The Impact of Methamphetamine Use on Emergency Care in San Diego County

Transcription

1 The Impact of Methamphetamine Use on Emergency Care in San Diego County Alan M. Smith, PhD, MPH Holly Shipp, MPH Barbara Stepanski, MPH Lacey Hicks, MPH Julie Cooke, MPH Leslie Upledger Ray, PhD (c), MPH, MPPA, MA

2 The Emergency Medical Care System Prehospital Paramedic/EMT calls Emergency Department Discharges Patients seen and discharged from ED Hospital Inpatient Discharges Patients admitted to hospital Medical Examiner Non-natural natural and unexpected deaths

3 Meth/Amphetamine /Amphetamine-Related Cases by Data Source (Injury Pyramid ) Medical Examiner 239 Hospital Discharge 4503 Emergency Department 2333 Prehospital Number of Patients Source: County of San Diego Health and Human Services Agency, MICN database FY 2005/06; Emergency Department database FY 2005/06 County Hospital Discharge of San database Diego 2004; Medical Division Examiner database of Emergency 2005 Medical Services

4 Prehospital Data: QCS Fiscal Year 2005/06 MICN data 140,000 patients/year Inclusion criteria key word search for meth, followed by individual record review Total meeting criteria: 576 Population rate: 19 per 100,000

5 Age Distribution: Prehospital Patients % 65+ 1% % % % Source: County of San Diego Health and Human Services Agency, MICN database FY 2005/06

6 Age-Specific Rates: Prehospital Patients Rate per 100, * Total *Rate not calculated, fewer than five incidents. Source: County of San Diego Health and Human Services Agency, MICN database FY 2005/06

7 Gender Distribution: Prehospital Patients Female 34% Male 66% Source: County of San Diego Health and Human Services Agency, MICN database FY 2005/06

8 Chief Complaints: Prehospital Patients Other Medical 10% OD Poison 12% Trauma 9% Psychiatric 8% Alt Neuro (Med) 6% Chest Pain Card 5% Abd Pain 4% Resp Distress 4% Seizure 3% Palpitations 3% Chest Pain Other 2% Other 7% ETOH/Sub Abuse 27% Source: County of San Diego Health and Human Services Agency, MICN database FY 2005/06

9 Status/Acuity: Prehospital Patients Moderate 9% Acute 3% Mild 88% Source: County of San Diego Health and Human Services Agency, MICN database FY 2005/06

10 External Cause of Injury: Prehospital Patients Legal Intervention 14% MV Traffic 19% MV Non-Traffic 5% Poisoning 3% Homicide/Assault 32% Fall 11% Other 5% Suicide/Self-Inflicted 11% N=37 Source: County of San Diego Health and Human Services Agency, MICN database FY 2005/06

11 Run Disposition: Prehospital Patients AMA 4% Release 1% DOS 1% Other 0% Transported 94% Source: County of San Diego Health and Human Services Agency, MICN database FY 2005/06

12 Patient Disposition: Prehospital Patients Transferred 3% Expired ER 1% Other 6% A.M.A. 5% Admitted 24% Discharged 61% Source: County of San Diego Health and Human Services Agency, MICN database FY 2005/06

13 HHSA Region of Receiving Hospital: Prehospital Patients 200 Number of patients Central East North Central North Coastal North Inland South Source: County of San Diego Health and Human Services Agency, MICN database FY 2005/06

14 Emergency Department Database Fiscal Year 2005/06 Patients seen and discharged from emergency departments 584,049 Total Patients/year Inclusion criteria Any ICD-9 9 diagnosis = (amphetamine and other psychostimulant dependence) or (amphetamine or related acting sympathomimetic abuse) Total meeting criteria: 2,333 Population rate: 76 per 100,000

15 Age Distribution: ED Patients % 65+ 1% % % % Source: HASD&IC, CHIP, County of San Diego Health and Human Services Agency, Emergency Department database FY 2005/06

16 Age-Specific Rates: ED Patients Rate per 100, Total Source: HASD&IC, CHIP, County of San Diego Health and Human Services Agency, Emergency Department database FY 2005/06

17 Gender Distribution: ED Patients Female 39% Male 61% Source: HASD&IC, CHIP, County of San Diego Health and Human Services Agency, Emergency Department database FY 2005/06

18 Race/Ethnicity Distribution: ED Patients Asian/Other 5% Unknown 2% Hispanic 22% Black 7% White 64% Source: HASD&IC, CHIP, County of San Diego Health and Human Services Agency, Emergency Department database FY 2005/06

19 Race/Ethnicity Rates: ED Patients Rate per 100, White Black Hispanic Asian/Other Source: HASD&IC, CHIP, County of San Diego Health and Human Services Agency, Emergency Department database FY 2005/06

20 Amphetamine Abuse vs. Dependence: Amphetamine Dependence 15% ED Patients Amphetamine Abuse 85% Source: HASD&IC, CHIP, County of San Diego Health and Human Services Agency, Emergency Department database FY 2005/06

21 Primary Diagnosis: ED Patients Symptoms, Signs, Ill- Defined Conditions 26% Injury & Poisoning 13% Skin / Subcutaneous Tissue 8% Other 21% Mental Disorders 32% Source: HASD&IC, CHIP, County of San Diego Health and Human Services Agency, Emergency Department database FY 2005/06

22 External Cause of Injury: ED Patients (N=411) Other 36% Motor Vehicle Related Other Vehicle 5% 2% Falls 13% Self Inflicted 16% OD/Poisoning 14% Assaults 14% Source: HASD&IC, CHIP, County of San Diego Health and Human Services Agency, Emergency Department database FY 2005/06 N=411

23 Source of Payment: ED Patients Private-HMO 11% Workers CompensationOther federal Private-Other 0.3% programs 7% 1.3% Other 0.3% Self-Pay 39% Medicare- Traditional 8% Medicare HMO 1.0% Medi-Cal 19% Non-federal programs 14% Source: HASD&IC, CHIP, County of San Diego Health and Human Services Agency, Emergency Department database FY 2005/06

24 Discharge Disposition: ED Patients Home 86.0% Psych 5.5% Other 8.5% Other 0.8% Other hospital 3.2% ICF 0.2% Other inpatient facility 0.8% AMA 3.3% Rehab facility 0.1% Expired 0.04% Source: HASD&IC, CHIP, County of San Diego Health and Human Services Agency, Emergency Department database FY 2005/06

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27 Hospital Patient Discharge Database Year 2004 Includes all patients discharged after admission to hospital 297,096 patients/year Inclusion criteria Any ICD-9 9 diagnosis = (amphetamine and other psychostimulant dependence) or (amphetamine or related acting sympathomimetic abuse) Total meeting criteria: 4,503 Population rate: 149 per 100,000

28 Age Distribution: Hospital Inpatients % % % % % Source: County of San Diego Health and Human Services Agency, Hospital Discharge database 2004

29 Age-Specific Rates: Hospital Inpatients Rate per 100, Total Source: County of San Diego Health and Human Services Agency, Hospital Discharge database 2004

30 Gender Distribution: Hospital Inpatients Female 40% Male 60% Source: County of San Diego Health and Human Services Agency, Hospital Discharge database 2004

31 Race/Ethnicity Distribution: Hospital Inpatients Asian/Other 5% Unknown 2% Hispanic 22% Black 8% White 63% Source: County of San Diego Health and Human Services Agency, Hospital Discharge database 2004

32 Race/Ethnicity Rates: Hospital Inpatients Rate per 100, White Black Hispanic Asian/Other Source: County of San Diego Health and Human Services Agency, Hospital Discharge database 2004

33 Route of Admission: Hospital Inpatients Not Hospital's ED 46.3% Hospital's ED 53.7% Source: County of San Diego Health and Human Services Agency, Hospital Discharge database 2004

34 Primary Diagnosis: Hospital Inpatients Other 28% Schizophrenic disorders 15% Pregnancy related 6% Skin / Subcutaneous Tissue 6% Circulatory 7% Alcohol/Drug Use 14% Affective psychoses 15% Other Nonorganic Psychoses 5% Other mental disorders 4% Source: County of San Diego Health and Human Services Agency, Hospital Discharge database 2004

35 External Cause of Injury: Hospital Inpatients (N=751) Other 21% Motor Vehicle 9% Other Vehicle 3% Falls 6% OD/Poisoning 19% Self Inflicted 25% Assaults 17% N=751 Source: County of San Diego Health and Human Services Agency, Hospital Discharge database 2004

36 Source of Payment: Hospital Inpatients Self pay 18.6% Other payer 0.9% Not reported 0.1% Medicare 17% Other indigent 3% Other gov't 2% County indigent programs 11% Workers' Comp 0.2% Private 20% Medi-Cal 27% Source: County of San Diego Health and Human Services Agency, Hospital Discharge database 2004

37 Discharge Disposition: Hospital Inpatients Home 74.4% Residential Care 7.2% AMA 6.6% Expired 1.0% Jail 2.4% Other 2.2% Other hospital 4.6% ICF 1.7% Source: County of San Diego Health and Human Services Agency, Hospital Discharge database 2004

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40 Medical Examiner Database Year 2005 Includes all non-natural natural deaths occurring in San Diego County 2,580 investigations per year 1,568 non-natural natural deaths Inclusion criteria positive toxicology for methamphetamine Total meeting criteria: 245 Population rate: 7.9 per 100,000 12% of all toxicologies

41 Age Distribution: ME Cases 65+ 0% % % % Source: County of San Diego Health and Human Services Agency, Medical Examiner database %

42 Age-Specific Rates: ME Cases Rate per 100, * Total Source: County of San Diego Health and Human Services Agency, Medical Examiner database 2005

43 Gender Distribution: ME Cases Female 22% Male 78% Source: County of San Diego Health and Human Services Agency, Medical Examiner database 2005

44 Race/Ethnicity Distribution: ME Cases Asian/Other 6% Hispanic 31% White 56% Black 7% Source: County of San Diego Health and Human Services Agency, Medical Examiner database 2005

45 Race/Ethnicity Rates: ME Cases Rate per 100, White Black Hispanic Asian/Other Source: County of San Diego Health and Human Services Agency, County Medical Examiner of San database Diego 2005 Division of Emergency Medical Services

46 Cause of Death: ME Cases Other/Unknown 8% Natural 5% Homicide 17% Suicide 11% Unint- Drug/Alcohol 45% Unint-Motor Vehicle 14% Source: County of San Diego Health and Human Services Agency, N=239 Medical County Examiner of database San Diego 2005 Division of Emergency Medical Services

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49 Summary: Comparison of Phases of Care Meth pervasive in emergency cases and sudden deaths Age: Comparable in ED, Hospital DC Older in ME (35% >=45 years vs % 24% in ED, HDC) Younger in prehospital (27% vs. 20% in ED, HDC) Sex: More male in ME (77% vs. 61% in ED, HDC) Race/Ethnicity: Whites, Blacks overrepresented Hispanics, Asians underrepresented

50 Summary (continued) Primary Diagnoses/Complaints Mental disorders 35% of hospital DC were schizophrenia/psychoses Circulatory disorders 7.5% of hospital DC Pregnancy 6% of hospital DC Skin/Subcutaneous 8% of ED and hospital DC

51 Summary: Injuries E-codes noted for 18% of ED patients, 17% of Hospital DC Higher % of injuries from self-inflicted and assault Self-Inflicted Injuries 17% of ED; 24% of hospital DC; 12% of ME Assault 14% of ED; 17% of hospital DC; 15% of ME Motor Vehicle Related 6% of ED; 9% of hospital DC; 15% of ME

52 Conclusions Meth impacts all phases of emergency care in San Diego County Increased psychosis (direction?) Increased violent injury risk Self inflicted Assault Geographic regions Central East

53 Acknowledgements The presenters wish to thank the following for contributing data: San Diego County Prehospital Agencies San Diego County Emergency Departments San Diego County Acute Care Hospitals San Diego County Medical Examiner s s Office Hospital Association CHIP

54 Contact Information Alan M. Smith, Ph.D., M.P.H. Holly E. Shipp, M.P.H. Barbara M. Stepanski, M.P.H. County of San Diego HHSA, Emergency Medical Services (619) Lacey Hicks, M.P.H. County of San Diego HHSA, Community Epidemiology Division (619) County of San Diego Community Health Statistics Unit (619)