Abstract
BackgroundThe objective of the study was to describe the frequencies of health-care utilization by people with substance use disorder (SUD), including contacts with general practitioners (GP), psychiatrists, emergency departments (ED) and hospital admissions and to compare this frequency to the general population.MethodsData from the national register of people who were in treatment for SUD between 2011 and 2014 was linked to health care data from the Belgian health insurance (N = 30,905). Four comparators were matched on age, sex and place of residence to each subject in treatment for SUD (N = 123,620). Cases were further divided in five mutually exclusive categories based on the main SUD (opiates, crack/cocaine, stimulants, cannabis and alcohol). We calculated the average number of contacts with GP, psychiatrists and ED, and hospital admissions per person over a ten year period (2008–2017), computed descriptive statistics for each of the SUD and used negative binomial regression models to compare cases and comparators.ResultsOver the ten-year period, people in treatment for SUD overall had on average 60 GP contacts, 3.9 psychiatrist contacts, 7.8 visits to the ED, and 16 hospital admissions. Rate ratios, comparing cases and corresponding comparators, showed that people in treatment for SUD had on average 1.9 more contacts with a GP (95 % CI 1.9-2.0), 7.4 more contacts with a psychiatrist (95 % CI 7.0-7.7), 4.2 more ED visits (95 % CI 4.2–4.3), and 6.4 more hospital admissions (95 % CI 6.3–6.5).ConclusionsThe use of health services for people with SUD is between almost two (GP) and seven times (psychiatrist) higher than for comparators. People in treatment for alcohol use disorders use health care services more frequently than people in treatment for other SUD. The use of health services remained stable in the five years before and after the moment people with SUD entered into treatment for SUD. The higher use of primary health care services by people with SUD might indicate that they have higher health care needs than comparators.
Highlights
The objective of the study was to describe the frequencies of health-care utilization by people with substance use disorder (SUD), including contacts with general practitioners (GP), psychiatrists, emergency departments (ED) and hospital admissions and to compare this frequency to the general population
The primary objective of this study is to describe the frequencies of health-care utilization by people with SUD, contacts with general practitioners (GP), psychiatrists, emergency departments (ED) and hospital admissions, for people with alcohol use disorders, cannabis use disorders, disorders related to the use of stimulants other than crack/cocaine, cocaine use disorders and opiate use disorders
Data for the current study was generated through the linkage and matching of two existing Belgian national health and population registers: (1) the Belgian Treatment Demand Indicator database (TDI) with information on socio-demographic variables and substances for which treatment was sought at the start of the treatment episode for people in treatment for SUD, covering almost all specialized drug treatment centers and by around one third of the general or psychiatric hospitals [26], and (2) the InterMutualistic Agency database (IMA, [27]) with data on reimbursed health care services, gathered through the seven Belgian health insurance agencies
Summary
The objective of the study was to describe the frequencies of health-care utilization by people with substance use disorder (SUD), including contacts with general practitioners (GP), psychiatrists, emergency departments (ED) and hospital admissions and to compare this frequency to the general population. In the same year (2017), illicit drugs were estimated to contribute to 0.25 % of all deaths and to 0.81 % of the DALYs. People with SUD have a higher risk of contracting cancers, cardiovascular, respiratory and liver disorders [3, 4] or infectious diseases such as tuberculosis [5], hepatitis C [6] or diseases due to the human immunodeficiency virus (HIV) [7], and more oral health problems [8]. Scientific literature on these obstacles is lacking for people with SUD in Belgium, there is no reason to believe that they face less barriers for these health problems than people in other parts of the world
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