluate changes in co-diagnoses).ResultsAlthough only 3 of every 1,000 ED visits within the time period were attributed to cannabis, the number of cannabis-related ED presentations increased post-legalization by 3.1 (range -11.5 to 12.6) visits per ED per month (IRR 1.45, 95% confidence interval [CI]; 1.39, 1.51; absolute level change: 43.5 visits per month, 95% CI; 26.5, 60.4). Cannabis-related calls to poison control also increased (IRR 1.87, 95% CI; 1.55, 2.37; absolute level change: 4.0 calls per month, 95% CI; 0.1, 7.9). Lastly, we observed increases in cannabis-related hyperemesis, unintentional ingestion, and individuals leaving the ED pre-treatment. We also observed a decrease in co-ingestant use.ConclusionOverall, Canadian cannabis legalization was associated with small increases in urban Alberta cannabis-related ED visits and calls to a poison control centre.

scholarly journals MP03: Clearing the air: A retrospective cohort study of cannabis-related harms in urban Alberta emergency departments following legalization

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S43-S43
Author(s):  
M. Yeung ◽  
C. Weaver ◽  
E. Lang ◽  
R. Saah-Haines ◽  
K. Janz
Keyword(s):  
Emergency Departments ◽  
Hospital Admissions ◽  
Population Increase ◽  
Relative Risk Ratio ◽  
Poison Control ◽  
Absolute Level ◽  
Study Objective ◽  
Level Change ◽  
Ed Visits ◽  
The Impact

Introduction: Non-medical cannabis recently became legal on October 18th, 2018 to Canadian adults. The impact of legalization on Emergency Departments (EDs) has been identified as a major concern. The study objective was to identify changes in cannabis-related ED visits and changes in co-existing diagnoses associated with cannabis-related ED visits pre- and post-legalization for the entire urban population of Alberta. Urban Alberta was defined as Calgary and Edmonton, inclusive of Sherwood Park and St. Albert given the proximity of some Edmontonians to their EDs) encompassing 12 adult EDs and 2 pediatric EDs. Methods: Retrospective data was collected from the National Ambulatory Care Reporting System, and from the HealthLink and the Alberta Poison and Drug Information Service (PADIS) public telehealth call databases. An interrupted time-series analysis was completed via segmented regression calculation in addition to incident rate and relative risk ratio calculation for the pre- and post-legalization periods to identify both differences among the entire urban Alberta population and differences among individuals presenting to the ED. Data was collected from October 1st, 2013 up to July 31st, 2019 for ED visits and was adjusted for natural population increase using quarterly reports from the Government of Alberta. Results: The sample included 11 770 pre-legalization cannabis-related visits, and 2962 post-legalization visits. Volumes of ED visits for cannabis-related harms were found to increase post-legalization within urban EDs (IRR 1.45, 95% CI 1.39, 1.51; absolute level change: 43.48 visits per month in urban Alberta, 95% CI 26.52, 60.43), and for PADIS calls (IRR 1.87, 95% CI 1.55, 2.37; absolute level change: 4.02 calls per month in Alberta, 95% CI 0.11, 7.94). The increase in visits to EDs equates to an increase of 2.72 visits per month, per ED. Lastly, increases were observed for cannabinoid hyperemesis (RR 1.23, 95% CI 1.10, 1.36), unintentional ingestion (RR 1.48, 95% CI 1.34, 1.62), and in individuals leaving the ED pre-treatment (RR 1.28, 95% CI 1.08, 1.49). Decreases were observed for coingestant use (RR 0.77, 95% CI 0.73, 0.81) and hospital admissions (RR 0.88, 95% CI 0.80, 0.96). Conclusion: Overall, national legalization of cannabis appears to be correlated with a small increase in cannabis-related ED visits and poison control calls. Post-legalization, fewer patients are being admitted, though cannabinoid hyperemesis appears to be on the rise.

scholarly journals Cannabis in the Emergency Department: The impact of cannabis legalization on cannabis and opioid-related presentations

2019 ◽  
Vol 2 (3) ◽  
pp. 6
Author(s):  
Matthew Yeung ◽  
Kevin Janz ◽  
Colin Weaver ◽  
Rebecca Saah-Haines ◽  
Eddy Lang
Keyword(s):  
Information Service ◽  
State Level ◽  
Interrupted Time Series ◽  
The United States ◽  
Poison Control ◽  
Medical Cannabis ◽  
Interrupted Time Series Analysis ◽  
Developed Country ◽  
Short Period ◽  
The Impact

Background: On October 17th, 2018, non-medical cannabis became legal to adults for the first time in Canada. This has created a previously unseen opportunity to investigate the effects of recreational cannabis legalization in a developed country, particularly on strained Emergency Departments (EDs). Secondly, reports within the United States have suggested state-level legalization of cannabis, both recreationally and medically, has resulted in a decrease of opiate-related presentations. Given the pressure of the opiate crisis on healthcare resources, we sought to examine if this trend was present in Alberta. Objectives: The current study aims to identify if presentation patterns in adult and pediatric populations have changed when comparing pre- and post-legalization periods, and if rural-urban disparities exist. We also aim to identify if the legalization of cannabis is correlated with a reduction in opiate-related ED presentations. Lastly, we aimed to address the aforementioned objectives in the context of telehealth by examining calls to poison control and HealthLink within Alberta. Methods: Retrospective data was collected from the National Ambulatory Care Reporting System, HealthLink, and Poison and Drug Information Service. Extraction is currently in progress, and we expect to include 20 000 records and 12 000 calls. An interrupted time-series analysis will be completed, allowing for a comparison of trends pre- and post-legalization. Participants have been identified based on International Disease Classifications for cannabis and opiate-related injury. Commonly reported injuries will be clustered to identify changes in injury patterns. Data was collected from October 1st 2013 up to May 31st, 2019 for all EDs within Alberta. Results: Preliminary results suggest the legalization of cannabis initially led to a dramatic increase in ED presentations, followed by a return to pre-legalization volume. HealthLink data suggests a different trend, with steadily increasing calls in the months prior to legalization, followed by stabilization. Cannabis legalization is also correlated with a decrease in post-legalization opiate-related calls (r=-0.51, p=0.01). Conclusion: Overall, national legalization of cannabis appears to be responsible for a short period of increased ED usage, but does not appear to have long-lasting effects on healthcare resource utilization. Differences are apparent between telehealth service and ED use.

scholarly journals Association of flavoured cigar regulations with wholesale tobacco volumes in Canada: an interrupted time series analysis

2018 ◽  
Vol 28 (4) ◽  
pp. 457-461 ◽  
Author(s):  
Michael O Chaiton ◽  
Robert Schwartz ◽  
Gabrielle Tremblay ◽  
Robert Nugent
Keyword(s):  
Time Series ◽  
Sensitivity Analysis ◽  
Time Series Analysis ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Level Change ◽  
Series Analysis ◽  
Tobacco Sales ◽  
Health Canada ◽  
Over Time

IntroductionThis study examines the association of Federal Canadian regulations passed in 2009 addressing flavours (excluding menthol) in small cigars with changes in cigar sales.MethodsQuarterly wholesale unit data as reported to Health Canada from 2001 through 2016 were analysed using interrupted time series analysis. Changes in sales of cigars with and without flavour descriptors were estimated. Analyses were seasonally adjusted. Changes in the flavour types were assessed over time.ResultsThe Federal flavour regulations were associated with a reduction in the sales of flavoured cigars by 59 million units (95% CI −86.0 to −32.4). Increases in sales of cigars with descriptors other than flavours (eg, colour or other ambiguous terms) were observed (9.6 million increase (95% CI −1.3 to 20.5), but the overall level (decline of 49.6 million units (95% CI −73.5 to −25.8) and trend of sales of cigars (6.9 million units per quarter (95% CI −8.1 to −5.7)) declined following the ban. Sensitivity analysis showed that there was no substantial difference in effect over time comparing Ontario and British Columbia, suggesting that other provincial tobacco control legislation was not associated with the changes in levels. Analyses suggested that the level change was sensitive to the specification of the date.ConclusionThis study demonstrates that flavour regulations have the potential to substantially impact tobacco sales. However, exemptions for certain flavours and product types may have reduced the effectiveness of the ban, indicating the need for comprehensive, well-designed regulations.

scholarly journals Impact of integrated care on trends in the rate of emergency department visits among older persons in Stockholm County: an interrupted time series analysis

BMJ Open ◽  
2020 ◽  
Vol 10 (6) ◽  
pp. e036182
Author(s):  
Megan Doheny ◽  
Janne Agerholm ◽  
Nicola Orsini ◽  
Pär Schön ◽  
Bo Burström
Keyword(s):  
Emergency Department ◽  
Time Series ◽  
Time Series Analysis ◽  
Integrated Care ◽  
Older Persons ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Stockholm County ◽  
Series Analysis ◽  
Ed Visits

ObjectiveTo investigate the association between the implementation of an integrated care (IC) system in Norrtälje municipality and changes in trends of the rate of emergency department (ED) visits.DesignInterrupted time series analysis from 2000 to 2015.SettingStockholm County.ParticipantsAll inhabitants 65+ years in Stockholm County on 31 December of each study year.InterventionIC was established by combining the funding, administration and delivery of health and social care for older persons in Norrtälje municipality, within Stockholm County.OutcomeRates of hospital-based ED visits.ResultsIC was associated with a decrease in the rate of ED visits (incidence rate ratio: 0.997, 95% CI 0.995 to 0.998) among inhabitants 65+ years in Norrtälje. However, the rate of ED visits remained higher in Norrtälje than the rest of Stockholm in the preintervention and postintervention periods. Stratified analyses showed that IC was associated with a decline in the trend of the rate of ED visits among those 65–79 years, the lowest income group and born outside of Sweden. However, there was no significant decrease in the trend among those 80+ years.ConclusionThe implementation of IC was associated with a modest change in the trend of ED visits in Norrtälje, though the rate of ED visits remained higher than in the rest of Stockholm. Changes in the composition of the population and contextual changes may have impacted our findings. Further research, using other outcome measures is needed to assess the impact of IC on healthcare utilisation.

scholarly journals The impact of an electronic medical record nudge on reducing testing for hospital-onset Clostridioides difficile infection

2020 ◽  
Vol 41 (4) ◽  
pp. 411-417 ◽  
Author(s):  
Jessica R. Howard-Anderson ◽  
Mary Elizabeth Sexton ◽  
Chad Robichaux ◽  
Zanthia Wiley ◽  
Jay B. Varkey ◽  
...  
Keyword(s):  
Medical Record ◽  
Electronic Medical Record ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Level Change ◽  
Order Rate ◽  
Clostridioides Difficile ◽  
Stool Softener ◽  
Clostridioides Difficile Infection ◽  
The Impact

AbstractObjective:To determine the effect of an electronic medical record (EMR) nudge at reducing total and inappropriate orders testing for hospital-onset Clostridioides difficile infection (HO-CDI).Design:An interrupted time series analysis of HO-CDI orders 2 years before and 2 years after the implementation of an EMR intervention designed to reduce inappropriate HO-CDI testing. Orders for C. difficile testing were considered inappropriate if the patient had received a laxative or stool softener in the previous 24 hours.Setting:Four hospitals in an academic healthcare network.Patients:All patients with a C. difficile order after hospital day 3.Intervention:Orders for C. difficile testing in patients administered a laxative or stool softener in <24 hours triggered an EMR alert defaulting to cancellation of the order (“nudge”).Results:Of the 17,694 HO-CDI orders, 7% were inappropriate (8% prentervention vs 6% postintervention; P < .001). Monthly HO-CDI orders decreased by 21% postintervention (level-change rate ratio [RR], 0.79; 95% confidence interval [CI], 0.73–0.86), and the rate continued to decrease (postintervention trend change RR, 0.99; 95% CI, 0.98–1.00). The intervention was not associated with a level change in inappropriate HO-CDI orders (RR, 0.80; 95% CI, 0.61–1.05), but the postintervention inappropriate order rate decreased over time (RR, 0.95; 95% CI, 0.93–0.97).Conclusion:An EMR nudge to minimize inappropriate ordering for C. difficile was effective at reducing HO-CDI orders, and likely contributed to decreasing the inappropriate HO-CDI order rate after the intervention.

scholarly journals Hospital admissions for stroke and bleeding in Hounslow following a quality improvement initiative

Open Heart ◽  
2021 ◽  
Vol 8 (1) ◽  
pp. e001558
Author(s):  
Kam Ying Wong ◽  
Bethan Davies ◽  
Yewande Adeleke ◽  
Thomas Woodcock ◽  
Dionne Matthew ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Hospital Admissions ◽  
Incidence Rate Ratio ◽  
Interrupted Time Series ◽  
Primary Diagnosis ◽  
Quality Improvement Initiative ◽  
Interrupted Time Series Analysis ◽  
Level Change ◽  
Slope Change

ObjectiveAtrial fibrillation (AF) is the most common arrhythmia. Undiagnosed and poorly managed AF increases risk of stroke. The Hounslow AF quality improvement (QI) initiative was associated with improved quality of care for patients with AF through increased detection of AF and appropriate anticoagulation. This study aimed to evaluate whether there has been a change in stroke and bleeding rates in the Hounslow population following the QI initiative.MethodsUsing hospital admissions data from January 2011 to August 2018, interrupted time series analysis was performed to investigate the changes in standardised rates of admission with stroke and bleeding, following the start of the QI initiative in October 2014.ResultsThere was a 17% decrease in the rate of admission with stroke as primary diagnosis (incidence rate ratio (IRR) 0.83; 95% CI 0.712 to 0.963; p<0.014). There was an even larger yet not statistically significant decrease in admission with stroke as primary diagnosis and AF as secondary diagnosis (IRR 0.75; 95% CI 0.550 to 1.025; p<0.071). No significant changes were observed in bleeding admissions. For each outcome, an additional regression model including both the level change and an interaction term for slope change was created. In all cases, the slope change was small and not statistically significant.ConclusionReduction in stroke admissions may be associated with the AF QI initiative. However, the immediate level change and non-significant slope change suggests a lack of effect of the intervention over time and that the decrease observed may be attributable to other events.

scholarly journals Effects of Rescheduling Hydrocodone on Opioid Prescribing in Ohio

Pain Medicine ◽  
2019 ◽  
Vol 21 (9) ◽  
pp. 1863-1870 ◽  
Author(s):  
Yingna Liu ◽  
Olesya Baker ◽  
Jeremiah D Schuur ◽  
Scott G Weiner
Keyword(s):  
Monitoring Program ◽  
Interrupted Time Series ◽  
Substitution Effect ◽  
The United States ◽  
Prescription Database ◽  
Interrupted Time Series Analysis ◽  
Opioid Prescribing ◽  
Level Change ◽  
Prescribing Trends ◽  
Before And After

Abstract Background We quantified opioid prescribing after the 2014 rescheduling of hydrocodone from schedule III to II in the United States using a state-wide prescription database and studied trends three years before and after the policy change, focusing on certain specialties. Methods We used Ohio’s state prescription drug monitoring program database, which includes all filled schedule II and III prescriptions regardless of payer or pharmacy, to conduct an interrupted time series analysis of the nine most prescribed opioids: hydrocodone, oxycodone, tramadol, codeine, and others. We analyzed hydrocodone prescribing trends for the physician specialties of internal medicine, anesthesiology, and emergency medicine. We evaluated trends 37 months before and after the rescheduling change. Results Rescheduling was associated with a hydrocodone level change of –26,358 (95% confidence interval [CI] = –36,700 to –16,016) prescriptions (–5.8%) and an additional decrease in prescriptions of –1,568 (95% CI = –2,296 to –839) per month (–0.8%). Codeine prescribing temporarily increased, at a level change of 6,304 (95% CI = 3,003 to 9,606) prescriptions (18.5%), indicating a substitution effect. Hydrocodone prescriptions by specialty were associated with a level change of –805 (95% CI = –1,280 to –330) prescriptions (–8.5%) for anesthesiologists and a level change of –14,619 (95% CI = –23,710 to –5,528) prescriptions (–10.2%) for internists. There was no effect on prescriptions by emergency physicians. Conclusions The 2014 federal rescheduling of hydrocodone was associated with declines in hydrocodone prescriptions in Ohio beyond what had already been occurring, and hydrocodone may have been briefly substituted with codeine. These results indicate that rescheduling did have a lasting effect but affected prescribing specialties variably.

Measuring the impact of step down intermediate care on delayed discharge: an interrupted time series analysis

2019 ◽  
Vol 73 (7) ◽  
pp. 674-679 ◽  
Author(s):  
Kate A Levin ◽  
Emilia Crighton
Keyword(s):  
Moving Average ◽  
Interrupted Time Series ◽  
Relative Reduction ◽  
Intermediate Care ◽  
Interrupted Time Series Analysis ◽  
Level Change ◽  
Before And After ◽  
Step Down ◽  
The Impact ◽  
Over Time

BackgroundIntermediate care (IC) acts as a bridging service between hospital and home, for those deemed medically fit for discharge but who are delayed in hospital. The aim of this study was to measure the effect of IC and a 72-hour discharge target on days delayed.MethodsRate of days delayed per 1000 population aged 75 years+ in Glasgow City was compared before and after onset of IC with a 6-month phase-in period, using segmented linear regression. Inverclyde and West Dunbartonshire (IWD) was a control. Autoregressive and moving average terms were included in the model, as well as a Fourier term to adjust for seasonality.ResultsPrior to IC, rate of days delayed increased in both Glasgow City and the rest of Scotland. There was a large reduction in rate of days delayed in Glasgow during the phase-in period, greater than the rest of Scotland but comparable with that observed in IWD, with subsequent increases thereafter. Adjusting for changes in IWD, the impact of IC and the discharge target in Glasgow City was a level change of −15.20 (95% CI −17.52 to –12.88) and a trend change of −0.29 (95% CI −0.55 to –0.02). This is equivalent to a predicted reduction due to IC of −16.04 days delayed per 1000 population per month, in June 2016, and a relative reduction of 35%.ConclusionIC and the 72-hour discharge target were associated with a reduction in days delayed. Rate of days delayed continued to increase over time, although at a slower rate than if IC had not been implemented.

Cohort study of medical cannabis authorisation and healthcare utilisation in 2014–2017 in Ontario, Canada

2019 ◽  
Vol 74 (3) ◽  
pp. 299-304
Author(s):  
Dean Eurich ◽  
Cerina Lee ◽  
Arsene Zongo ◽  
Jasjett K Minhas-Sandhu ◽  
John G Hanlon ◽  
...  
Keyword(s):  
Cohort Study ◽  
Statistical Difference ◽  
Healthcare Utilisation ◽  
Interrupted Time Series ◽  
Initial Increase ◽  
Medical Cannabis ◽  
Physician Visits ◽  
Ed Visits ◽  
The Impact

BackgroundThe impact of medical cannabis on healthcare utilisation between 2014 and 2017 in Ontario, Canada. With cannabis legalisation in Canada and some states in the USA, high-quality longitudinal cohort research studies are of urgent need to assess the impact of cannabis use on healthcare utilisation.MethodsA matched cohort study of 9925 medical cannabis authorised adult patients (inhaled (smoked or vaporised) or orally consumed (oils)) at specialised cannabis clinics, and inclusion of 17 732 controls (not authorised) between 24 April 2014 and 31 March 2017 from Ontario, Canada. Interrupted time series and multivariate Poisson regression analyses were conducted. Medical cannabis impact on healthcare utilisation was measured over 6 months: all-cause physician visits, all-cause hospitalisation, ambulatory care sensitive conditions (ACSC)-related hospitalisations, all-cause emergency department (ED) visits and ACSC-related ED visits.ResultsFor medical cannabis patients compared with controls, there was an initial (within the first month) increase in physician visits (additional 4330 visits per 10 000 patients). However, a numerical reduction was noted over the 6-month follow-up, and no statistical difference was observed (p=0.126). Likewise, in hospitalisations and ACSC ED visits, there was an initial increase (44 per 10 000 people, p<0.05) but no statistical difference after follow-up (p=0.34). Conversely, no initial increase in all-cause ED visits was observed with a slight decrease (19 visits per 10 000 patients, p=0.014) in follow-up.ConclusionsAn initial increase (within first month) in healthcare utilisation may be expected among medical cannabis users that appears to wane over time. Proactive follow-up of patients using medical cannabis is warranted to minimise initial risks to patients and actively assess potential benefits/harms of ongoing use.

Suicidal Behavior and Non-Suicidal Self-Injury in Emergency Departments Underestimated by Administrative Claims Data

Crisis ◽  
2018 ◽  
Vol 39 (5) ◽  
pp. 318-325 ◽  
Author(s):  
Barbara Stanley ◽  
Glenn W. Currier ◽  
Megan Chesin ◽  
Sadia Chaudhury ◽  
Shari Jager-Hyman ◽  
...  
Keyword(s):  
Emergency Departments ◽  
Suicide Attempts ◽  
The United States ◽  
Administrative Claims ◽  
Suicide Attempters ◽  
Self Injury ◽  
Axis I ◽  
Ed Visits ◽  
External Causes ◽  
Severe Psychopathology

Abstract. Background: External causes of injury codes (E-codes) are used in administrative and claims databases for billing and often employed to estimate the number of self-injury visits to emergency departments (EDs). Aims: This study assessed the accuracy of E-codes using standardized, independently administered research assessments at the time of ED visits. Method: We recruited 254 patients at three psychiatric emergency departments in the United States between 2007 and 2011, who completed research assessments after presenting for suicide-related concerns and were classified as suicide attempters (50.4%, n = 128), nonsuicidal self-injurers (11.8%, n = 30), psychiatric controls (29.9%, n = 76), or interrupted suicide attempters (7.8%, n = 20). These classifications were compared with their E-code classifications. Results: Of the participants, 21.7% (55/254) received an E-code. In all, 36.7% of research-classified suicide attempters and 26.7% of research-classified nonsuicidal self-injurers received self-inflicted injury E-codes. Those who did not receive an E-code but should have based on the research assessments had more severe psychopathology, more Axis I diagnoses, more suicide attempts, and greater suicidal ideation. Limitations: The sample came from three large academic medical centers and these findings may not be generalizable to all EDs. Conclusion: The frequency of ED visits for self-inflicted injury is much greater than current figures indicate and should be increased threefold.

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