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Frequency of healthcare utilisation by adults who use illicit drugs: a systematic review and meta-analysis.

Lewer, D, Freer, J, King, E, Larney, S, Degenhardt, L, Tweed, EJ, Hope, VD, Harris, M, Millar, T, Hayward, A, Ciccarone, D and Morley, KI (2019) Frequency of healthcare utilisation by adults who use illicit drugs: a systematic review and meta-analysis. Addiction. ISSN 0965-2140 (Accepted)

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Abstract

AIMS: To summarise evidence on the frequency and predictors of healthcare utilisation among people who use illicit drugs. DESIGN: Systematic search of MEDLINE, EMBASE and PsychINFO for observational studies reporting healthcare utilisation published between 1 January 2000 and 3 December 2018. We conducted narrative synthesis and meta-analysis following a registered protocol (identifier: CRD42017076525). SETTING AND PARTICIPANTS: People who use heroin, powder cocaine, crack cocaine, methamphetamine, amphetamine, ecstasy/MDMA, cannabis, hallucinogens, or novel psychoactive substances; have a diagnosis of 'substance use disorder'; or use drug treatment services. MEASUREMENTS: Primary outcomes were the cumulative incidence (risk) and rate of care episodes in three settings: primary care, hospital admissions (inpatient) and emergency department (ED). FINDINGS: 92 studies were included, 84% from North America and Australia. Most studies focused on people using heroin, methamphetamine or crack cocaine, or who had a diagnosis of drug dependence. We were able to conduct meta-analysis of rates across 25 studies reporting ED episodes and 25 reporting hospital admissions, finding pooled rates of 151 (95% CI 114-201) and 41 (95% CI 30-57) per 100 person-years respectively; on average 4.8 and 7.1 times more often than the general population. Heterogeneity was very high and was not explained by drugs used, country of study, recruitment setting or demographic characteristics. Predictors of healthcare utilisation were consistent across studies and included unstable housing, drug injection and mental health problems. Opioid substitution therapy was consistently associated with reduced ED presentation and hospital admission. There was minimal research on healthcare utilisation by people using ecstasy/MDMA, powder cocaine, hallucinogens or novel psychoactive substances. CONCLUSIONS: People who use illicit drugs are admitted to emergency department or hospital several times more often than the general population.

Item Type: Article
Uncontrolled Keywords: 11 Medical and Health Sciences, 17 Psychology and Cognitive Sciences
Subjects: R Medicine > RA Public aspects of medicine
R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine > RA0440 Study and Teaching. Research
Divisions: Public Health Institute
Publisher: Wiley
Related URLs:
Date Deposited: 12 Nov 2019 10:39
Last Modified: 12 Nov 2019 10:45
DOI or Identification number: 10.1111/add.14892
URI: http://researchonline.ljmu.ac.uk/id/eprint/11751

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