title: Factors identifying high-frequency and low-frequency health service utilization among substance-using adults.
abstract: Understanding why substance-using patients seek care at emergency departments (EDs) and who utilizes such service at high rates is important in tailoring and targeting interventions. We conducted a retrospective/prospective cohort study of 326 medically ill substance-using adults to identify factors associated with 12-month high-frequency utilization of ambulatory care, ED, and inpatient medical care. The majority were actively using heroin (74.6%), cocaine (62.4%), and alcohol (54.4%); 94.8% had a chronic medical condition; and 53.8% reported a chronic mental health condition. High-frequency use of ED (> or = 3 visits) was independently associated with being female (adjusted odds ratio [AOR] = 1.88; 95% confidence interval [95% CI] = 1.12, 3.17), being African American (AOR = 2.36; 95% CI = 1.30, 4.29), being homeless (AOR = 2.07; 95% CI = 1.08, 3.96), a history of > 1 substance abuse treatment episode (AOR = 4.10; 95% CI = 3.28, 10.87), and > or = 1 ambulatory care visit (AOR = 8.94; 95% CI = 3.28, 24.41). However, the combination of having certain chronic conditions (seizure disorder, hepatitis B, and hepatitis C) and accessing ambulatory care was protective against high-frequency use of ED. In contrast, high-frequency use of ambulatory care (> or = 3 visits) was independently associated with having insurance (Medicare/Medicaid: AOR = 2.39; 95% CI = 1.31, 4.69), having HIV/AIDS (AOR = 3.15; 95% CI = 1.70, 5.85), and receiving substance abuse treatment during the study period (AOR = 3.58; 95% CI = 1.61, 7.98) Efforts to redirect medical care to more subacute settings will likely require both capacity building and addressing a client's underlying needs, including homelessness, access to substance abuse treatment, and chronic disease management.
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, MD, USA. thomas.o'toole@va.gov
authors.forename: Thomas P
authors.initials: TP
authors.lastname: O'Toole
authors.forename: Robin
authors.initials: R
authors.lastname: Pollini
authors.forename: Paulette
authors.initials: P
authors.lastname: Gray
authors.forename: Theodore
authors.initials: T
authors.lastname: Jones
authors.forename: George
authors.initials: G
authors.lastname: Bigelow
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Ford
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D015142:Baltimore; D015331:Cohort Studies; D015897:Comorbidity; D019033:Delivery of Health Care, Integrated / Q000706:statistics & numerical data; D017831:Diagnosis, Dual (Psychiatry); D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000534:rehabilitation; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000534:rehabilitation; D014600:Utilization Review / Q000706:statistics & numerical data