Public Health and Primary CareREVIEW ARTICLE
Abstract
Context: In the United States, nearly 80 % of the adult population reported lifetime alcohol use, with 50 % of those reporting alcohol consumption within the past 30 days in 2019. The expense of excess alcohol intake was estimated to have an annual associated healthcare cost of $28 billion, and there was greater than $221 billion in additional costs due to the detrimental effects of excess alcohol intake on productivity and societal setbacks over the last year. Alcohol use disorder (AUD) provides a major barrier for patients seeking medical treatment, because AUD is consistently regarded as one of the most stigmatized disorders globally. Provider-based discrimination toward patients with AUD may lead to providing a lower quality of care.
Objectives: Our objective was to assess whether patients with a history of AUD and/or positive blood alcohol content (BAC+) affect emergency department (ED) wait times. We hypothesized that patients presenting to the ED with AUD+/BAC+ would have longer wait times. Secondarily, we investigated the impacts of sociodemographics within these analyses.
Methods: We conducted a cross-sectional analysis of the 2019–2021 National Hospital Ambulatory Medical Care Survey (NHAMCS). Individuals’ primary diagnosis had to be of musculoskeletal origin based on ICD-10 codes starting with ‘S’ for skeletal or bodily injuries or ‘M’ for diagnoses related to musculoskeletal or connective tissue conditions. Wait time was quantified from time of entry into the triage system to the time patients were seen by the first provider. We included data points with or without a recorded history of alcohol misuse or dependence (AUD+/−) in their chart and those with a positive or negative blood alcohol content (BAC+/−).
Results: ED wait times among individuals presenting with musculoskeletal injuries with a current history of AUD presenting with BAC- at the time of triage were not significantly different from those without a history of AUD. Individuals who were BAC+ at the time of triage had shorter wait times regardless of AUD history – and only AUD-/BAC+ had shorter wait times. Our binary regression and adjusted models showed that individuals who were AUD-/BAC+ had a significantly shorter wait time (minimum −18.43, standard error [SE]=1.92, t=−9.59, p<0.001; SE=2.97; t=−5.62, p<0.001) compared to individuals who were AUD-/BAC- respectively. Those who were AUD+/BAC+ also had shorter wait times compared to AUD-/BAC− (min=−11.11, SE=4.05; t=−2.75, p=0.006).
Conclusions: Overall, our study showed no significant difference in ED wait times between individuals with and without a history of AUD – indicating that AUD history does not delay being seen. Shorter wait times for those entering the ED BAC+ may be due to their immediate need for treatment due to toxicity or alcohol withdrawal syndrome, having more severe injuries, or harm prevention.