Diagnosis Of Alcohol-related Disorders Research Articles

Defining the Psychiatric and Financial Landscape of Mental and Substance Use Disorders in Head and Neck Cancer Patients

<h3>Purpose/Objective(s)</h3> To evaluate and describe mental and substance use disorders (MSUD) among head and neck cancer patients admitted to the emergency department (ED) in the United States. <h3>Materials/Methods</h3> We analyzed the Nationwide Emergency Database Sample (NEDS) which produces national estimates of ED visits across the United States. Inclusion criteria included patients with a head and neck cancer diagnosis identified through the Clinical Classifications Software. Mental and Substance use disorders were identified using ICD-9 and ICD-10 codes. Variables analyzed include patient demographics, hospital characteristics, expected payment source, and total visit charge. Survey weighted multivariable logistic regression was used to analyze predictors of MSUD. <h3>Results</h3> From 2009-2018, there were 1,398,671 discharges from the ED associated with head and neck cancer, of which 334,056 (23.9%) also presented with a concurrent MSUD. Patients presenting with a MSUD as the primary visit reason (2.3%) were more likely to be younger (58 vs 66 years, p<0.001), male (73.3% vs 70.6%, p<0.001), and less likely to be admitted to the hospital (51.6% vs 53.5%, p<0.001). Among all patients, the 5 most common MSUD disorders were depressive disorders (n=133,377; 9.5%), anxiety disorders (n=122,679; 8.8%), alcohol related disorders (n=80,994; 5.8%), opioid related disorders (n=23,801; 1.7%), and schizophrenia related disorders (n=22,540; 1.6%). Suicidal ideation or attempt was found in 10,228 discharges (3.1%). The total cost of ED admissions related to a primary MSUD was $103,828,679. The cost of ED admission was most expensive for patients with a primary admission diagnosis of alcohol related disorders (34.8%), opioid related disorders (12.5%), and suicidal ideation or attempt (10.9%). On multivariable logistic regression, younger age (OR: 0.98, p<0.001), female gender (OR:1.26, p<0.001), and non-Medicare insurance were associated with the odds of having any diagnosis of MSUD. <h3>Conclusion</h3> There is a high rate of concomitant MSUD in head and neck cancer patients who present to the ED. Our study identifies a subset of younger and female patients who may be at high risk of developing an MSUD. The financial burden of MSUD was high and the head and neck cancer population are particularly vulnerable to depressive, anxiety, and alcohol related disorders. Future studies should design therapeutic or behavioral interventions to mitigate and address mental health disorders in this population.

A multifaceted quality improvement intervention to improve management of alcohol withdrawal on a general medicine ward: impact on benzodiazepine use

Objective: To measure the effects of a quality improvement intervention on length of stay and benzodiazepine use among patients admitted for alcohol use disorder. Methods: This retrospective cohort study was performed at the Salt Lake City Veterans Affairs Medical Center. Patients 18 years and older admitted to a general medical ward with a diagnosis of alcohol related disorders who were treated for alcohol withdrawal were included. The baseline cohort included patients admitted over 12 months. The post-intervention cohort included patients admitted over 12 months. Primary outcomes were total benzodiazepine dose and length of stay. Secondary outcomes included episodes of delirium tremens and seizures. Results: Total benzodiazepine dose decreased significantly over the intervention period. Length of stay also decreased. No episodes of delirium tremens or seizures were observed. Conclusions: A quality improvement intervention directed at general medicine inpatients admitted for alcohol withdrawal was associated with reductions in total benzodiazepine administration and length of stay.

Predictors and Costs of 30-Day Readmissions After Index Hospitalizations for Alcohol-Related Disorders in U.S. Adults.

In 2015, the Hospital Readmissions Reduction Program mandated financial penalties to hospitals with greater rates of readmissions for certain conditions. Alcohol-related disorders (ARD) are the fourth leading cause of 30-day readmissions. Yet, there is a dearth of national-level research to identify high-risk patient populations and predictors of 30-day readmission. This study examined patient- and hospital-level predictors for index hospitalizations with principal diagnosis of ARD and predicted the cost of 30-day readmissions. The 2014 Nationwide Readmissions Database was used to identify ARD-related index hospitalizations. Multivariable logistic regression was used to estimate patient- and hospital-level predictors for readmissions, and a 2-part model was used to predict the incremental cost conditional upon readmission. In 2014, 285,767 index hospitalizations for ARD were recorded, and 18.9% of ARD-associated hospitalizations resulted in at least one 30-day readmission. Patients who were males, aged 45 to 64years, Medicaid enrollees, living in urban and low-income areas, or with 1 to 2 comorbidities had high risk of readmission. Index hospitalization costs were higher among readmitted patients ($8,840 vs. $8,036, p<0.01). Predicted mean costs for readmissions on index stay with ARD were greater among those aged 45 to 64years ($1,908, p<0.001), Medicare enrollees ($2,133, p<0.001), rural residents ($1,841, p<0.01), living in high-income areas ($1,876, p<0.001), with 4 or more comorbidities ($2,415, p<0.001), or admitted in large metropolitan hospitals ($2,032, p<0.001), with large number of beds ($1,964, p<0.001), with government ownership ($2,109, p<0.001), or with low volume of ARD cases ($2,155, p<0.001). One in 5 ARD-related index hospitalizations resulted in a 30-day readmission. Overall, costs of index hospitalizations for ARD were $2.3 billion, of which $512 million were spent on hospitalizations that resulted in at least 1 readmission. There is a need to develop patient-centric health programs to reduce readmission rates and costs among ARD patients.

Psychiatric morbidity in spouses of patients with alcohol related disorders.

Context:Alcohol dependence is on rise world over, especially in developing countries such as India. According to the World Health Organization, about 30% of Indians consume alcohol, out of which 4%–13% are daily consumers and up to 50% of them, fall under the category of hazardous drinking. Another worrying trend from India is that the average age of initiation of alcohol use has reduced from 28 years during the 1980s to 17 years in 2007. In India, alcohol abuse also amounts to huge annual losses due to alcohol-related problems in workplaces. This was a cross-sectional, noninterventional study which was carried out at the Department of Psychiatry, Sri Venkateswara Ramnaraian Ruia Government General Hospital (SVRRGGH), Tirupati, Andhra Pradesh.Aim:The aim of this study was to determine the frequency and nature of psychiatric morbidity in spouses of patients with alcohol-related disorders (ARDs).Methods:Study design - Hospital-based cross-sectional study. Study setting - Psychiatry Department of SVRRGGH, Sri Venkateswara Medical College, Tirupati. Study period - October 1, 2014 to September 30, 2015. Study units - the spouses of adult patients attending the Department of Psychiatry, with a diagnosis of ARDs. After the ethical clearance from the Institutional Ethical Committee, the spouses of adult patients attending the Department of Psychiatry with a diagnosis of ARDs according to the International Classification of Diseases-10 classification of mental and behavioral disorders constitute the population for the investigation. After obtaining written informed consent from each of the concerned subjects, demographic details and history of psychiatric illness were noted as per the structured pro forma.Results:The age of the alcohol-dependent men and spouses of men with ADS ranged from 23 to 67 years (mean ± standard deviation [SD] 41.24 ± 10.101) and 21–60 years (mean ± SD 35.04 ± 8.98), respectively. Among the study population, 36.6% of alcohol-dependent men were in the age group of 31–40 years and 43.6% of wives were in between 31 and 40 years.Conclusion:The findings of association of duration of alcohol abuse by husband, marital life satisfaction, poor family support, low socioeconomic status with psychological morbidities in spouses of men of alcohol related disorder are in agreement with earlier studies. But community studies with adequate sample size are required to estimate the effect of these key determinants.

CONCURRENT AND CONSTRUCT VALIDITY OF THE AUDIT IN AN URBAN BRAZILIAN SAMPLE

To assess the concurrent and the construct validity of the Alcohol Use Disorders Identification Test (AUDIT) in an urban Brazilian sample. A random sample of 166 clients of a health management organization, participated in this study. They were visited in their households and completed a self-report questionnaire, which included the AUDIT. Later, they answered the alcohol-related disorders (ARDs) Section of the Composite International Diagnostic Interview. The receiver operating curve (ROC) was used to find the best cut-off point for ICD-10 diagnosis of ARDs. Confirmatory factor analysis was run to assess the construct validity. The ROC analysis showed the same cut-off point (7/8) for ICD-10 diagnosis of ARDs found in previous studies carried out in primary care settings, including in Brazil, with a sensitivity of 100% and a specificity of 76%. The confirmatory factor analysis suggested a two-factor structure. The first factor measured consumption and the second factor alcohol-related problems. The results supported the use of the self-reported version of the AUDIT in epidemiologic studies, and showed a similar cut-off point for detection of ARDs and hazardous drinking.