Reviewing the burden of comorbidity in patients receiving specialist in-patient treatment for drug and alcohol problems

Aims and methodTo compare and contrast the burden of comorbidity in a population receiving in-patient treatment for substance misuse with that of a cohort admitted to the same unit 4 years previously. The Charlson Comorbidity Index (CCI) was used to quantify patients' comorbidity and predict 10-year survival.ResultsThere was a marked reduction in predicted 10-year survival: in 2014, 22% of patients had a predicted 98% chance of 10-year survival, whereas only 2% in the 2018 cohort had a predicted 98% chance. Additionally, in 2014 only 9% of patients had a <20% 10-year predicted survival chance, whereas 28% in 2018 had a predicted 10-year survival chance of <20%. In this time, funding for services was cut by 23% and the 12-bed unit was reduced to 8 beds. This resulted in an increase in the average waiting time from 30 to 65 days. In 2018, more patients were admitted for alcohol detoxification, rising from 79% to 93% of admissions. Chronic respiratory disease remains the most prominent comorbidity; however, there is also an increase in the percentage of patients with liver disease.Clinical implicationsIn-patient substance misuse units are known to serve individuals with complex illnesses. With service funding cuts, subsequent bed reductions and increased waiting times, this complexity is increasing, with a considerably higher burden of comorbidity. The consequential increased mortality risk highlights the ongoing need for adequate community and in-patient services with integrated care of mental and physical health alongside social work.

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Medical comorbidity and projected survival in patients admitted to a specialist addictions in-patient unit

BJPsych Bulletin ◽

10.1192/pb.bp.115.051987 ◽

2016 ◽

Vol 40 (5) ◽

pp. 255-260 ◽

Cited By ~ 1

Author(s):

Daniel V. Mogford ◽

Rebecca J. Lawrence

Keyword(s):

Respiratory Disease ◽

Chronic Respiratory Disease ◽

Alcohol Problems ◽

Patient Treatment ◽

Medical Comorbidity ◽

Data Set ◽

High Burden ◽

Survival Chance ◽

Treatment Services ◽

Comorbidity Index

Aims and methodTo investigate the burden of medical comorbidity in a population receiving in-patient treatment for drug and alcohol problems. All patients admitted over a 6-month period were included in the data-set. We recorded diagnostic information on admission that allowed the calculation of predicted 10-year survival using a previously validated comorbidity index.ResultsDespite the majority of the sample having a predicted 10-year survival chance of greater than 75%, a sizeable minority (16.7%) are carrying a high burden of medical comorbidity, with a predicted 10-year survival chance of less than 50%. More than half (55.2%) of these patients were under the age of 55. Chronic respiratory disease was the most frequent diagnosis.Clinical implicationsIn-patient substance misuse units serve a complicated group of patients, whose needs are met by active medical input, resident medical cover and effective liaison with general hospitals. This is important when planning and commissioning treatment services. The high burden of respiratory disease suggests the utility of robust smoking cessation interventions among this population.

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Patient experience survey for community drug and alcohol service users in hospitals

BJPsych Open ◽

10.1192/bjo.2021.611 ◽

2021 ◽

Vol 7 (S1) ◽

pp. S229-S229

Author(s):

Nurul Yahya ◽

Derrett Watts

Keyword(s):

Mental Health ◽

Patient Experience ◽

Hospital Care ◽

Waiting Times ◽

Patient Treatment ◽

Easy Access ◽

Free Text ◽

Treatment Access ◽

Opioid Substitution Treatment ◽

Drug And Alcohol

AimsTo explore and monitor experience of hospital care provided to patients of Stoke Community Drug and Alcohol Services (CDAS) and Edward Myers Unit (EMU; detox inpatient based unit).MethodThe sample was collected from patients who attended face-face clinics at CDAS and patients living in Stoke-On-Trent who were admitted to the Edward Myers Unit. The survey pertains to four locations, which include Royal Stoke Hospital, A + E, Harplands Hospital (Mental Health Unit), and EMU.We collected data of over two months from September–November 2020. The cohort of patients from CDAS included new presentations or restart Opioid Substitution Treatment (OST) clinics and people known to the alcohol team at CDAS.We delivered a survey pertaining to experience of hospital care in the last 12 months. This includes treatment at A&E Royal Stoke Hopital, any of the wards at Royal Stoke Hospital, Harplands Hospital and Edward Myers Unit.ResultThe uptake for the survey was 53/83 (64%) at CDAS clinic and 23/44 (52%) at Edward Myers Unit. The sample comprised more men than women. The majority were aged 31–40 years. Most common substances used were alcohol.Majority of patients has been admitted to the general hospital, either in the ward or seen at A + E. Most people were very satisfied with their treatment in all four locations. This include withdrawal symptoms, pain, mental health, and discharge plan. There were diverse reasons given of the satisfactory scores. EMU seems to have the best overall scores comparatively to the other units, with Harplands Hospital seems to be doing worse.The free text comments revealed that the staffs' courtesy, respect, careful listening and easy access of care was particularly the strongest driver of overall patient satisfaction. Patients look for supportive relationships, to be involved in treatment decisions, effective approaches to care, easy treatment access and a non-judgemental treatment environment. In some aspects, patients were dissatisfied with pain management, longer waiting times and inability to treat them as equal to non drug/alcohol users.ConclusionOn objective measures, patients were satisfied with treatment received, however, some has point out their dissatisfaction, particularly in the mental health setting. This project calls for greater attention and support for addiction service provision in emergency departments and hospital wards. Although these findings do not represent the views of all patients in SUD treatment, findings give insight into the ways treatment providers, service managers and policy makers might enhance the patient experience to improve patient treatment prognosis and outcomes

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Social Ecology and the Invention of New Regulatory Strategies for Preventing Drug and Alcohol Problems

Preventing Harmful Substance Use ◽

10.1002/9780470713624.ch24 ◽

2010 ◽

pp. 291-306 ◽

Cited By ~ 2

Author(s):

Bridget Freisthler ◽

Paul J. Gruenewald

Keyword(s):

Social Ecology ◽

Alcohol Problems ◽

Regulatory Strategies ◽

Drug And Alcohol

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Young Males Attending a Family-Planning Clinic: Some Ideas about Consequences of Child Abuse

Psychological Reports ◽

10.2466/pr0.1999.85.2.529 ◽

1999 ◽

Vol 85 (2) ◽

pp. 529-532

Author(s):

PEggy B. Smith ◽

Maxine L. Weinman ◽

Ruth S. Buzi

Keyword(s):

Smoking Cessation ◽

Child Abuse ◽

Family Planning ◽

Behavioral Problems ◽

Substance Misuse ◽

Alcohol Misuse ◽

Family Planning Clinic ◽

Young Males ◽

Medical Needs ◽

Drug And Alcohol

33 young males attending a family-planning clinic were asked about the consequences of child abuse as it affects behavioral problems of teens and their interest in programs that deal specifically with these problems. Nine reported they had been victims of abuse. Most believed that drug and alcohol misuse and suicide were the major consequences of child abuse. Fifteen were interested in programs for prevention of child abuse but not for specific problems such as substance misuse and smoking cessation. This study's findings suggest that family-planning clinics with services for males must address their behavioral as well as medical needs.

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