Risk of discharge against medical advice among hospital inpatients with a history of opioid agonist therapy in New South Wales, Australia: A cohort study and nested crossover-cohort analysis

Dan Lewer*, Nicola R. Jones, Matthew Hickman, Sarah Larney, Nadine Ezard, Suzanne Nielsen, Louisa Degenhardt

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)

Abstract

Background: People who use illicit opioids have high rates of hospital admission. We aimed to measure the risk of discharge against medical advice among inpatients with a history of opioid agonist therapy (OAT), and test whether OAT is associated with lower risk of discharge against medical advice. Methods: We conducted a cohort study of patients admitted to hospital in an emergency between 1 August 2001 and 30 April 2018 in New South Wales, Australia. All patients had a previous episode of OAT in the community. The main outcome was discharge against medical advice, and the main exposure was whether patients had an active OAT permit at the time of admission. Results: 14,035/116,957 admissions (12 %) ended in discharge against medical advice. Admissions during periods of OAT had 0.79 (0.76−0.83; p < 0.001) times the risk of discharge against medical advice, corresponding to an absolute risk reduction of 3.0 percentage points. Risk of discharge against medical advice was higher among patients who were younger, male, identified as Aboriginal and/or Torres Strait Islander, and those admitted for accidents, drug-related reasons, or injecting-related injuries (such as cutaneous abscesses). In a subsample of 7793 patients included in a crossover-cohort analysis, OAT was associated with 0.84 (95 % CI 0.76−0.93; p < 0.001) times the risk of discharge against medical advice. Conclusions: Among patients with a history of OAT, one in eight emergency hospital admissions ends in discharge against medical advice. OAT enrolment at the time of admission is associated with a reduction of this risk.

Original languageEnglish
Article number108343
JournalDrug and Alcohol Dependence
Volume217
DOIs
Publication statusPublished - 1 Dec 2020
Externally publishedYes

Bibliographical note

Funding Information:
DL is funded by the National Institute of Health Research (NIHR) [Doctoral Research Fellowship DRF- 2018-11-ST2016 ]. MH acknowledges funding from NIHR Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation, NIHR School of Public Health Research (SPHR) , and NIHR Biomedical Research Centre (BRC) at Bristol. This paper presents independent research. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. The OATS study is funded by the National Institutes of Health (R01 DA144740 PI: Degenhardt). LD is supported by an Australian National Health and Medical Research Council Senior Principal Research Fellowship . The National Drug and Alcohol Research Centre is supported by funding from the Australian Government Department of Health under the Drug and Alcohol Program .

Funding Information:
DL is funded by the National Institute of Health Research (NIHR) [Doctoral Research Fellowship DRF-2018-11-ST2016]. MH acknowledges funding from NIHR Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation, NIHR School of Public Health Research (SPHR), and NIHR Biomedical Research Centre (BRC) at Bristol. This paper presents independent research. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. The OATS study is funded by the National Institutes of Health (R01 DA144740 PI: Degenhardt). LD is supported by an Australian National Health and Medical Research Council Senior Principal Research Fellowship. The National Drug and Alcohol Research Centre is supported by funding from the Australian Government Department of Health under the Drug and Alcohol Program.This study is approved by the NSW Population and Health Services Research Ethics Committee (2018/HRE0205) and Aboriginal Health and Medical Research Council Research Ethics Committee (1400/18).This research article was reviewed by the OATS Aboriginal reference group, including Alan Bennett, Doug James, Kim Sullivan, and Craig Vaughan. Record linkage was conducted by the NSW Ministry of Health and the Centre for Health Record Linkage. The Cause of Death Unit Record File (COD URF) is provided by the Australian Coordinating Registry for the COD URF on behalf of the NSW Registry of Births Deaths and Marriages, NSW Coroner and the National Coronial Information System.

Publisher Copyright:
© 2020 Elsevier B.V.

Keywords

  • Continuity of patient care
  • Health services
  • Hospitalization
  • Opioid-related disorders
  • Patient discharge
  • Substance-related disorders

Fingerprint

Dive into the research topics of 'Risk of discharge against medical advice among hospital inpatients with a history of opioid agonist therapy in New South Wales, Australia: A cohort study and nested crossover-cohort analysis'. Together they form a unique fingerprint.

Cite this