Substance use disorders and medical comorbidities among high-need, high-risk patients with diabetes.
This is the Results Article for CTN-0057-Ot.
The majority of the U.S. health care resources are utilized by a small population characterized as high-risk, high-need persons with complex care needs (e.g., adults with multiple chronic conditions). Substance use disorders (SUDs) and mental health disorders (MHDs) are a driver of poor health and additional healthcare costs, but they are understudied among high-need patients. This study examined the prevalence and correlates of SUDs and MHDs among adults with high-risk diabetes, who are patients at the top 10% risk score for developing poor outcomes (hospital admission or death). A risk algorithm developed from Duke University Health System electronic health record (EHR) data was used to identify patients with high-risk diabetes for targeting home-based primary care. The EHR data of the 263 patients with high-risk diabetes were analyzed to understand patterns of SUDs and MHDs to inform care-coordinating efforts
Results found that both SUDs and MHDs were prevalent:
- Any SUD: 48.3%; Alcohol: 12.5%; Tobacco: 38.8%; Drug: 23.2%
- Any MHD: 74.9%; Mood: 53.2%; Sleep: 37.3%; Anxiety: 32.7%; Schizophrenia/Psychotics/Delusional: 14.8%; Dementia/Delirium/Amnestic/Cognitive: 14.4%; Adjustment: 9.1%
Overall, 81% of the same had SUD or MHD. Elevated odds of SUD were noted among men (tobacco, alcohol) and those who were never married (alcohol, cannabis). African American race (vs. other race/ethnicity) was associated with lower odds of anxiety disorders.
Conclusions: This study is the first to document a comprehensive pattern of SUD and MHD prevalence among adults with high-risk diabetes. While data are limited to one large academic health system, they provide clinical evidence revealing that 82% of patients with high-risk diabetes had SUD and/or MHD record in their EHRs, highlighting a need for developing service models to optimize high-risk care.
Related protocols: CTN-0057-Ot