Understanding patients with substance abuse and their healthcare pathway : towards better management in Hong Kong

Abstract

In Hong Kong, the clinical profiles of patients with substance abuse and their corresponding utilization of the public healthcare system have not yet been systematically investigated. A cohort of 8,423 patients with a diagnosis of substance abuse, who presented to the Accident and Emergency (A&E) department in Hong Kong public hospitals, between 2004 and 2016 were identified from the Hong Kong Hospital Authority electronic databases, with supplementary data supported by Hong Kong Poison Information Centre. Their medical conditions, trends of A&E attendances and hospitalizations were analysed. Comparison between patients with and without substance abuse on healthcare resources utilization were conducted. Patients were matched using a 1:1 ratio, according to sex, age, admission month and year. The most abused substance among the identified A&E cases were opioids (27.1%), followed by ketamine (24.6%), barbiturate/hypnotics (7.4%), amphetamines (6.7%) and cocaine (2%). Ketamine and opioids are the two main substances that contribute to patients with substance abusere-attending to A&E departments. The most common concurrent medical condition of patients with substance abuse is a diagnosis of mental disorder (n=2,598[30.8%]). Patients with substance abuse had a higher mean number of A&E attendances (11.7 versus 4.9, P <0.001) and hospitalizations (8.49 versus 6.16, P=0.009) when compared to the non-substance abusers.

Excess A&E attendances and hospitalizations cause impact on the resources allocation for the public healthcare system in Hong Kong. Interventions to support and treat patients with substance abuse may help reduce A&E department attendances and hospitalizations in this vulnerable patient group.

Abstract in Laymen’s language: In Hong Kong, the clinical profiles of patients with substance abuse and their corresponding utilization of the public healthcare system have not yet been systematically investigated. A population of 8,423 patients with a diagnosis of substance abuse, who presented to the Accident and Emergency (A&E) department in Hong Kong public hospitals, between 2004 and 2016 were identified from the Hong Kong Hospital Authority electronic databases, with supplementary data supported by Hong Kong Poison Information Centre. Their health characteristics, pattern of hospitals’ attendances and admissions were analyzed. Comparison between patients with and without substance abuse on healthcare resources utilization was also conducted. The most abused substance among the A&E cases were opioids (27.1%), followed by ketamine (24.6%), barbiturate/hypnotics (7.4%), amphetamines (6.7%) and cocaine (2%). Ketamine and opioids are the two main substances that contribute to patients with substance abuse re-attending to hospitals. Around 30% of patients with substance abuse were having mental disorder concurrently. Patients with substance abuse showed higher number of accident and emergency departments’ attendances (11.7 versus 4.9) and hospital admissions (8.49 versus 6.16) when compared to those without substance abuse. Excess A&E attendances and hospitalizations cause impact on the resources allocation for the public healthcare system in Hong Kong. Implementations are needed to facilitate early treatment and care for patients with substance abuse, in order to reduce burden on public healthcare resources.