Impact of Substance Use Disorder on Quality of Inpatient Mental Health Services for People With Anxiety and Depression

Article


Williams, R., Farquharson, L., Rhodes, E., Dang, M., Butler, J., Quirk, A., Baldwin, D. S. and Crawford, M. J. 2020. Impact of Substance Use Disorder on Quality of Inpatient Mental Health Services for People With Anxiety and Depression. Journal of Dual Diagnosis. https://doi.org/10.1080/15504263.2020.1825892
AuthorsWilliams, R., Farquharson, L., Rhodes, E., Dang, M., Butler, J., Quirk, A., Baldwin, D. S. and Crawford, M. J.
Abstract

Objective

Substance use disorders are commonly comorbid with anxiety and depressive disorders and are associated with poor treatment outcomes. The mechanisms underlying this association remain unclear—one possibility is that patients with anxiety/depressive disorders and substance use disorders receive poorer treatment. Concerns have been raised about the quality of inpatient care received by patients with substance use disorders. The purspose of this research was to examine the quality of care received by inpatients with an anxiety or depressive disorder, comparing subgroups with or without a comorbid substance use disorder.

Methods

This was a retrospective case-note review of 3,795 patients admitted to inpatient psychiatric wards in England. Data were gathered on all acute admissions with anxiety/depressive illness over a 6-month period, for a number of measures of quality of care derived from national standards. Association of coexisting substance use disorders with a variety of quality of care outcomes (relating to assessment, care planning, medication management, psychological therapies, discharge, crisis planning, and follow-up) was investigated using multivariable regression analyses.

Results

In all, 543 (14.3%) patients in the study had a secondary diagnosis of a substance use disorder. Patients with substance use disorders were less likely to have had care plans that were developed jointly (i.e., with input from both patient and clinician; odds ratio [OR] = 0.76, 95% confidence interval [CI] [0.55, 0.93], p = .034) and less likely to have had their medication reviewed either during the admission (OR = 0.83, 95% CI [0.69, 0.94], p = .030) or at follow-up after discharge (OR = 0.58, 95% CI [0.39, 0.86], p = .007). Carers of patients with substance use disorders were less likely to have been provided with information about available support services (OR = 0.79, 95% CI [0.57, 0.98], p = .047). Patients with substance use disorders were less likely to have received adequate (at least 24 hours) notice in advance of their discharge (OR = 0.72, 95% CI [0.54, 0.96], p = .033), as were their carers (OR = 0.63, 95% CI [0.41, 0.85], p = .007). They were less likely to have a crisis plan in place at the point of discharge (OR = 0.85, 95% CI [0.74, 0.98], p = .044). There was also strong evidence that patients with substance use disorders were less likely to have been referred for psychological therapy (OR = 0.69, 95% CI [0.55, 0.87], p = .002).

Conclusions

We found evidence of poorer quality of care for inpatients with anxiety and depressive disorders with comorbid substance use disorders, highlighting the need for more to be done to support these patients. Discrepancies in care quality may be contributed to the poor treatment outcomes experienced by patients with substance use disorders, and strategies to reduce this inequality are necessary to improve the well-being of this substantial patient group.

JournalJournal of Dual Diagnosis
ISSN1550-4263
Year2020
PublisherTaylor & Francis (Routledge)
Accepted author manuscript
License
File Access Level
Anyone
Digital Object Identifier (DOI)https://doi.org/10.1080/15504263.2020.1825892
Publication dates
Online13 Oct 2020
Publication process dates
Accepted13 Oct 2020
Deposited16 Dec 2020
Copyright holder© 2020 Taylor & Francis
Additional information

This is an Accepted Manuscript of an article published by Taylor & Francis in Journal of Dual Diagnosis on 13/10/2020, available online: http://www.tandfonline.com/10.1080/15504263.2020.1825892.

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