What question did this study set out to answer?

This research aims to identify predictors that impact the engagement of individuals in outpatient treatment for substance use disorders following visits to specialized emergency departments.

January 27, 2026

Predictors of outpatient treatment engagement following a visit to a specialized emergency department for substance use: A cohort study using high‐resolution electronic health records

Puntos clave

This research aims to identify predictors that impact the engagement of individuals in outpatient treatment for substance use disorders following visits to specialized emergency departments.
Conducted a retrospective cohort study using electronic health records and multiple registries.
Linked data covering clinical history and healthcare consumption for a large sample of SUD patients.
Defined post-acute treatment engagement as two or more outpatient visits in six months and categorized engagement levels using quantile regression.
Utilized multinomial logistic regression models to analyze 19 potential predictors of treatment engagement.
One-third of patients (33.2%) engaged in post-acute outpatient treatment, while 49.9% did not engage in treatment.
Police-initiated admissions showed lower odds of high treatment engagement compared to ambulance-initiated admissions (aOR = 0.71).
Prior visits to needle and syringe programs significantly increased odds of post-acute treatment engagement (aOR = 2.09).
Lack of prior outpatient treatment consistently decreased the likelihood of engagement across all levels (e.g., aOR = 0.30 for moderate engagement).

Resumen

Abstract Background and aims Substance‐related emergency department (ED) visits represent a critical opportunity to link individuals with sustained treatment for substance use disorders (SUD), yet few transition to post‐acute treatment. Among emerging initiatives to integrate specialized SUD care into ED services, the Stockholm SUD‐ED is an example of a fully integrated model that remains unmapped. This study aimed to systematically map care pathways and identify predictors of post‐acute SUD treatment engagement among SUD‐ED patients in Stockholm. Design Retrospective cohort study. Electronic health records data were linked with five registries covering, among other aspects, clinical history and healthcare consumption. Setting The Stockholm SUD‐ED, Sweden. Participants n = 9771 SUD‐ED patients during a sixteen‐month period (2018–2019). Measurements For care flow mapping, post‐acute SUD treatment engagement was defined as ≥2 outpatient visits during a six‐month follow‐up. Four engagement levels (none, low, moderate, high) were derived using a quantile regression approach and regressed on 19 candidate predictors in multinomial logistic regression models. Findings Of all SUD‐ED patients, one‐third (33.2%; n = 3248) primarily engaged in post‐acute outpatient SUD treatment, 16.9% ( n = 1651) primarily engaged in non‐SUD psychiatric services and 49.9% ( n = 4872) did not engage in either. Police‐initiated admissions had lower odds of moderate or high post‐acute treatment engagement than ambulance‐initiated admissions high engagement: adjusted odds ratio (aOR) = 0.71, 95% confidence interval (CI) = 0.53–0.95. Prior needle and syringe program visits increased the odds of post‐acute treatment engagement (aOR = 2.09, 95% CI = 1.59–2.75). Lack of prior SUD outpatient treatment was consistently associated with lower odds of post‐acute engagement across all levels (e.g. moderate engagement: aOR = 0.3, 95% CI = 0.25–0.35). Conclusions The Stockholm model for fully integrating specialized substance use disorder care into emergency departments appears to generate high post‐acute treatment engagement and highlights the need for (1) targeted interventions for police‐initiated admissions and (2) broad aftercare options to better attract treatment‐naïve patients.

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