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Assessing substance abuse treatment need: a statewide hospital emergency department study.
Ann Emerg Med. 2003 Jun; 41(6):802-13.AE

Abstract

STUDY OBJECTIVE

Health care providers in hospital emergency departments rarely take substance abuse histories or assess associated treatment need. This study compares documentation of psychoactive drug-related diagnoses for adult ED patients in medical records with treatment need assessed through self-report, toxicologic screening, and Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), criteria.

METHODS

A statewide, 2-stage, probability sample survey was conducted in 7 Tennessee general hospital EDs from June 1996 to January 1997. Main outcome measures were the prevalence of diagnosed substance abuse problems, positive bioassay results, denied use, and treatment need. Sensitivity and multivariate analyses were conducted by using varied case definitions of treatment need.

RESULTS

Thirty-one percent (95% confidence interval [CI] 27.3% to 34.7%) of screened ED patients (n=1,330) had positive test results for substance use. Their prevalence of denial of use in the 30 days before the survey ranged from 10% for alcohol (95% CI 5.7% to 14.3%) to 100% for phencyclidine. One percent of all ED patients (n=1,502) had a recorded diagnosis of substance abuse. By contrast, as many as 27% (95% CI 23.3% to 31.8%) were assessed as needing substance abuse treatment on the basis of a comprehensive case definition that accounted for denial and positive test results. A sensitivity analysis using other case definitions is also presented. For example, 4% (95% CI 2.8% to 5.3%) of patients met the very strict definition of DSM-IV current drug dependence only. Under the comprehensive case definition, TennCare patients (adjusted odds ratio [OR] 1.63; 95% CI 1.30 to 2.05) and Medicare patients (adjusted OR 2.50; 95% CI 1.34 to 4.65) showed excess treatment need relative to the privately insured. Excess need was also exhibited by patients reporting 1 or more prior ED visits in the past year (adjusted OR 1.62; 95% CI 1.13 to 2.31) and by patients taking 2 or more hours to reach the ED after the onset of injury or illness (adjusted OR 1.54; 95% CI 1.16 to 2.04). Treatment need was inversely associated with age. Irrespective of case definition, less than 10% of ED patients who needed substance abuse treatment were receiving such treatment.

CONCLUSION

EDs can be important venues for detecting persons in need of substance abuse treatment.

Authors+Show Affiliations

Rockett IR
Department of Community Medicine, West Virginia University, Morgantown, WV 26506, USA. irocket@hsc.wvu.edu
Putnam SL
No affiliation info available
Jia H
No affiliation info available
Smith GS
No affiliation info available

MeSH

AdolescentAdultAlcohol DrinkingEmergency Service, HospitalFemaleHealth Services Needs and DemandHumansLogistic ModelsMaleMedical History TakingMedical RecordsMiddle AgedNeeds AssessmentOdds RatioPrevalenceReferral and ConsultationSelf DisclosureSubstance-Related DisordersTennessee

Pub Type(s)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

12764335

Citation

Rockett, Ian R H., et al. "Assessing Substance Abuse Treatment Need: a Statewide Hospital Emergency Department Study." Annals of Emergency Medicine, vol. 41, no. 6, 2003, pp. 802-13.
Rockett IR, Putnam SL, Jia H, et al. Assessing substance abuse treatment need: a statewide hospital emergency department study. Ann Emerg Med. 2003;41(6):802-13.
Rockett, I. R., Putnam, S. L., Jia, H., & Smith, G. S. (2003). Assessing substance abuse treatment need: a statewide hospital emergency department study. Annals of Emergency Medicine, 41(6), 802-13.
Rockett IR, et al. Assessing Substance Abuse Treatment Need: a Statewide Hospital Emergency Department Study. Ann Emerg Med. 2003;41(6):802-13. PubMed PMID: 12764335.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Assessing substance abuse treatment need: a statewide hospital emergency department study. AU - Rockett,Ian R H, AU - Putnam,Sandra L, AU - Jia,Haomiao, AU - Smith,Gordon S, PY - 2003/5/24/pubmed PY - 2003/8/9/medline PY - 2003/5/24/entrez SP - 802 EP - 13 JF - Annals of emergency medicine JO - Ann Emerg Med VL - 41 IS - 6 N2 - STUDY OBJECTIVE: Health care providers in hospital emergency departments rarely take substance abuse histories or assess associated treatment need. This study compares documentation of psychoactive drug-related diagnoses for adult ED patients in medical records with treatment need assessed through self-report, toxicologic screening, and Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), criteria. METHODS: A statewide, 2-stage, probability sample survey was conducted in 7 Tennessee general hospital EDs from June 1996 to January 1997. Main outcome measures were the prevalence of diagnosed substance abuse problems, positive bioassay results, denied use, and treatment need. Sensitivity and multivariate analyses were conducted by using varied case definitions of treatment need. RESULTS: Thirty-one percent (95% confidence interval [CI] 27.3% to 34.7%) of screened ED patients (n=1,330) had positive test results for substance use. Their prevalence of denial of use in the 30 days before the survey ranged from 10% for alcohol (95% CI 5.7% to 14.3%) to 100% for phencyclidine. One percent of all ED patients (n=1,502) had a recorded diagnosis of substance abuse. By contrast, as many as 27% (95% CI 23.3% to 31.8%) were assessed as needing substance abuse treatment on the basis of a comprehensive case definition that accounted for denial and positive test results. A sensitivity analysis using other case definitions is also presented. For example, 4% (95% CI 2.8% to 5.3%) of patients met the very strict definition of DSM-IV current drug dependence only. Under the comprehensive case definition, TennCare patients (adjusted odds ratio [OR] 1.63; 95% CI 1.30 to 2.05) and Medicare patients (adjusted OR 2.50; 95% CI 1.34 to 4.65) showed excess treatment need relative to the privately insured. Excess need was also exhibited by patients reporting 1 or more prior ED visits in the past year (adjusted OR 1.62; 95% CI 1.13 to 2.31) and by patients taking 2 or more hours to reach the ED after the onset of injury or illness (adjusted OR 1.54; 95% CI 1.16 to 2.04). Treatment need was inversely associated with age. Irrespective of case definition, less than 10% of ED patients who needed substance abuse treatment were receiving such treatment. CONCLUSION: EDs can be important venues for detecting persons in need of substance abuse treatment. SN - 0196-0644 UR - https://www.unboundmedicine.com/medline/citation/12764335/Assessing_substance_abuse_treatment_need:_a_statewide_hospital_emergency_department_study_ DB - PRIME DP - Unbound Medicine ER -