 |
|
Study objectivePatients with sickle cell disease often receive a substantial amount of their health care in the emergency department (ED) and some come to the ED frequently, seeking treatment for pain. As a result, patients with sickle cell disease are often stigmatized as opioid-seeking ED overutilizers. We describe the proportion of sickle cell disease patients who are high utilizers of the ED and compare them with other sickle cell disease patients on demographics, pain characteristics, health data, psychosocial characteristics, and quality of life. MethodsTwo hundred thirty-two patients completed baseline data and at least 30 days of daily diary data. Baseline data included demographics, health data, and quality of life (Medical Outcome Study 36 Item Short Form). Daily diary data included ED utilization for sickle cell pain and descriptors of pain and distress. ResultsEighty-two (35.5%) patients were found to be high ED utilizers. Clinically important and statistically significant differences were found between high ED utilizers and all other sickle cell disease patients: lower hematocrit level, more transfusions, more pain days, more pain crises, higher mean pain and distress, and worse quality of life on Medical Outcome Study 36 Item Short Form physical function summary scales. After controlling for severity and frequency of pain, high ED utilizers did not use opioids more frequently than other sickle cell disease patients. ConclusionA substantial minority of sickle cell disease patients are high ED utilizers. However, high ED utilizers with sickle cell disease are more severely ill as measured by laboratory variables, have more pain, more distress, and have a lower quality of life. a Departments of Anesthesiology and Emergency Medicine, Virginia Commonwealth University Reanimation Engineering Shock Center (VCURES), Virginia Commonwealth University, Richmond, VA b Division of Quality Health Care, Virginia Commonwealth University, Richmond, VA c Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA d Department of Biostatistics, Virginia Commonwealth University, Richmond, VA e Department of Psychiatry, Virginia Commonwealth University, Richmond, VA f Department of Pathology, Virginia Commonwealth University, Richmond, VA g Division of Hematology/Oncology, Virginia Commonwealth University, Richmond, VA h University of North Carolina-Chapel Hill Schools of Medicine and Public Health, Chapel Hill, NC
Provide feedback on this article at the journal's Web site, www.annemergmed.com. Supervising editor: Knox H. Todd, MD, MPH Author contributions: All authors helped conceive the study, design the trial, and supervise conduct of trial data collection. WRS obtained funding. All authors contributed to study subject recruitment supervision. IPA drafted the article, and all authors contributed substantially to the article. IPA is the guarantor of the article. IPA takes responsibility for the paper as a whole. Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article, that might create any potential conflict of interest. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement. This research was funded by an NIH grant: Pain in Sickle Cell Epidemiology Study 1R01HL064122-01. Publication dates: Available online October 16, 2008. Reprints not available from the authors. PII: S0196-0644(08)01635-1 doi:10.1016/j.annemergmed.2008.07.050 © 2008 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.
| |||||||||||||||||||||||||
ABSTRACT
Comparisons of High Versus Low Emergency Department Utilizers in Sickle Cell Disease