Alvaro Castillo-Carniglia
A. Castillo-Carniglia1,2, A. González-Santa Cruz1, M. Cerdá2, J. Sapag3, J. Gaete4. 1Society and Health Research Center, Universidad Mayor, Chile; 2Department of Population Health, New York University, United States; 3Departments of Public Health and Family Medicine, School of Medicine, Pontificia Universidad Católica de Chile; 4Department of Public Health and Epidemiology. Universidad de los Andes, Chile
Background. In Chile, the Government funds substance use disorders (SUD) treatment for all people with public health insurance (79% of the population). Despite long-term efforts and significant economic investment, there is limited information regarding the short, middle and long-term results of these programs. We described the incidence rate of SUD treatment readmissions for all adult patients in publicly funded SUD treatment in 2010-2019.
Methods. We created a population-based retrospective cohort design using the electronic registration system for people in treatment, which registers all patients admitted to adult SUD treatment programs in centers receiving Government funding. We described the cumulative incidence rate of readmission and its variation by treatment outcome (i.e., early and late withdrawal from treatment vs. therapeutic discharge) and main substance of abuse at admission. Early withdraw was defined as withdraw within the first 90 days of treatment.
Results. There were 111,526 admissions from 81,923 people during 2010 and 2019. Seventy five percent were male and the average age at admission was 35. The main substance at admission was cocaine paste base (43.6%), followed by alcohol (30.5%), snort cocaine (18.3%), and marihuana (5.8%%). Among those with discharge information (N=103,723), the 22.6% had a therapeutic discharge, 34.1% had early withdraw, 16.9% had late withdraw, and 9.1% were expelled. The incidence rate of treatment readmission was 197 per 1,000 patients-year and the average time outside treatment (among readmitted patients) was 2.3 years. Compared with those with therapeutic discharge, the incidence rate ratio (IRR) for people with early and late withdraw was 2.85 (95%CI: 2.69, 3.01) and 1.72 (95%CI: 1.64, 1.80), respectively. Compared with those using alcohol as main substance at admission, the IRR for snort cocaine was 1.28 (IC95%: 1.22, 1.34) and for cocaine paste base was 1.53 (95%CI: 1.47, 1.58); no difference was observed for those using marijuana (IRR=1.03; 95%CI: 0.96, 1.10).
Conclusions. Readmissions to SUD treatment were high, particularly among early withdrawers and those using cocaine paste at admission. Individual risk assessment at admission seems to be a crucial component of treatment to prevent early withdrawal and subsequent problems, such treatment readmission.