Impact of Mental Health and Substance Use Disorders on Emergency Department Visit Outcomes for HIV Patients

INTRODUCTION:

A disproportionate number of individuals with human immunodeficiency virus (HIV) have mental health and substance-use disorders (MHSUDs), and MHSUDs are significantly associated with their emergency department (ED) visits. With an increasing share of older adults among HIV patients, this study investigated the associations of MHSUDs with ED outcomes of HIV patients in four age groups: 21-34, 35-49, 50-64, and 65+ years.

METHODS:

We used the 2012 Nationwide Emergency Department Sample (NEDS) dataset (unweighted n=23,244,819 ED events by patients aged 21+, including 115,656 visits by patients with HIV). Multinomial and binary logistic regression analyses, with "treat-and-release" as the base outcome, were used to examine associations between ED outcomes and MHSUDs among visits that included a HIV diagnosis in each age group.

RESULTS:

• Mood and "other" mental disorders had small effects on ED-to-hospital admissions, as opposed to treat-and-release, in age groups younger than 65+ years, while suicide attempts had medium effects . 
• Cognitive disorders had medium-to-large effects on hospital admissions in all age groups and large effects on death in the 35-49 age groups. 
• Alcohol use disorders (AUDs) had small effects on hospital admission in all age groups. 
• Drug use disorders (DUDs) had small-to-medium effects on hospital admission. AUDs and DUDs were also significantly related to the risk of death, and DUDs had a small effect on the risk of discharge against medical advice in the 35-49 and 50-64 age groups.

CONCLUSION:

The high prevalence of MHSUDs and their significant roles in ED visit outcomes in patients with HIV provide support for integrated care for these patients outside the ED to reduce their ED visits and costly hospital admissions and institutional care that follows, especially for the increasing numbers of older adults with HIV.

Full article at:   http://goo.gl/3tf6pP

By:  Choi BY1, DiNitto DM2, Marti CN2, Choi NG2.

• 1Warren Alpert Medical School at Brown Univeristy and Rhode Island Hospital, Department of Emergency Medicine, Providence, Rhode Island.
• 2The University of Texas at Austin, School of Social Work, Austin, Texas. 
• West J Emerg Med. 2016 Mar;17(2):153-64. doi: 10.5811/westjem.2016.1.28310. Epub 2016 Mar 2.

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