Kristen A Morin1, Joseph K Eibl2, Joseph M Caswell3, Brian Rush4, Christopher Mushquash1,5, Nancy E Lightfoot6, David C Marsh1,4,6,7. 1. Northern Ontario School of Medicine, Sudbury, Ontario, Canada. 2. Health Sciences North Research Institute, Sudbury, Ontario, Canada. 3. ICES North, Sudbury, Ontario, Canada. 4. Center for Addiction and Mental Health, Toronto, Ontario, Canada. 5. Lakehead University, Thunder Bay, Ontario, Canada. 6. Laurentian University, Sudbury, Ontario, Canada. 7. Canadian Addiction Treatment Centres, Markam, Ontario, Canada.
Abstract
OBJECTIVE: The objective of this study was to evaluate the relationship between concurrent physician-based mental health services, all-cause mortality, and acute health service use for individuals enrolled in Opioid Agonist Treatment in Ontario, Canada. METHODS: A cohort study of patients enrolled in opioid agonist treatment in Ontario was conducted between January 1, 2011, and December 31, 2015, in Ontario with an inverse probability of treatment weights using the propensity score to estimate the effect of physician-based mental health services. Treatment groups were created based on opioid agonist treatment patients' utilization of physician-based mental health services. Propensity score weighted odds ratios were calculated to assess the relationship between the treatment groups and the outcomes of interest. The outcomes included all-cause mortality using data from the Registered Persons Database, Emergency Department visits from the National Ambulatory Care Database, and hospitalizations using data from the Discharge Abstract Database. Encrypted patient identifiers were used to link across databases. RESULTS: A total of 48,679 individuals in OAT with mental disorders. Opioid agonist treatment alone was associated with reduced odds of all-cause mortality (odds ratio (OR) 0.4, 95% confidence interval (CI) 0.3-0.4). Patients who received mental health services from a psychiatrist and primary care physician while engaged in OAT, the estimated rate of ED visits per year was higher (OR = 1.3, 95% CI 1.2-1.4) and the rate of hospitalizations (OR = 0.5, 95% CI 0.4-0.6) than in the control group. CONCLUSION: Our findings support the view that opioid agonist treatment and concurrent mental health services can improve clinical outcomes for complex patients, and is associated with enhanced use of acute care services.
OBJECTIVE: The objective of this study was to evaluate the relationship between concurrent physician-based mental health services, all-cause mortality, and acute health service use for individuals enrolled in Opioid Agonist Treatment in Ontario, Canada. METHODS: A cohort study of patients enrolled in opioid agonist treatment in Ontario was conducted between January 1, 2011, and December 31, 2015, in Ontario with an inverse probability of treatment weights using the propensity score to estimate the effect of physician-based mental health services. Treatment groups were created based on opioid agonist treatment patients' utilization of physician-based mental health services. Propensity score weighted odds ratios were calculated to assess the relationship between the treatment groups and the outcomes of interest. The outcomes included all-cause mortality using data from the Registered Persons Database, Emergency Department visits from the National Ambulatory Care Database, and hospitalizations using data from the Discharge Abstract Database. Encrypted patient identifiers were used to link across databases. RESULTS: A total of 48,679 individuals in OAT with mental disorders. Opioid agonist treatment alone was associated with reduced odds of all-cause mortality (odds ratio (OR) 0.4, 95% confidence interval (CI) 0.3-0.4). Patients who received mental health services from a psychiatrist and primary care physician while engaged in OAT, the estimated rate of ED visits per year was higher (OR = 1.3, 95% CI 1.2-1.4) and the rate of hospitalizations (OR = 0.5, 95% CI 0.4-0.6) than in the control group. CONCLUSION: Our findings support the view that opioid agonist treatment and concurrent mental health services can improve clinical outcomes for complex patients, and is associated with enhanced use of acute care services.
Authors: Marion Selfridge; Kiffer Card; Taylor Kandler; Erin Flanagan; Emily Lerhe; Ash Heaslip; Anne Nguyen; Matthew Moher; Bernie Pauly; Karen Urbanoski; Chris Fraser Journal: Int J Drug Policy Date: 2022-05-04
Authors: K A Morin; T N Marsh; C Eshakakogan; J K Eibl; M Spence; G Gauthier; J D Walker; Dean Sayers; Alan Ozawanimke; Brent Bissaillion; D C Marsh Journal: BMC Health Serv Res Date: 2022-08-16 Impact factor: 2.908