Outpatient psychiatric service use is associated with a reduced risk of 1-year readmission and mortality following alcohol-related hospitalizations: A historical cohort study.

ABSTRACT

INTRODUCTION: Alcohol-related hospitalizations are common and associated with high rates of short-term readmission and mortality. Providing rapid access to physician-based mental health and addiction (MHA) services post-discharge may help to reduce the risk of adverse outcomes in this population. This study used population-based data to evaluate the prevalence of outpatient MHA service use following alcohol-related hospitalizations and its association with downstream harms. METHODS: This was a population-based historical cohort study of individuals who experienced an alcohol-related hospitalization between 2016 and 2018 in Ontario, Canada. The primary exposure was whether an individual received follow-up outpatient MHA services from either a psychiatrist or primary care physician within 30 days of discharge from the index hospitalization. The outcomes of interest were alcohol-related hospital readmission and all-cause mortality in the year following discharge from the index alcohol-related hospitalization. Information on health service use and mortality was captured using comprehensive health administrative databases. The associations between receiving outpatient MHA services and the time to each outcome were assessed using multivariable time-to-event regression. RESULTS: A total of 43,343 individuals were included. 19.8% of the cohort received outpatient MHA services within 30 days of discharge. Overall, 19.1% of the cohort was readmitted to hospital and 11.5% of the cohort died in the year following discharge. Receiving outpatient MHA services was associated with a reduced hazard of alcohol-related hospital readmission (adjusted hazard ratio [aHR] 0.94, 95% confidence interval [CI] 0.88-0.99) and all-cause mortality (aHR 0.74, 95% CI 0.66-0.83) after adjusting for demographic and clinical covariates. CONCLUSIONS: Short-term outcomes following alcohol-related hospitalizations are poor. Facilitating rapid access to follow-up MHA services may help to reduce the risk of recurrent harm and death in this population.