Utilisation de l’urgence au Québec des patients avec des troubles mentaux incluant les troubles liés aux substances psychoactives
Notice bibliographique
Résumé
Objectives This study investigated emergency department (ED) use, reasons for emergency visits, hospitalization rates, and duration of hospitalization in 2014-15 for a cohort of patients with mental disorders (MDs) including substance use disorders (SUDs), regarding sex, age and residential areas. Results were compared with data from patients without MDs for 2014-15, and with another cohort from 2000-01, which marked the beginning of primary care reform in Quebec and elsewhere, with the aim of measuring ED use over time. Methods Based on data from the Quebec Integrated Chronic Disease Surveillance System (QICDSS), participants included patients age 12 and over, diagnosed with at least one MD (or SUD) during an ED visit, hospitalization, or outpatient consultation in 2014-15 and 2000-01. Frequency distributions for ED visits and hospitalizations were produced, as well as for MDs or SUDs exclusively, or for co-occurring MDs-SUDs, and among high or very high ED users (4 to 11 visits/year, ≥12 visits/year), by gender, age (12-17, 18-24, 25-44, 45-64, and 65 and over) and residential area (Montreal, urban areas:>100,000, semi-urban areas: <100,000, and rural areas: <10,000). The age-standardized method based on the age structure of the 2014-15 population was used to compare data from 2014-15 to 2000-01. Frequency distributions for patients with and without MDs, and on ED and hospitalization rates were also produced for 2014-15. Results For the Quebec population, 12% had MDs including SUDs, of whom 39% had visited an ED, a decrease of 6% since 2000-01. Approximately twice as many patients with MDs had ED visits or hospitalizations, compared to patients without MDs. Nearly 17% of patients were high or very high ED users; and 34% were hospitalized. ED use was higher among patients 65 years and older, and those living in rural areas. Sixty-eight percent of ED visits for MDs exclusively were made by patients affected by anxiety-depression; whereas 51% of visits for SUDs exclusively were alcohol-related. Physical illnesses were the main reason for ED visits and hospitalizations; yet patients with severe MDs, co-occurring MDs and SUDs as well as those with more frequent ED visits tended to use EDs more for MD reasons. Conclusion This study demonstrated a very high volume of ED visits and hospitalizations among patients with MDs, including SUDs, compared to patients without MDs. Co-occurring disorders, especially physical conditions and multiple and severe MDs, contributed to frequent ED use and hospitalizations. Better care management, including more comprehensive personal care, for patients with MDs including SUDs and co-occurring disorders is needed, as well as the deployment of strategies that provide integrated mental health and medical care, particularly in Montreal where ED use by patients with predominantly severe and co-occurring MDs and physical illnesses, is more frequent.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,006 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».