Virginia Research Day 2021

Retrospective Assessment of Intravenous Drug Use on Southwest Virginia For Relative Risk Reduction of Proposed Needle Exchange Program Jake Norris, DO, Yelena Kiseleva, DO, Billy Turner, DO, Madiha Kamal, MD, William Dehart, PhD

Results Proportion of Re-admissions - 2 = 59.205, p < .002 Re-admitted IVDU Disease

Objective

Results Cont.

Odds of Readmission Within 90 Days Predictors Odds Ratios

Our project examined the impacts of IV drug abuse on a regional healthcare system in Southwest Virginia; including associated infections, length of stay, admission costs, and readmission rates.

CI

Total

No

Yes

Age

1.00*** 0.54*** 1.42***

1.00 – 1.01 0.49 – 0.60 1.22 – 1.65 1.09 – 2.35

5684 93.5 % 54.3 % 4781 89.4 % 45.7 % 10465 91.6 %

398 6.5 % 41.3 % 565 10.6 % 58.7 %

6082 100 % 53.2 % 5346 100 % 46.8 % 11428 100 %

Background

No

Insurance (non-Medicaid)

The social, economic, and health consequences of intravenous drug abuse cannot be understated. Harm reduction refers a number of approaches aimed at alleviating or curtailing the damages correlated definitively with various behaviors in high-risk groups or individuals. Our project examined the impacts of IV drug abuse on a regional healthcare system in Southwest Virginia. Methods and Analyses • Patient electronic health records were analyzed from four hospitals in Southwest Virginia from the following dates: 01/01/2015 through 12/31/2019 • 11,428 patients identified as having a substance use disorder • The data were divided into those without an intravenous drug-use related infection (n=10,465) and those patients with an intravenous drug-use related infection such as Hepatitis C, HIV, osteomyelitis, endocarditis etc. (n=963) • Percentage differences instead of gross amounts were used to report total billed charges due to their proprietary • Regression models were conducted to evaluate the differences in encounter cost (log transformed) and likelihood of re-admittance • Due to the large number of patients with hospital stays <24 hours, a zero-inflated negative binomial model was conducted to analyze length of stay • Lastly, logistic regression model was performed with readmission dichotomously coded as yes or no

IV Disease (Yes)

Yes

IV Disease (Yes) x Race (Black)

1.59*

* p < .05, ** p < .01, *** p < .001 Note – Race comparison group is Caucasian, Sex comparison group is Female

963 8.4 %

Total

Conclusion

Encounter Cost Predictors

This project was specific to our local community (Montgomery County, Virginia and surrounding area), in order to evaluate if there could be a benefit from a needle exchange program. Our findings indicate a higher healthcare cost for patients with IV- drug use related. Also, length of hospital stay is about twice as long (RR = 1.24, p < .001) . Our analyses also found a significantly higher re- admittance rate in patients with IVDU associated infections compared to SUD patients without such corresponding infections. Overall, there is significant evidence to support the assertion that needle sharing and re-use in IV drug users contribute to these findings. Further, this data indicates that our community may benefit from programs aimed at reducing the re-use of contaminated needles with the possible benefit of reducing healthcare costs.

Estimate

CI

Age

0.00*** -0.49*** 0.75***

0.00 - 0.00 -0.55 - -0.43 0.51 – 0.99 -0.02 – 0.07 0.73 – 0.91 -0.71 - -0.29

Insurance (non-Medicaid)

Race (Black) Sex (Male)

0.03

IV Disease (Yes)

0.82*** -0.50***

IV Disease (Yes) x Race (Black)

* p < .05, ** p < .01, *** p < .001 Note – Race comparison group is Caucasian, Sex comparison group is Female

References

• Des Jarlais, D.C. (2017). Harm Reduction in the USA: the research perspective and an archive to David Purchase. Harm Reduction Journal, 14(1), 1-7. https://doi.org/10.1186/s12954-017-0178-6 • Harm reduction: An approach to reducing risky health behaviours in adolescents. (2008). Paediatrics & Child Health, 13(1), 53-56. https://doi.org/10.1093/pch/13.1.53

This research was supported (in whole or in part) by HCA Healthcare and/or an HCA Healthcare affiliated entity. The views expressed in this publication represent those of the author(s) and do not necessarily represent the official views of HCA Healthcare or any of its affiliated entities.

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