MedicalResearch: What are the main findings of the study?
Answer: We found that within our group of 255 known Emergency Department “super-frequent users,” 77% had with some type of addiction disorder, and 47 percent visited the Emergency Department seeking narcotics for pain. Women were more likely to be narcotic seeking. Using our individualized Electronic Medical Record care plan intervention, created and overseen by our multidisciplinary team (comprised of Emergency Department staff physicians, a psychologist, residents, nurses and support staff), we found that our plan significantly decreased annual rates of visits by these super-frequent users and those who sought pain-relief narcotics and other super-frequent users.
MedicalResearch: Were any of the findings unexpected?
Answer: The large proportion of super-frequent users with some type of addiction was a surprising finding as was the gender differences with narcotic seeking. In the past it had been suggested super users presented with these types of addiction issues. Our study substantiated how prevalent addiction disorder is within this group of patients. Because of our care plan program and our patient population, we were able to more definitively detect “narcotic seeking” as an underlying problem for about half of our super-frequent user population.
MedicalResearch: What should clinicians and patients take away from your report?
Answer: For clinicians, electronic medical records help to easily distinguish how often patients come to the Emergency Department. Thus, if a patient has a super user presenting pattern, even with known chronic medical problems, clinicians should have an increased suspicion of addiction and engage increased resources to help patients address his/her substance abuse. It is also an opportunity for both clinicians and patients to advocate together for increasing the number of addiction resources available as the Emergency Department cannot provide the long term and consistent work needed to help patients’ achieve sobriety.
MedicalResearch: What recommendations do you have for future research as a result of this study?
Answer: While we have a way to identify the patients in our care plan program as having a substance abuse disorder, including narcotic seeking, our study reviewed 255 patients in the last 10 years. Larger studies are needed to help further substantiate the type of addiction among these super-frequent users. For Emergency Departments that don’t have a care plan for treating super-frequent users, implementing narcotic prescriber guidelines would help measure the effectiveness the guidelines.