Impact of Substance Use Disorder on Healthcare Utilization in Patients Admitted with Severe Infections A Retrospective Study
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Keywords
severe infections, substance use disorder, healthcare utilization
Abstract
Patients who use drugs (PWUD) can develop serious infections requiring long-term parenteral antibiotics through peripherally inserted central catheters (PICC). Due to provider fears of ongoing substance use, PWUD often remain hospitalized for the duration of therapy. This retrospective study compares hospital out-comes among PWUD to those without a documented history of substance use. Patients with an infection listed as the most responsible diagnosis and received a PICC were included. The primary outcomes were length-of-stay and total costs. Ethics approval was obtained from the Health Sciences North Research Ethics Board. Compared to those without a documented history of substance use, PWUD had a longer median length-of-stay in the hospital (30 days vs. 7 days, p < 0.001) and incurred higher median total costs ($23,036.32 vs. $7,477.84, p < 0.001). Therefore, a multi-pronged approach should be considered, including outpatient parenteral antibiotic therapy programs, adaptive antibiotic regimens, and concurrent substance use disorder treatment.
Résumé
Les patients qui consomment des substances psychoactives (PWUD pour patients who use drugs) peuvent contracter des infections graves nécessitant une antibiothérapie à long terme administrée par voie parentérale à l’aide de cathéters centraux insérés par voie périphérique (PICC pour peripherally-inserted central catheter). En raison des craintes du fournisseur de soins par rapport à leur consommation de substances psychoactives, les PWUD sont souvent hospitalisés pendant toute la durée du traitement. Cette étude rétrospective compare les résultats en milieu hospitalier de PWUD à ceux de patients qui n’ont aucun antécédent documenté de consommation de substances psychoactives. Font partie de cette étude, les patients atteints d’une infection indiquée comme étant le diagnostic principal et chez qui l’on a installé un PICC. Les critères d’évaluation prin-cipaux sont la durée du séjour à l’hôpital et les coûts totaux. L’approbation déontologique a été obtenue auprès du Comité d’éthique de la recherche d’Horizon Santé-Nord. Comparativement aux patients qui n’ont aucun antécédent documenté de consommation de substances psychoactives, les PWUD ont une durée médiane de séjour à l’hôpital plus longue (30 jours contre 7 jours, p < 0,001) et engendrent des coûts totaux médians plus élevés (23 036,32 $ contre 7 477,84 $, p < 0,001). Une approche à volets multiples comprenant des programmes d’antibiothérapie parentérale ambulatoire, des schémas d’antibiothérapie adaptatifs et un traitement concomitant des troubles liés à la consommation de substances psychoactives devrait être envisagée.
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Jollee S.T. Fung, Northern Ontario School of Medicine, Sudbury, Ontario, Canada
Jollee S.T. Fung is an internal medicine resident at NOSM University with an interest in infections in immunocompromised patients and marginalized groups.
Emir Ali, Northern Ontario School of Medicine, Sudbury, Ontario, Canada
Northern Ontario School of Medicine, Sudbury, Ontario, Canada
Tian Xiao, Northern Ontario School of Medicine, Sudbury, Ontario, Canada
Northern Ontario School of Medicine, Sudbury, Ontario, Canada
Renée Borkovich, Northern Ontario School of Medicine, Sudbury, Ontario, Canada
Northern Ontario School of Medicine, Sudbury, Ontario, Canada
Department of Internal Medicine, Northern Ontario School of Medicine, Sudbury, Ontario, Canada