Healthcare Utilisation, Morbidities and Alcohol Use Monitoring Prior to Alcoholic Psychosis Diagnosis

Abstract

Aims
The aim of this study was to describe healthcare utilisation, morbidities and monitoring of alcohol use in patients prior to a diagnosis of alcoholic psychosis in order to inform the early identification of patients at risk.

Methods
Using linked general practice and hospitalisation data in England (April 1997 to June 2014), we identified 1731 individuals (≥18 years) with a clinical recorded diagnosis of alcoholic psychosis and 17,310 matched controls without the disorder, we examined all prior general practitioner (family doctor) visits, hospitalisations, medically recorded morbidities and alcohol assessment/interventions records. Poisson regression models were used to compare rates of healthcare utilisation in people with alcoholic psychosis to those without. Logistic regression models were used to evaluate the association between alcoholic psychosis and prior morbidities.

Results
Patients with alcoholic psychosis showed increased levels of healthcare utilisation at least 5 years prior to their diagnosis. The most common reasons for prior healthcare visits were seizures and injuries and there was >4-fold higher rate of seizures, unintentional injuries and self-harm incidents among these patients up to 10 years prior to diagnosis, compared to the control population. A high proportion (78%) of patients had their alcohol consumption recorded, 50% had a record of heavy drinking but only one in five had any evidence of receiving an alcohol-related intervention.

Conclusion
Patients present more often with seizures and injuries than the general population several years prior to a diagnosis of alcoholic psychosis. These visits represent opportunities for preventive action and imply that we may be missing opportunities to intervene.