Resource consumption of multi-substance users in the emergency room: A neglected patient group


Autoři: Laurence Klenk aff001;  Christina von Rütte aff001;  Jonathan F. Henssler aff002;  Thomas C. Sauter aff001;  Wolf E. Hautz aff001;  Aristomenis K. Exadaktylos aff001;  Martin Müller aff001
Působiště autorů: Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland aff001;  Department of Psychiatry and Psychotherapy, St. Hedwig Hospital Berlin, Charité University Medicine, Berlin, Germany aff002;  Medical Skills Lab, Charité Medical School Berlin, Berlin, Germany aff003;  Institute of Health Economics and Clinical Epidemiology, Cologne University Hospital, Cologne, Germany aff004
Vyšlo v časopise: PLoS ONE 14(9)
Kategorie: Research Article
doi: 10.1371/journal.pone.0223118

Souhrn

Background

Multi-substance use is accompanied by increased morbidity and mortality and responsible for a large number of emergency department (ED) consultations. To improve the treatment for this vulnerable group of patients, it is important to quantify and break down in detail the ED resources used during the ED treatment of multi-substance users.

Methods

This retrospective single centre case-control study included all ED consultations of multi-substance users over a three-year study period at a university hospital in Switzerland. Resource consumption of these patients was compared to an age-matched control group of non-multi-substance users.

Results

The analysis includes 867 ED consultations of multi-substance users compared to 4,335 age-matched controls (5:1). Multi-substance users needed more total resources (median tax points [medical currency] (IQR): 762 (459–1226) vs. 462 (196–833), p<0.001), especially physician, radiology, and laboratory resources. This difference persisted in multivariable analysis (geometric mean ratio (GMR) 1.2, 95% CI: 1.1–1.3, p = 0.001) adjusted for sociodemographic parameters, consultation characteristics, and patient comorbidity; the GMR was highest in ED laboratory and radiology resource consumption. Among multi-substance user, indirect and non-drug-related consultations had higher ED resource consumption compared to drug-related consultations. Furthermore, leading discipline as well as urgency were predictors of ED resource consumption. Moreover, multi-substance users had more revisits (55.2% vs. 24.9%, p<0.001) as well as longer ED and in-hospital stays (both: GMR 1.2, 95% CI: 1.1–1.3, p<0.001).

Conclusion

ED consultations of multi-substance users are expensive and resource intensive. Multi-substance users visited the ED more often and stayed longer at the ED and in-hospital. The findings of our study underline the importance of this patient group. Additional efforts should be made to improve their ED care. Special interventions should target this patient group in order to decrease the high frequency and costs of emergency consultations caused by multi-substance users.

Klíčová slova:

Computed axial tomography – Critical care and emergency medicine – Intensive care units – Linear regression analysis – Physicians – Radiology and imaging – Resuscitation – Drug users


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Článek vyšel v časopise

PLOS One


2019 Číslo 9

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