Does referral from an emergency department to an alcohol treatment center reduce subsequent emergency room visits in patients with alcohol intoxication?

Study Objective: In October 2005, a facility opened in Albuquerque whose purpose is to provide treatment for persons addicted to alcohol and other substances. The goal of this study is to evaluate the effect of this facility on emergency room utilization among patients who were seen in the Emergency Department for alcohol intoxication. Methods: This is a historical prospective study that measures health care utilization among two groups of patients treated at the University of New Mexico Emergency Department (UNM ED) for alcohol intoxication. One group is identified as being subsequently treated at an alcohol treatment facility, the Metropolitan Assessment and Treatment Services (MATS), and the second is composed of those who have not been exposed to this facility. All UNM ED patients who were between the ages 18 and 100 and had a diagnosis of alcohol intoxication were eligible. Exposure classification groups are: 1) ever treated at MATS (with the first UNM ED visit for alcohol intoxication with subsequent referral and treatment at MATS as the index visit); and, 2) never treated at MATS (with first alcohol intoxication visit to UNM ED after the MATS opening date of 10/27/05 as the index visit). The principal outcome is: time between index visit for alcohol intoxication and subsequent UNM ED visit for any complaint. Total numbers of visits were analyzed using univariate, bivariate and multivariate analysis. Results: Patients who were discharged to MATS on their index visit to the UNM ED for alcohol intoxication (n=74) had a shorter time between their index visit and a return ED visit. The mean number of days from index visit to return to the UNM ED for MATS patients was 100 days (confidence interval (CI) 72.21 to 128.14) while for patients who were not discharged to MATS (n=109), the mean was 83 days (CI 61.42 to 104.67). A small subset of patients were found to be using the most health care services, 4 patients presented 50 or more times. One patient had 24 visits involving an alcohol related diagnosis. Of 5,222 alcohol related visits, during the entire period only 8.6% were discharged to MATS. The large portion of patients (40.3%) only had one visit in the entire period. This made statistical analysis of number of subsequent visits unanalyzable in terms of significance. Conclusion: Treatment at substance abuse treatment centers may have an impact on health care utilization. Referrals to such a center increased time from index visits to subsequent ER visits for MATS users but was not statistically significant. Increasing referrals to such facilities may reduce ER visits and subsequently reduce ED costs but in order to draw this conclusion, further study needs to be done with a larger sample size