title: High users of emergency departments in Quebec among patients with both schizophrenia and a substance use disorder.
abstract: OBJECTIVE
  The study assessed factors associated over time with high use of emergency departments by patients in Quebec who had schizophrenia and a co-occurring substance use disorder.
  
  
  METHODS
  The cohort study included 2,921 patients who received a diagnosis of schizophrenia in 2006 and had at least one emergency department visit during fiscal year 2006-2007. Generalized estimating equations were used to estimate predictors of high use of emergency departments over time.
  
  
  RESULTS
  After adjustment for all covariates, predictors of high use over time were as follows: living in either a university medical region (OR=2.10) or a peripheral medical region (OR=2.10), frequent hospitalization (OR=1.16), and greater number of psychiatric (OR=1.64) or physical comorbidities (OR=1.23).
  
  
  CONCLUSIONS
  Because high use of emergency departments is a strong indicator of poor care continuity, identified associated factors could help develop and offer new programs to be deployed in the community to better support these patients with greater needs.
authors.affiliation: Dr. Ngamini-Ngui and Dr. Fleury are with the Centre de Réadaptation en Dépendance de Montréal, Institut Universitaire, Montreal, Quebec, Canada (e-mail: ngaminingui@gmail.com ). Dr. Ngamini-Ngui is also with the Centre de Recherche CSSS Champlain-Charles-Le Moyne, Longueuil, Quebec. Dr. Fleury is also with the Douglas Mental Health University Institute, McGill University, Montreal. Dr. Moisan and Dr. Grégoire are with the Faculté de Pharmacie, Université Laval, and with the Centre de Recherche du Centre Hospitalier Universitaire de Québec. Dr. Lesage is with the Centre de Recherche Fernand-Seguin, Hôpital Louis-H. Lafontaine, Montreal, Quebec. Dr. Vanasse is with the Department of Family Medicine, Université de Sherbrooke, Sherbrooke, Quebec.
authors.forename: André
authors.initials: A
authors.lastname: Ngamini-Ngui
authors.forename: Marie-Josée
authors.initials: MJ
authors.lastname: Fleury
authors.forename: Jocelyne
authors.initials: J
authors.lastname: Moisan
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Grégoire
authors.forename: Alain
authors.initials: A
authors.lastname: Lesage
authors.forename: Alain
authors.initials: A
authors.lastname: Vanasse
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D017831:Diagnosis, Dual (Psychiatry); D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D011792:Quebec / Q000453:epidemiology; D012559:Schizophrenia / Q000453:epidemiology*; D019966:Substance-Related Disorders / Q000453:epidemiology*; D055815:Young Adult