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Brief Reports   |    
High Users of Emergency Departments in Quebec Among Patients With Both Schizophrenia and a Substance Use Disorder
André Ngamini-Ngui, Ph.D.; Marie-Josée Fleury, Ph.D.; Jocelyne Moisan, Ph.D.; Jean-Pierre Grégoire, Ph.D.; Alain Lesage, M.D.; Alain Vanasse, M.D., Ph.D.
Psychiatric Services 2014; doi: 10.1176/appi.ps.201300474
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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.

Copyright © 2014 by the American Psychiatric Association


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.

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Table 1Analysis of predictors of high emergency department use among 2,921 patients with schizophrenia and a substance use disordera
Table Footer Note

a Emergency department use was measured during the five years preceding the initial diagnosis of schizophrenia in 2006.



Curran  GM;  Sullivan  G;  Williams  K  et al:  The association of psychiatric comorbidity and use of the emergency department among persons with substance use disorders: an observational cohort study.  BMC Emergency Medicine 8:17, 2008
[CrossRef] | [PubMed]
 International Classification of Diseases and Related Health Problems , 10th revision [in French].  Geneva,  World Health Organization, 2008
Andersen  R;  Newman  JF:  Societal and individual determinants of medical care utilization in the United States.  Milbank Quarterly  (Epub Nov 18, 2005)
Quan  H;  Sundararajan  V;  Halfon  P  et al:  Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data.  Medical Care 43:1130–1139, 2005
[CrossRef] | [PubMed]
Hanley  JA;  Negassa  A;  Edwardes  MD  et al:  Statistical analysis of correlated data using generalized estimating equations: an orientation.  American Journal of Epidemiology 157:364–375, 2003
[CrossRef] | [PubMed]
Ghisletta  P;  Spini  D:  An introduction to generalized estimating equations and an application to assess selectivity effects in a longitudinal study on very old individuals.  Journal of Educational and Behavioral Statistics 29:421–437, 2004
Hunt  KA;  Weber  EJ;  Showstack  JA  et al:  Characteristics of frequent users of emergency departments.  Annals of Emergency Medicine 48:1–8, 2006
[CrossRef] | [PubMed]
Pines  JM;  Asplin  BR;  Kaji  AH  et al:  Frequent users of emergency department services: gaps in knowledge and a proposed research agenda.  Academic Emergency Medicine 18:e64–e69, 2011
[CrossRef] | [PubMed]
Curran  GM;  Sullivan  G;  Williams  K  et al:  Emergency department use of persons with comorbid psychiatric and substance abuse disorders.  Annals of Emergency Medicine 41:659–667, 2003
[CrossRef] | [PubMed]
Methadone-Related Emergency Department Visits Involving Nonmedical Use. Rockville, Md, Center for Behavioral Statistics and Quality, 2012
Turner  BJ;  Laine  C;  Yang  CP  et al:  Effects of long-term, medically supervised, drug-free treatment and methadone maintenance treatment on drug users’ emergency department use and hospitalization.  Clinical Infectious Diseases 37(suppl 5):S457–S463, 2003
[CrossRef] | [PubMed]
Gindi  RM;  Cohen  RA;  Kirzinger  WK: Emergency Room Use Among Adults Aged 18–64: Early Release of Estimates From the National Health Interview Survey, January–June 2011.  Atlanta,  Centers for Disease Control and Prevention, 2012. Available at www.cdc.gov/nchs/data/nhis/earlyrelease/emergency_room_use_january-june_2011.pdf
Woodward  CA;  Pong  RW:  Factors associated with open practices: results from the Canadian National Family Physician Survey.  Canadian Family Physician 52:66–67, 2006
Chaput  YJ;  Lebel  M-J:  An examination of the temporal and geographical patterns of psychiatric emergency service use by multiple visit patients as a means for their early detection.  BMC Psychiatry 7:60, 2007
[CrossRef] | [PubMed]
Vanasse  A;  Courteau  J;  Fleury  M-J  et al:  Treatment prevalence and incidence of schizophrenia in Quebec using a population health services perspective: different algorithms, different estimates.  Social Psychiatry and Psychiatric Epidemiology 47:533–543, 2012
[CrossRef] | [PubMed]
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