Factors associated with unplanned early discharges from a dual diagnosis inpatient detoxification unit in Israel. Sofer, M. M., Kaptsan, A., & Anson, J. Journal of Dual Diagnosis, April, 2018.
Factors associated with unplanned early discharges from a dual diagnosis inpatient detoxification unit in Israel [link]Paper  doi  abstract   bibtex   
OBJECTIVES: Currently, Israel has a single governmental inpatient dual diagnosis detoxification unit. We provide a cross-section of patient profiles in this unit, as well as explore possible associations between clinical/demographic factors, and the unplanned early discharge of patients from the unit, aiming at improving rehabilitation success rates. METHODS: In this retrospective study, medical records of all patients admitted to the unit between January 1st 2012 and July 1st 2013 were examined (N = 323). ICD-10 was used for diagnosis. Statistical analysis was carried out using Pearson chi-square and binary logistic regression. RESULTS: Patient population. Patients admitted to our unit were affected by Schizophrenia (31.8%), personality disorder (25%) and depression (18.3%). Substances in use included alcohol (67.5%), cannabis (8.35%) and benzodiazepines (9%). Almost half of the patients were poly-substance users (48.9%). The unit had high rates of immigrants, mainly Ex-USSR and Ethiopian born. It had low rates of individuals who had served in the army (52.8%), despite the service being mandatory in Israel. Treatment completion status. Sixty-eight percent of patients completed the program as planned, and 32% were discharged early: 8.6% discharged due to drug use in detox settings, violence or hospitalization for clinical reasons and 23.2% discharged against medical advice. Immigrants had increased rates of completing the program as scheduled. Of the 46.7% of patients suffering from severe mental illness (SMI), 44.3% were discharged early. Higher education and a diagnosis of depression were associated with program completion as planned. Using logistic regression, we found patients with disability pensions (OR = 0.36, 95%CI [0.14-0.91], p = 0.03) and poly-substance use (OR = 0.39, 95%CI [0.23-0.66], p = 0.000) had a higher risk for early discharge. Upon completion of individual programs, 52% were referred to an ambulatory addiction center and 13% to a nationally-sponsored dual diagnosis therapeutic community. CONCLUSIONS: Israel's single official Dual Diagnosis detox inpatient unit has satisfactory annual program completion rates when compared to similar institutions. Suboptimal treatment regimen may contribute to the early discharge of patients using polysubstance use and diagnosed with personality disorders. An association between early discharges with a disability pension warrant further investigation as there is no apparent connection between the two.
@article{sofer_factors_2018-1,
	title = {Factors associated with unplanned early discharges from a dual diagnosis inpatient detoxification unit in {Israel}},
	issn = {1550-4271},
	url = {https://www.ncbi.nlm.nih.gov/pubmed/29668421},
	doi = {10.1080/15504263.2018.1461965},
	abstract = {OBJECTIVES: Currently, Israel has a single governmental inpatient dual diagnosis detoxification unit. We provide a cross-section of patient profiles in this unit, as well as explore possible associations between clinical/demographic factors, and the unplanned early discharge of patients from the unit, aiming at improving rehabilitation success rates.
METHODS: In this retrospective study, medical records of all patients admitted to the unit between January 1st 2012 and July 1st 2013 were examined (N = 323). ICD-10 was used for diagnosis. Statistical analysis was carried out using Pearson chi-square and binary logistic regression.
RESULTS: Patient population. Patients admitted to our unit were affected by Schizophrenia (31.8\%), personality disorder (25\%) and depression (18.3\%). Substances in use included alcohol (67.5\%), cannabis (8.35\%) and benzodiazepines (9\%). Almost half of the patients were poly-substance users (48.9\%). The unit had high rates of immigrants, mainly Ex-USSR and Ethiopian born. It had low rates of individuals who had served in the army (52.8\%), despite the service being mandatory in Israel. Treatment completion status. Sixty-eight percent of patients completed the program as planned, and 32\% were discharged early: 8.6\% discharged due to drug use in detox settings, violence or hospitalization for clinical reasons and 23.2\% discharged against medical advice. Immigrants had increased rates of completing the program as scheduled. Of the 46.7\% of patients suffering from severe mental illness (SMI), 44.3\% were discharged early. Higher education and a diagnosis of depression were associated with program completion as planned. Using logistic regression, we found patients with disability pensions (OR = 0.36, 95\%CI [0.14-0.91], p = 0.03) and poly-substance use (OR = 0.39, 95\%CI [0.23-0.66], p = 0.000) had a higher risk for early discharge. Upon completion of individual programs, 52\% were referred to an ambulatory addiction center and 13\% to a nationally-sponsored dual diagnosis therapeutic community.
CONCLUSIONS: Israel's single official Dual Diagnosis detox inpatient unit has satisfactory annual program completion rates when compared to similar institutions. Suboptimal treatment regimen may contribute to the early discharge of patients using polysubstance use and diagnosed with personality disorders. An association between early discharges with a disability pension warrant further investigation as there is no apparent connection between the two.},
	language = {eng},
	journal = {Journal of Dual Diagnosis},
	author = {Sofer, Menachem M. and Kaptsan, Alexander and Anson, Jonathan},
	month = apr,
	year = {2018},
	pmid = {29668421},
	keywords = {Army service, Ethiopian immigrants, Israel national insurance institute, Personality disorder, Poly-substance use, Russian immigrants, Schizophrenia, Severe mental illness},
	pages = {0}
}

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