Show simple item record

Substance use disorders and medical comorbidities among high-need, high-risk patients with diabetes.

dc.contributor.author Wu, Li-Tzy
dc.contributor.author Ghitza, Udi E
dc.contributor.author Zhu, He
dc.contributor.author Spratt, Susan
dc.contributor.author Swartz, Marvin
dc.contributor.author Mannelli, Paolo
dc.date.accessioned 2020-02-03T03:57:12Z
dc.date.available 2020-02-03T03:57:12Z
dc.date.issued 2018-05
dc.identifier S0376-8716(18)30106-6
dc.identifier.issn 0376-8716
dc.identifier.issn 1879-0046
dc.identifier.uri https://hdl.handle.net/10161/19930
dc.description.abstract The majority of the U.S. healthcare resources are utilized by a small population characterized as high-risk, high-need persons with complex care needs (e.g., adults with multiple chronic conditions). Substance use disorders (SUDs) and mental health disorders (MHDs) are a driver of poor health and additional healthcare costs, but they are understudied among high-need patients.We examine the prevalence and correlates of SUDs and MHDs among adults with high-risk diabetes, who are patients at the top 10% risk score for developing poor outcomes (hospital admission or death).A risk algorithm developed from Duke University Health System electronic health records (EHRs) data was used to identify patients with high-risk diabetes for targeting home-based primary care. The EHR data of the 263 patients with high-risk diabetes were analyzed to understand patterns of SUDs and MHDs to inform care-coordinating efforts.Both SUDs (any SUD 48.3%, alcohol 12.5%, tobacco 38.8%, drug 23.2%) and MHDs (any MHD 74.9%, mood 53.2%, sleep 37.3%, anxiety 32.7%, schizophrenia/psychotics/delusional 14.8%, dementia/delirium/amnestic/cognitive 14.4%, adjustment 9.1%) were prevalent. Overall, 81.7% of the sample had SUD or MHD. Elevated odds of SUD were noted among men (tobacco, alcohol) and those who were never-married (alcohol, cannabis). African-American race (vs. other race/ethnicity) was associated with lower odds of anxiety disorders.While data are limited to one large academic health system, they provide clinical evidence revealing that 82% of patients with high-risk diabetes had SUD and/or MHD recorded in their EHRs, highlighting a need for developing service models to optimize high-risk care.
dc.language eng
dc.publisher Elsevier BV
dc.relation.ispartof Drug and alcohol dependence
dc.relation.isversionof 10.1016/j.drugalcdep.2018.01.008
dc.subject Humans
dc.subject Diabetes Complications
dc.subject Substance-Related Disorders
dc.subject Treatment Outcome
dc.subject Prevalence
dc.subject Hospital Mortality
dc.subject Risk
dc.subject Mental Disorders
dc.subject Comorbidity
dc.subject Algorithms
dc.subject Socioeconomic Factors
dc.subject Adult
dc.subject Aged
dc.subject Middle Aged
dc.subject Delivery of Health Care
dc.subject Female
dc.subject Male
dc.title Substance use disorders and medical comorbidities among high-need, high-risk patients with diabetes.
dc.type Journal article
duke.contributor.id Wu, Li-Tzy|0380644
duke.contributor.id Spratt, Susan|0225107
duke.contributor.id Swartz, Marvin|0053343
duke.contributor.id Mannelli, Paolo|0331498
dc.date.updated 2020-02-03T03:57:11Z
pubs.begin-page 86
pubs.end-page 93
pubs.organisational-group School of Medicine
pubs.organisational-group Duke
pubs.organisational-group Center for Child and Family Policy
pubs.organisational-group Sanford School of Public Policy
pubs.organisational-group Duke Clinical Research Institute
pubs.organisational-group Institutes and Centers
pubs.organisational-group Duke Institute for Brain Sciences
pubs.organisational-group University Institutes and Centers
pubs.organisational-group Institutes and Provost's Academic Units
pubs.organisational-group Psychiatry & Behavioral Sciences, Social and Community Psychiatry
pubs.organisational-group Psychiatry & Behavioral Sciences
pubs.organisational-group Clinical Science Departments
pubs.organisational-group Medicine, General Internal Medicine
pubs.organisational-group Medicine
pubs.organisational-group Medicine, Endocrinology, Metabolism, and Nutrition
pubs.organisational-group Family Medicine and Community Health, Community Health
pubs.organisational-group Family Medicine and Community Health
pubs.publication-status Published
pubs.volume 186
duke.contributor.orcid Wu, Li-Tzy|0000-0002-5909-2259
duke.contributor.orcid Mannelli, Paolo|0000-0002-7834-6138


Files in this item

Thumbnail

This item appears in the following Collection(s)

Show simple item record