Abstract 313: Investigation of Substance Use in the Bridge Population

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Rossteen Abbasi ◽  
Rachel H Krallman ◽  
Delaney Feldeisen ◽  
Daniel G Montgomery ◽  
Eva M Kline-Rogers ◽  
...  
Keyword(s):  
Substance Use ◽  
Transitional Care ◽  
Substance Users ◽  
Care Clinic ◽  
Illicit Substance ◽  
Comorbidity Scores ◽  
History Of ◽  
Ed Visits ◽  
Alcohol Users ◽  
The Impact

Background: Alcohol and drug dependence has been linked to increased readmissions and ED visits in some populations. This study investigated the impact of different substance use (SU) on outcomes (ED visit, readmission, death) among hospitalized cardiac patients (pts). Methods: Data on all pts referred to the BRIDGE cardiac transitional care clinic from 2008-2017 were collected. Chart review was conducted on a random selection of pts with a history of SU (n=152) to determine the type of substance used: alcohol, tobacco, illicit substances (i.e. cocaine, narcotics, marijuana) (study conducted prior to Michigan’s legalization of marijuana), or multiple substances. Demographics and outcomes at 30 and 180 days were compared between SU groups. Results: Of 3536 pts, 305 (8.6%) had a history of SU. Compared to those without SU, SU pts were younger (57.3±13.2 v 66.7±14.5 years, p<0.001), male (72.8% v 62.1%, p<0.001), single (62.5% v 38.0%, p<0.001), non-white (21.9% v 15.6%, p=0.005), less likely to attend their BRIDGE appointment (35.7% v 28.3%, p=0.012), had lower Charlson comorbidity scores (CCS) (3.7 v 4.9, p<0.001), and were more likely to visit the ED within 180 days of discharge (44.4% v 38.1%, p=0.033). Of 152 randomly selected SU pts, 57 (37.5%) used alcohol, 20 (13.2%) tobacco, 28 (18.4%) illicit, and 47 (30.9%) multiple substances. Illicit substance users were more likely to be from low SES communities. Despite older age and higher CCS than the other SU groups, alcohol users had fewer 180 day ED visits (p=0.007) and 180 day readmissions (p=0.024) than illicit substance users, as well as fewer 180 day readmissions (p=0.044) than multiple substance users. Conclusion: Compared to the national average (US Department of Health and Human Services), pts referred to BRIDGE appear more likely to have a history of SU (6.4% v 8.6%). Despite being younger and having lower comorbid burden, SU pts in this population had worse outcomes, as seen in prior studies. Additionally, they were less likely to attend a transitional care appointment, putting them at greater risk. Alcohol users, while older and sicker, had the best outcomes among SU pts; illicit substance users had the worst. Further research to identify the causes of these ED visits and readmissions, as well as targeted strategies to improve outcomes in this population are warranted.

scholarly journals Help-seeking behavior for problematic substance uses in Bahir Dar town, North-West Ethiopia

2018 ◽  
Author(s):  
Habte Belete ◽  
Tesfa Mekonen ◽  
Wubalem Fekadu ◽  
Getasew Legas ◽  
Asmamaw Getnet
Keyword(s):  
Substance Use ◽  
Mental Disorders ◽  
Help Seeking ◽  
Common Mental Disorders ◽  
Bahir Dar ◽  
Help Seeking Behavior ◽  
Substance Users ◽  
Seeking Behavior ◽  
Problematic Substance ◽  
History Of

AbstractBackgroundMental, neurological and substance use disorders are common, but 76% to 85% of people with those disorders in low and middle-income countries did not receive treatment.ObjectiveOur objective was to assess the level of help seeking behavior and associated factors among residents with problematic substance uses (alcohol, khat, tobacco and hashish).MethodsCommunity based cross sectional study was conducted in Bahir Dar town among total of 548 participants with problematic substance users. We had interviewed for help seeking behavior by pre-tested modified General Help Seeking Questionnaire. Logistic regression was done and p-value < 0.05 was used for declaration of significant level. Adjusted odds ratios (AOR) and 95% confidence intervals (CI) have been used.ResultsAmong five hundred and forty-eight participants with problematic substance users, only one hundred and sixty-eight (30.7%) sought help for their substance related problems. Participants’ age above 35 years [AOR = .47 95% CI (.25, .90)], positively screened for common mental disorders [AOR = 4.12, 95% CI (2.7, 6.3)], comorbid medical [AOR = 3.0, 95% CI (1.7, 5.3)], and grand-families’ history of substance user [AOR = 2.18, 95% CI (1.4, 3.4)] found significantly associated with help seeking.ConclusionThere was low proportion of help seeking behavior among participants with problematic substance users. Advanced age was a barrier to seek help while medical illnesses, common mental disorders and history of substance use in grand families were found to enforce to seek help.

scholarly journals Independent risk factors for chronic illicit substance use during pregnancy

2020 ◽  
Vol 16 (5) ◽  
pp. 351-356
Author(s):  
Manuel C. Vallejo, MD, DMD ◽  
Robert E. Shapiro, MD ◽  
Mitchell W. Lippy, BS ◽  
Christa L. Lilly, PhD ◽  
Leo R. Brancazio, MD
Keyword(s):  
Substance Use ◽  
Alcohol Use ◽  
Medical Center ◽  
Academic Medical Center ◽  
Illicit Substance ◽  
Illicit Substance Use ◽  
Academic Medical ◽  
Multiple Variable ◽  
History Of ◽  
Independent Risk Factors

Objective: We aimed to determine the incidence of chronic illicit substance use during pregnancy and to identify associated risk factors.Design: A 2-year time-matched retrospective maternal quality control database (n = 4,470) analysis of parturients with chronic illicit substance use compared to controls.Setting: A tertiary academic medical center located in a rural setting.Results: The rate of chronic illicit substance use was 1.95 percent. Demographic factors associated with chronic illicit substance use in pregnancy-included lower body mass index (BMI; OR: 0.93; 95 percent CI: 0.89-0.96, p 0.0001), higher gravidity (OR: 1.24; 95 percent CI: 1.13-1.36, p 0.0001), higher parity (OR: 1.38; 95 percent CI: 1.22-1.57, p 0.0001), and more live births (OR: 1.30; 95 percent CI: 1.16-1.46, p 0.0001). A history of smoking (OR: 10.51; 95 percent CI: 5.69-19.42, p 0.0001), alcohol use (OR: 48.98; 95 percent CI: 17.33-138.40, p 0.0001), anxiety (OR: 1.88; 95 percent CI: 1.16-3.05, p = 0.01), depression (OR: 2.44; 95 percent CI: 1.55-3.85, p = 0.0001), transfer on admission (OR: 2.12; 95 percent CI: 1.16-3.87, p = 0.01), payor insurance (OR: 2.12, 95 percent CI: 2.10-5.04, p 0.0001), and Apgar scores 7 at 1 minute (OR: 0.50; 95 percent CI: 0.25-1.00, p = 0.049) were significant. Multiple variable logistic regression-revealed BMI, smoking, alcohol use, and Apgar score 7 at 1 minute as significant factors.Conclusions: Awareness of these factors can assist in identifying and treating parturients with chronic illicit substance use.

The Mental Health of U.S. Parents During the COVID-19 Pandemic

2021 ◽  
Vol 43 (4) ◽  
pp. 319-335
Author(s):  
Margaret R. Lamar ◽  
Megan Speciale ◽  
Lisa K. Forbes ◽  
Courtney Donovan
Keyword(s):  
Mental Health ◽  
Substance Use ◽  
Alcohol Use ◽  
School Closures ◽  
Higher Alcohol ◽  
Problem Alcohol Use ◽  
History Of ◽  
Long Term Impact ◽  
The Impact

Evidence suggests parents experience unique pandemic-related stressors related to isolation, food insecurity, school closures, and unemployment. This study examined 1,048 U.S. parents’ depression, anxiety, stress, and alcohol and substance use behaviors during March and April 2020 to better understand the impact of pandemic-related conditions on parents’ mental health. Mean scores indicated severe levels of depression and stress and extremely severe anxiety. Nearly two thirds (74.7%) indicated alcohol use in the past month, with 26.5% scoring in the range for problem alcohol use. Almost half of the sample reported using at least one substance in the previous 2 weeks. Men had significantly higher alcohol consumption and substance use than women. Depression, anxiety, and stress were higher for parents who consumed alcohol or substances and had a history of depression or anxiety. The long-term impact of COVID-19 is unknown, and mental health care is likely to be in high demand moving forward.

The lasting mental health effects of Hurricane Sandy on residents of the Rockaways

2016 ◽  
Vol 14 (4) ◽  
pp. 269 ◽  
Author(s):  
Rebecca M. Schwartz, PhD ◽  
Patricia Rothenberg, BA ◽  
Samantha M. Kerath, MS ◽  
Bian Liu, PhD ◽  
Emanuela Taioli, MD, PhD
Keyword(s):  
Mental Health ◽  
Substance Use ◽  
Tobacco Use ◽  
Traumatic Stress ◽  
Hurricane Sandy ◽  
Post Traumatic Stress ◽  
Illicit Substance ◽  
Post Traumatic ◽  
The Impact ◽  
Hurricane Exposure

 Objective: To examine the impact of Hurricane Sandy on the mental health and substance use of residents of the Rockaways, which is a lower income, ethnically diverse region of NYC that was devastated by the hurricane. Design: Prospective, cross sectional. Setting: Rockaways, Queens, NYC community residents. Participants: From October 2013 to April 2015, 407 adult residents of the Rockaways completed self-report, validated measures of depression, anxiety, and post-traumatic stress symptoms as well as indicators of substance use (alcohol, illicit substance, and tobacco use) and exposure to Hurricane Sandy. Main Outcome Measures: Depression, anxiety, post-traumatic stress, alcohol use, illicit substance use, and tobacco use. Results: Differences in exposure scores on outcomes were compared using Wilcoxon tests. Associations between hurricane exposure (categorized into “personal” and “property” exposure) and outcomes were investigated using logistic regression, adjusting for demographic covariates, mental health history, and time since hurricane. The study participants were predominately female (57.5 percent) and black (63.9 percent) and average age was 44.7 years. Multivariable results showed that property exposure scores were positively associated with increased risks of mental health difficulties across all three mental health symptom outcomes, but not substance use. Increased personal and total exposures were also significantly associated with increased Posttraumatic Stress Disorder symptoms. Substance use variables were not significantly associated with any of the hurricane exposure indicators. Conclusions: The present study quantifies the lasting impact that Hurricane Sandy has had on the mental health of Rockaways residents indicating the need for continued recovery efforts and increased mental health service provision in this vulnerable region. 

Patient loneliness in an urban, underserved family medicine residency clinic: prevalence and relationship to health care utilization

2020 ◽  
Vol 37 (6) ◽  
pp. 751-758
Author(s):  
Stephanie A Hooker ◽  
Paul Stadem ◽  
Michelle D Sherman ◽  
Jason Ricco
Keyword(s):  
Primary Care ◽  
Health Care ◽  
African American ◽  
Family Medicine ◽  
Health Care Utilization ◽  
Care Utilization ◽  
Care Clinic ◽  
Family Medicine Residency ◽  
Ed Visits ◽  
The Impact

Abstract Background Mounting evidence suggests that loneliness increases the risk of poor health outcomes, including cardiovascular disease and premature mortality.Objective: This study examined the prevalence of loneliness in an urban, underserved family medicine residency clinic and the association of loneliness with health care utilization. Methods Adult patients (N = 330; M age = 42.1 years, SD = 14.9; 63% female; 58% African American) completed the 3-item UCLA Loneliness screener at their primary care visits between November 2018 and January 2019. A retrospective case–control study design was used to compare health care utilization [hospitalizations, emergency department (ED) visits, primary care visits, no-shows and referrals] in the prior 2 years between patients who identified as lonely versus those who did not. Covariates included demographics and clinical characteristics. Results Nearly half (44%) of patients exceeded the cut-off for loneliness. Patients who were lonely were more likely to identify as African American, have depression and have a substance use disorder. Patients in the lonely group had significantly longer hospital stays and more primary care visits, no-shows and referrals than patients in the non-lonely group; there were no differences in number of hospitalizations or ED visits. Conclusions The prevalence of loneliness in an urban, underserved primary care clinic was much higher than prior prevalence estimates in primary care. Patients who are lonely may use more health care resources than patients who are not lonely. Primary care may be an ideal setting in which to identify patients who are lonely to further understand the impact of loneliness on health care outcomes.

The Role of Ultrasound-Guided Therapeutic Paracentesis in an Outpatient Transitional Care Program: A Case Series

2018 ◽  
Vol 35 (9) ◽  
pp. 1256-1260 ◽  
Author(s):  
Jeffrey Wang ◽  
Shahida Khan ◽  
Paige Wyer ◽  
Jessica Vanderwilp ◽  
Justin Reynolds ◽  
...  
Keyword(s):  
Transitional Care ◽  
Effective Means ◽  
Case Series ◽  
Care Program ◽  
Cost Effective ◽  
Refractory Ascites ◽  
Ultrasound Guided ◽  
Care Clinic ◽  
Wide Range ◽  
Ed Visits

Background: Patients with ascites suffer from distressing symptoms and are at high risk for readmission after hospitalization. Timely paracentesis is an important palliative tool in managing this vulnerable population. At our institution, we have developed a multidisciplinary transitional care program for patients discharged from the hospital with a wide range of complex conditions including refractory ascites. Methods: We present a case series of 10 patients with symptomatic ascites who were enrolled in our transitional care program and treated with ultrasound-guided therapeutic paracentesis in our clinic. Patient medical records were retrospectively reviewed to collect procedure details, outcomes, and follow-up data on emergency department (ED) visits and readmissions. Cost data were obtained from the hospital financial system. Results: Over the span of 9 months (September 2016 to July 2017), 22 total therapeutic paracenteses were performed on 10 unique patients in the transitional care clinic. Median age of the patient cohort was 52.5 years (range: 27-71 years). All patients reported immediate relief of ascites-related discomfort following the procedure. We did not observe any major adverse effects due to the in-clinic procedure. Nine of the 10 patients did not have any ED visits or readmissions within 30 days of discharge. The cost of performing ultrasound-guided paracentesis in the transitional care clinic was US$546.77 compared to US$978.32 when performed in the hospital. Conclusion: Our experience suggests that outpatient paracentesis may be a safe, feasible, and cost-effective means of providing symptom management for patients with ascites during their transition from hospital to home.

Abstract 357: Effect of an Early Nurse Practitioner Based Transitional Care Program on Atrial Fibrillation Readmissions

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Redah Z Mahmood ◽  
Sherry M Bumpus ◽  
Daniel G Montgomery ◽  
Eva Kline-Rogers ◽  
James B Froehlich ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Nurse Practitioner ◽  
Transitional Care ◽  
Tertiary Care ◽  
Care Program ◽  
Discharge Diagnosis ◽  
Chart Audit ◽  
Care Clinic ◽  
Coronary Syndrome ◽  
Ed Visits

Background: BRIDGE is a nurse practitioner (NP) based transitional care program for cardiac patients(pts) discharged from a large tertiary care health system. Attendance at the BRIDGE clinic has been shown to reduce early readmission and ED visits for acute coronary syndrome (ACS) pts. Little is known about causes of readmission for atrial fibrillation (AF) pts and whether an NP based program affects overall readmissions. Methods: Retrospective data on 1188 pts was abstracted from 2008 to 2010 for pts referred to BRIDGE. Early (30 day) readmission of pts with discharge diagnosis of AF underwent qualitative chart audit by a trained MD abstractor. When examining if BRIDGE affected readmissions, we excluded pts with ED visits/readmits prior to BRIDGE. Results: Median time to BRIDGE was 16 days. Of 1010 with complete data, 148 (15%) had a discharge diagnosis of AF; 110/148 (74%) AF pts attended BRIDGE. Thirty day readmission (30DR) for AF was 23% (34/148); 17/34 (57%) were sent to the ED by a MD or nurse. Attending BRIDGE had no effect on outcomes at all time points (table 1); 17 patients were readmitted before BRIDGE. Readmission at 6 months for AF was 41% for those who attended BRIDGE, 29% for those who did not (p=0.190). Table 2 details reasons for all 30DR in AF pts. Chart review demonstrated that all 30DR were appropriate, 83% (25/30) of non-elective readmissions were unavoidable, and of 5 potentially avoidable readmissions, 2 were due to patient non-compliance. Conclusions: 30-day readmission rates are high for pts recently discharged with a diagnosis of AF and most are unavoidable. A NP based transitional care clinic successful in reducing 30 day readmissions for ACS pts did not prevent either early or late readmissions in AF pts.

Abstract 095: Lessons Learned from the BRIDGE Registry: Major Findings From 8 Years of BRIDGE

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Morgan Bradford ◽  
Rachel Krallman ◽  
Colin McMahon ◽  
Daniel Montgomery ◽  
Eva Kline-Rogers ◽  
...  
Keyword(s):  
Transitional Care ◽  
The United States ◽  
Lessons Learned ◽  
Unplanned Readmission ◽  
Post Discharge ◽  
Care Clinic ◽  
Coronary Syndrome ◽  
Patient Reported ◽  
Comorbidity Scores

Background: Readmissions after cardiac hospitalizations are frequent and costly in the United States. Delays in follow-up and lack of adherence to guidelines may contribute to high unplanned readmission rates. Bridging the Discharge Gap Effectively (BRIDGE) is a nurse practitioner (NP) led, transitional care clinic for cardiac patients, aimed at reducing readmissions. Data on patients referred to BRIDGE has been collected since 2009; herein we report a summary of significant findings from these data. Methods: A qualitative review of results and conclusions from all published abstracts, oral presentations, and papers from the BRIDGE registry (June 2008-August 2015) was conducted. Content analysis was used to synthesize findings across studies. Results: Data from 3982 patients referred to BRIDGE have been collected. Seven themes were identified in the analysis of BRIDGE publications. During BRIDGE, NPs focused on medical history, symptoms, medication management (in 24.8% of visits), patient education, and referrals. In addition to addressing provider priorities, addressing patient concerns (daily living and clinical questions, feelings and fears) was highly salient, resulting in a high level of patient-NP connectedness as evidenced by high patient-reported scores on the Consultation and Relational Empathy scale (mean 43.5 ± 2.8; possible range 0, 50) and the Patient-Doctor Relationship Questionnaire (mean 43.05 ± 3.1; possible range 5, 45). Readmissions within 30 days were consistently lower for acute coronary syndrome (ACS) patients who attended BRIDGE compared to those who did not (6.4% v. 13.1%; p<0.01); similar results were not seen in heart failure (HF) (15.4% v. 15.7%; p=0.944) or atrial fibrillation (AF) (8.5% v. 5.2%; p=0.343) patients. A spike in HF readmissions was seen between 8-14 days post-discharge, suggesting the need for a sooner appointment. However, follow-up within 7 days of discharge did not show reduced readmissions in HF patients. AF readmissions were also difficult to avoid; in a subset of AF patients readmitted within 30 days, 51.1% (n=23) were readmitted for non-AF diagnoses. High risk patients (i.e. those with an adverse event before BRIDGE) were older, had higher Charlson comorbidity scores, and were more likely to have depression. However, marriage was associated with fewer readmissions. Conclusions: Data from the BRIDGE registry have shown that clinic attendance reduced ACS readmissions; has characterized older, depressed patients with higher Charlson comorbidity scores as being those most likely to be readmitted; and has identified areas for improvement in transitional care (e.g. AF and HF) where readmissions are difficult to avoid. Continuous quality improvement and real-time monitoring of patient outcomes have translated this research into more prompt transitional care, illustrating the importance of registry-based research.

Abstract 309: Outcomes of Depressed Patients With and Without Antidepressant Prescription

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Ashley Francis ◽  
Rachel H Krallman ◽  
Delaney Feldeisen ◽  
Daniel G Montgomery ◽  
Eva M Kline-Rogers ◽  
...  
Keyword(s):  
Transitional Care ◽  
Additional Treatment ◽  
Cardiac Patients ◽  
Treatment Modalities ◽  
Post Discharge ◽  
Care Clinic ◽  
Antidepressant Prescription ◽  
Increased Risk ◽  
Antidepressant Use ◽  
Ed Visits

Background: Many studies have shown a relationship between depression and an increased risk of rehospitalization, suggesting assessment and management, potentially including antidepressants, should remain an important part of inpatient treatment. However, studies analyzing the outcomes associated with antidepressant use among cardiac patients have shown mixed results. This study aims to describe the long-term outcomes (ED visits, readmissions, and death) of a cohort of cardiac patients with concomitant depression treated with antidepressants. Methods: A total of 151 patients with a medical history of depression were randomly selected between 2008-2017 from a cardiac transitional care clinic registry. A retrospective chart review was conducted to determine the frequency of antidepressant prescription at discharge following a cardiac hospital admission. Demographics and outcomes were compared between those prescribed and those not prescribed antidepressants at discharge. Results: Of 4,298 patients, 1,067 (24.8%) had a diagnosis of depression recorded in their medical record. Of the 151 randomly selected depression patients, 106 (70.2%) were on at least one antidepressant at discharge. Significantly more females were prescribed antidepressants at discharge than males (78.0% v. 58.3%, p=0.010). No significant differences were seen in race, socioeconomic status, or outcomes at 30, 60, 90, or 180 days post-discharge between those prescribed and those not prescribed antidepressants at discharge. However, when compared to patients without depression (n=3,231), those on at least one antidepressant had significantly more 30-day ED visits (25.5% vs 17%, p=0.026), 180-day ED visits (52.9% vs 38.1%, p=0.002), and 180-day readmissions (55.8% vs 40.1%, p=0.001). Conclusions: Patients with depression had worse outcomes than those without depression, despite the majority (70.2%) being treated with antidepressants. These results suggest efforts should be made post-discharge to closely monitor patients with depression, even if they are prescribed antidepressants, and additional treatment modalities should be researched.

Illicit substance use and opioid misuse in adolescent and young adult (AYA) patients with cancer.

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 205-205
Author(s):  
Ritika Oberoi-Jassal ◽  
Young Doo Chang ◽  
Joshua Smith ◽  
Sahana Rajasekhara ◽  
Vijay Desai ◽  
...  
Keyword(s):  
Palliative Care ◽  
Substance Use ◽  
Young Adult ◽  
Clinical Characteristics ◽  
Adult Patients ◽  
Adolescent And Young Adult ◽  
Opioid Misuse ◽  
Care Clinic ◽  
Illicit Substance ◽  
Illicit Substance Use

205 Background: Rates of illicit substance use and misuse of opioid medications are high in the adolescent and young adult (AYA) general population. Despite this, screening for substance use and opioid misuse is not standard in the care of AYA oncology supportive/palliative care. To inform our clinical practice, we sought to determine the prevalence of illicit substance use and potential opioid misuse in AYA cancer patients relative to adult patients and to examine correlates of use and misuse. Methods: We conducted retrospective chart review of patients newly referred to an outpatient palliative care clinic between 2014 and 2016. Results: Consecutive patients (N = 963) underwent urine drug testing as part of their initial visit; 16% of patients were between 18 and 39 years of age. Rate of illicit drug use was 31% for AYAs and 19% for adults. AYAs were nearly 2 times more likely to have positive results for marijuana (OR = 1.79; 95% CI = 1.19 – 2.69) and nearly 3 times more likely to test positive for amphetamines (OR = 2.94; 95% CI = 1.15 – 7.49). AYAs were no more likely than adults to test positive for cocaine, barbiturates or heroin. In univariate analyses, only male sex and being single, and no clinical characteristics or symptom scores, were significantly associated with illicit substance use (ps < .05). AYAs were no more likely than adults to test positive for the presence of opioids, not currently prescribed (OR = 1.07; 95% CI = 0.70 – 1.65). No symptoms scores or demographic and clinical characteristics were significantly associated with misuse. Conclusions: AYA patients demonstrated a high rate of illicit substance use and similar rate of potential opioid misuse relative to adult patients. Findings suggest AYAs may benefit from consistent screening, support and treatment for substance use and potential opioid misuse during anticancer and cancer-related therapies.

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