Insurance-related Risk Factors for Leaving Against Medical Advice after Opioid Overdose: A Cross-sectional Study Using Electronic Health Records.

IF 4.2 3区医学 Q1 SUBSTANCE ABUSE

Journal of Addiction Medicine Pub Date : 2025-06-23 DOI:10.1097/ADM.0000000000001521

Bailey W Osweiler, William D Hutson, Phillip L Marotta

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引用次数: 0

Abstract

Objectives: The United States is in an overdose crisis, with many Americans seeking emergency medical services for drug overdose. Patients who leave against medical advice (AMA) have higher risk of subsequent health complications and hospital readmission. This cross-sectional study uses electronic health records (EHRs) to identify insurance-related risk factors for leaving AMA among patients hospitalized for opioid overdose.

Methods: Documented opioid overdose hospitalizations between June 2019 and November 2021 were identified using ICD-10 codes from EHR at a large Midwest academic hospital. Multivariate logistic regression was used to identify risk factors associated with leaving AMA. Opioid overdose hospitalizations were aggregated by patient, and bivariate analyses (χ2, ANOVA) and logistic regression were used to test for associations between demographics and repeat hospitalization.

Results: Among 3608 hospitalizations, 2985 unique patients were admitted. Compared with Medicare, patients with all other specified insurance types were more likely to leave AMA: self-pay 294% more (aOR = 3.94; 95% CI = 1.83-10.34), Medicaid 299% more (aOR = 3.99; 95% CI = 1.78-10.72), and commercial 402% more (aOR = 5.02; 95% CI = 1.88-14.94). Risk factors for repeat hospitalization included black race (aOR = 1.61, 95% CI = 1.26,2.07), and young age (aOR = 0.99, 95% CI = 0.98, 0.99), while female sex was associated with decreased odds (aOR = 0.73, 95% CI = 0.57, 0.92).

Conclusions: Insurance may be associated with AMA discharge after opioid overdose. Tailored interventions addressing patients' financial concerns after hospitalization may increase access to care and reduce inequities.

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阿片类药物过量后不遵医嘱离开的保险相关风险因素：一项使用电子健康记录的横断面研究

目标：美国正处于药物过量危机中，许多美国人因药物过量寻求紧急医疗服务。不遵医嘱（AMA）离开的患者有更高的后续健康并发症和再次住院的风险。本横断面研究使用电子健康记录（EHRs）来确定阿片类药物过量住院患者离开AMA的保险相关风险因素。方法：使用来自中西部一家大型学术医院电子病历的ICD-10代码，对2019年6月至2021年11月期间记录的阿片类药物过量住院进行鉴定。多变量逻辑回归用于确定与离开AMA相关的危险因素。按患者汇总阿片类药物过量住院，并使用双变量分析（χ2， ANOVA）和logistic回归来检验人口统计学与重复住院之间的相关性。结果：在3608例住院患者中，有2985例特殊患者入院。与医疗保险相比，所有其他指定保险类型的患者更有可能离开AMA：自付多294% (aOR = 3.94；95% CI = 1.83-10.34)，医疗补助计划高出299% (aOR = 3.99；95% CI = 1.78-10.72)，商用高402% (aOR = 5.02；95% ci = 1.88-14.94)。重复住院的危险因素包括黑人（aOR = 1.61, 95% CI = 1.26,2.07）和年轻（aOR = 0.99, 95% CI = 0.98, 0.99），而女性与风险降低相关（aOR = 0.73, 95% CI = 0.57, 0.92）。结论：保险可能与阿片类药物过量后AMA出院有关。针对患者住院后的经济问题采取量身定制的干预措施，可能会增加获得护理的机会，减少不公平现象。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Addiction Medicine 医学-药物滥用

CiteScore

6.10

自引率

9.10%

发文量

260

审稿时长

>12 weeks

期刊介绍： The mission of Journal of Addiction Medicine, the official peer-reviewed journal of the American Society of Addiction Medicine, is to promote excellence in the practice of addiction medicine and in clinical research as well as to support Addiction Medicine as a mainstream medical sub-specialty. Under the guidance of an esteemed Editorial Board, peer-reviewed articles published in the Journal focus on developments in addiction medicine as well as on treatment innovations and ethical, economic, forensic, and social topics including: •addiction and substance use in pregnancy •adolescent addiction and at-risk use •the drug-exposed neonate •pharmacology •all psychoactive substances relevant to addiction, including alcohol, nicotine, caffeine, marijuana, opioids, stimulants and other prescription and illicit substances •diagnosis •neuroimaging techniques •treatment of special populations •treatment, early intervention and prevention of alcohol and drug use disorders •methodological issues in addiction research •pain and addiction, prescription drug use disorder •co-occurring addiction, medical and psychiatric disorders •pathological gambling disorder, sexual and other behavioral addictions •pathophysiology of addiction •behavioral and pharmacological treatments •issues in graduate medical education •recovery •health services delivery •ethical, legal and liability issues in addiction medicine practice •drug testing •self- and mutual-help.