"Before medically advised" departure from hospital and subsequent drug overdose: a population-based cohort study.

Autor:	Khan M; Departments of Medicine (Khan, Hu, Nasmith, Daly-Grafstein, Staples), Statistics (Hu, Daly-Grafstein), Emergency Medicine (Moe, Brubacher), and School of Population and Public Health (Crabtree, Slaunwhite), University of British Columbia; BC Centre for Disease Control (Crabtree, Moe); Centre for Clinical Epidemiology & Evaluation (Staples); Centre for Advancing Health Outcomes (Staples, Slaunwhite); BC Mental Health and Substance Use Services (Slaunwhite), Vancouver, BC., Nicole X; Departments of Medicine (Khan, Hu, Nasmith, Daly-Grafstein, Staples), Statistics (Hu, Daly-Grafstein), Emergency Medicine (Moe, Brubacher), and School of Population and Public Health (Crabtree, Slaunwhite), University of British Columbia; BC Centre for Disease Control (Crabtree, Moe); Centre for Clinical Epidemiology & Evaluation (Staples); Centre for Advancing Health Outcomes (Staples, Slaunwhite); BC Mental Health and Substance Use Services (Slaunwhite), Vancouver, BC., Crabtree A; Departments of Medicine (Khan, Hu, Nasmith, Daly-Grafstein, Staples), Statistics (Hu, Daly-Grafstein), Emergency Medicine (Moe, Brubacher), and School of Population and Public Health (Crabtree, Slaunwhite), University of British Columbia; BC Centre for Disease Control (Crabtree, Moe); Centre for Clinical Epidemiology & Evaluation (Staples); Centre for Advancing Health Outcomes (Staples, Slaunwhite); BC Mental Health and Substance Use Services (Slaunwhite), Vancouver, BC., Moe J; Departments of Medicine (Khan, Hu, Nasmith, Daly-Grafstein, Staples), Statistics (Hu, Daly-Grafstein), Emergency Medicine (Moe, Brubacher), and School of Population and Public Health (Crabtree, Slaunwhite), University of British Columbia; BC Centre for Disease Control (Crabtree, Moe); Centre for Clinical Epidemiology & Evaluation (Staples); Centre for Advancing Health Outcomes (Staples, Slaunwhite); BC Mental Health and Substance Use Services (Slaunwhite), Vancouver, BC., Nasmith T; Departments of Medicine (Khan, Hu, Nasmith, Daly-Grafstein, Staples), Statistics (Hu, Daly-Grafstein), Emergency Medicine (Moe, Brubacher), and School of Population and Public Health (Crabtree, Slaunwhite), University of British Columbia; BC Centre for Disease Control (Crabtree, Moe); Centre for Clinical Epidemiology & Evaluation (Staples); Centre for Advancing Health Outcomes (Staples, Slaunwhite); BC Mental Health and Substance Use Services (Slaunwhite), Vancouver, BC., Daly-Grafstein D; Departments of Medicine (Khan, Hu, Nasmith, Daly-Grafstein, Staples), Statistics (Hu, Daly-Grafstein), Emergency Medicine (Moe, Brubacher), and School of Population and Public Health (Crabtree, Slaunwhite), University of British Columbia; BC Centre for Disease Control (Crabtree, Moe); Centre for Clinical Epidemiology & Evaluation (Staples); Centre for Advancing Health Outcomes (Staples, Slaunwhite); BC Mental Health and Substance Use Services (Slaunwhite), Vancouver, BC., Brubacher JR; Departments of Medicine (Khan, Hu, Nasmith, Daly-Grafstein, Staples), Statistics (Hu, Daly-Grafstein), Emergency Medicine (Moe, Brubacher), and School of Population and Public Health (Crabtree, Slaunwhite), University of British Columbia; BC Centre for Disease Control (Crabtree, Moe); Centre for Clinical Epidemiology & Evaluation (Staples); Centre for Advancing Health Outcomes (Staples, Slaunwhite); BC Mental Health and Substance Use Services (Slaunwhite), Vancouver, BC., Slaunwhite AK; Departments of Medicine (Khan, Hu, Nasmith, Daly-Grafstein, Staples), Statistics (Hu, Daly-Grafstein), Emergency Medicine (Moe, Brubacher), and School of Population and Public Health (Crabtree, Slaunwhite), University of British Columbia; BC Centre for Disease Control (Crabtree, Moe); Centre for Clinical Epidemiology & Evaluation (Staples); Centre for Advancing Health Outcomes (Staples, Slaunwhite); BC Mental Health and Substance Use Services (Slaunwhite), Vancouver, BC., Staples JA; Departments of Medicine (Khan, Hu, Nasmith, Daly-Grafstein, Staples), Statistics (Hu, Daly-Grafstein), Emergency Medicine (Moe, Brubacher), and School of Population and Public Health (Crabtree, Slaunwhite), University of British Columbia; BC Centre for Disease Control (Crabtree, Moe); Centre for Clinical Epidemiology & Evaluation (Staples); Centre for Advancing Health Outcomes (Staples, Slaunwhite); BC Mental Health and Substance Use Services (Slaunwhite), Vancouver, BC. john.staples@ubc.ca.
Jazyk:	angličtina
Zdroj:	CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne [CMAJ] 2024 Sep 22; Vol. 196 (31), pp. E1066-E1075. Date of Electronic Publication: 2024 Sep 22.
DOI:	10.1503/cmaj.240364
Abstrakt:	Background: A substantial number of hospital admissions end in patient-initiated departure before medical treatment is complete. Whether "before medically advised" (BMA) discharge increases the risk of subsequent drug overdose remains uncertain. Methods: We performed a retrospective cohort study using administrative health data from a 20% random sample of residents of British Columbia, Canada. We focused on nonelective, nonobstetric hospital stays occurring between 2015 and 2019. We used survival analysis to compare the rate of fatal or nonfatal illicit drug overdose in the first 30 days after BMA discharge versus the rate after physician-advised discharge. Results: Overall, 6440 of 189 808 (3.4%) hospital stays ended in BMA discharge. Among 820 overdoses occurring in the first 30 days after any hospital discharge, 755 (92%) involved patients with a history of substance use disorder. Unadjusted overdose rates were 10-fold higher after BMA discharge than after physician-advised discharge, and BMA discharge was associated with subsequent overdose even after adjustment for potential confounders (crude incidence, 2.8% v. 0.3%; adjusted hazard ratio [HR] 1.58; 95% confidence interval [CI] 1.31-1.89). Before medically advised discharge was associated with increases in subsequent emergency department visits (adjusted HR 1.92; 95% CI 1.83-2.02) and unplanned hospital readmissions (adjusted HR 2.07; 95% CI 1.96-2.19), but there was no significant association with the uncommon outcomes of fatal overdose and all-cause mortality. Interpretation: Before medically advised departure is associated with an increased risk of drug overdose in the first 30 days after discharge. Improved treatment of substance use disorder, expanded access to overdose prevention services, and new means of postdeparture outreach should be explored to reduce this risk. Competing Interests: Competing interests:: Jeffrey Brubacher reports receiving grants from the Canadian Institutes of Health Research (CIHR), Public Safety Canada, Transport Canada, British Columbia Ministry of Public Safety and Solicitor General, and Saskatchewan Government Insurance. Alexis Crabtree is an employee of the BC Centre for Disease Control, an agency of the BC Provincial Health Services Authority. Jessica Moe reports receiving grants or contracts from the Vancouver Physician Staff Association, the Canadian Association of Emergency Physicians/Schwartz-Reisman Emergency Medicine Institute, the Health Canada Substance Use and Addictions Program, CIHR (team grant: Partnerships for Cannabis Policy Evaluation; project grants: Opioid Overdose-Related Cardiac Arrest, Evaluating Microdosing in Emergency Departments, and Drug Overdose after Departure from Hospital Against Medical Advice; training grants: Clinical Trials Training Platforms), and the BC Centre for Disease Control (STARTS grant). Dr. Moe has also received the Vancouver Coastal Health Research Institute Mentored Clinician Scientist Award. Amanda Slaunwhite reports receiving project grant funds from Health Canada, CIHR, the Public Health Agency of Canada, the Community Action Initiative, the province of British Columbia, and Michael Smith Health Research BC (all payments made to the University of British Columbia or Provincial Health Services Authority for staff, trainee, or other project costs). Dr. Slaunwhite has also served on the Board of Directors of Unlocking the Gates and Moms Stop the Harm (unpaid). John Staples reports receiving salary support from a Michael Smith Health Research BC Health Professional–Investigator Award and the UBC Division of General Internal Medicine’s Academic Investment Fund. No other competing interests were declared. (© 2024 CMA Impact Inc. or its licensors.)
Databáze:	MEDLINE
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