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Enhancing opportunities to reduce escalation to substance use disorders through early engagement: a retrospective observational data linkage study of primary and secondary care in Wales

Columbus Ohaeri Orcid Logo, Ian Farr, Grace Bailey Orcid Logo, Hywel Evans Orcid Logo, Ryan Phillips, Olabambo Oluwasuji, Josh Dixon, Josie Smith Orcid Logo

BMJ Public Health, Volume: 3, Issue: 2, Start page: e002369

Swansea University Authors: Ian Farr, Grace Bailey Orcid Logo, Hywel Evans Orcid Logo

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DOI (Published version): 10.1136/bmjph-2024-002369

Abstract

Introduction Substance misuse (SM) remains a challenging public health concern despite substantial evidence from traditional research methods for effective interventions. Studies which used whole population linked data are scarce but may be useful in informing early identification and prevention of...

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Published in: BMJ Public Health
ISSN: 2753-4294
Published: BMJ 2025
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Studies which used whole population linked data are scarce but may be useful in informing early identification and prevention of escalation. We examined the type and timing of healthcare service contacts in those presenting with SM-related issues in Wales to describe sociodemographic characteristics and quantify the frequency of pre-and-post index SM healthcare contacts as potential opportunities for preventative interventions. We defined the index as the first SM-related record in healthcare settings.Methods We conducted a whole population cohort study on 168 774 persons aged at least 10 years whose index SM contact with health services was between 1 January 2010 and 31 December 2019. We examined their records both prospectively and retrospectively for 2 years from the index SM event date.Results Inpatient admission (36.0%) and primary care (30.0%) were the main points of first SM-related contact. Median age was 39 years; the majority were males (62.3%) of white ethnicity (71.0%). One in four lived in the most deprived areas. The majority (60.3%) had alcohol as the problem substance at baseline. Approximately 38.0% (63 520) of the cohort had at least a second SM-related event within 24 months postindex SM event, indicating potential missed opportunities for referral to relevant SM specialist treatment services. Inpatient admissions increased by 71.0% after the index SM date (ISMD) compared with pre-ISMD (84 237 and 49 327, respectively). Injury, poisoning and digestive disorders were the most frequent reasons for admissions. However, admissions relating to mental disorders more than tripled after the ISMD (8421 admissions from 2696 patients&#x2014;a 212.0% increase). Similar increases were found in emergency and GP contacts. Around 1.0% had their first SM record captured at death.Conclusion Individuals with SM records are frequent attendees to healthcare services, particularly after their index SM event. Healthcare contacts represent vital opportunities to engage those with SM issues early to reduce harm and potential escalation of use and refer to specialist treatment and support.</abstract><type>Journal Article</type><journal>BMJ Public Health</journal><volume>3</volume><journalNumber>2</journalNumber><paginationStart>e002369</paginationStart><paginationEnd/><publisher>BMJ</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint/><issnElectronic>2753-4294</issnElectronic><keywords/><publishedDay>13</publishedDay><publishedMonth>7</publishedMonth><publishedYear>2025</publishedYear><publishedDate>2025-07-13</publishedDate><doi>10.1136/bmjph-2024-002369</doi><url/><notes/><college>COLLEGE NANME</college><department>Medical School</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>MEDS</DepartmentCode><institution>Swansea University</institution><apcterm>Another institution paid the OA fee</apcterm><funders>This study was funded by the UK Government.</funders><projectreference/><lastEdited>2025-08-14T15:51:48.9500278</lastEdited><Created>2025-07-15T23:07:22.5238324</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">Swansea University Medical School - Health Data Science</level></path><authors><author><firstname>Columbus</firstname><surname>Ohaeri</surname><orcid>0000-0002-6016-3245</orcid><order>1</order></author><author><firstname>Ian</firstname><surname>Farr</surname><order>2</order></author><author><firstname>Grace</firstname><surname>Bailey</surname><orcid>0000-0003-4646-3134</orcid><order>3</order></author><author><firstname>Hywel</firstname><surname>Evans</surname><orcid>0000-0001-6745-4187</orcid><order>4</order></author><author><firstname>Ryan</firstname><surname>Phillips</surname><order>5</order></author><author><firstname>Olabambo</firstname><surname>Oluwasuji</surname><order>6</order></author><author><firstname>Josh</firstname><surname>Dixon</surname><order>7</order></author><author><firstname>Josie</firstname><surname>Smith</surname><orcid>0000-0002-7671-104x</orcid><order>8</order></author></authors><documents><document><filename>69978__34951__30f5ca96d882423c8291140f6dc9b853.pdf</filename><originalFilename>69978.VoR.pdf</originalFilename><uploaded>2025-08-14T15:49:04.5985813</uploaded><type>Output</type><contentLength>2546487</contentLength><contentType>application/pdf</contentType><version>Version of Record</version><cronfaStatus>true</cronfaStatus><documentNotes>&#xA9; Author(s) (or their employer(s)) 2025. 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spelling 2025-08-14T15:51:48.9500278 v2 69978 2025-07-15 Enhancing opportunities to reduce escalation to substance use disorders through early engagement: a retrospective observational data linkage study of primary and secondary care in Wales 3c02e7e9c2b064ee3e96e83b9777dde4 Ian Farr Ian Farr true false 1e09a407fca9e8047e7738b18d381130 0000-0003-4646-3134 Grace Bailey Grace Bailey true false 73cc98a5b8e4122fdfcee5d88208b0b7 0000-0001-6745-4187 Hywel Evans Hywel Evans true false 2025-07-15 MEDS Introduction Substance misuse (SM) remains a challenging public health concern despite substantial evidence from traditional research methods for effective interventions. Studies which used whole population linked data are scarce but may be useful in informing early identification and prevention of escalation. We examined the type and timing of healthcare service contacts in those presenting with SM-related issues in Wales to describe sociodemographic characteristics and quantify the frequency of pre-and-post index SM healthcare contacts as potential opportunities for preventative interventions. We defined the index as the first SM-related record in healthcare settings.Methods We conducted a whole population cohort study on 168 774 persons aged at least 10 years whose index SM contact with health services was between 1 January 2010 and 31 December 2019. We examined their records both prospectively and retrospectively for 2 years from the index SM event date.Results Inpatient admission (36.0%) and primary care (30.0%) were the main points of first SM-related contact. Median age was 39 years; the majority were males (62.3%) of white ethnicity (71.0%). One in four lived in the most deprived areas. The majority (60.3%) had alcohol as the problem substance at baseline. Approximately 38.0% (63 520) of the cohort had at least a second SM-related event within 24 months postindex SM event, indicating potential missed opportunities for referral to relevant SM specialist treatment services. Inpatient admissions increased by 71.0% after the index SM date (ISMD) compared with pre-ISMD (84 237 and 49 327, respectively). Injury, poisoning and digestive disorders were the most frequent reasons for admissions. However, admissions relating to mental disorders more than tripled after the ISMD (8421 admissions from 2696 patients—a 212.0% increase). Similar increases were found in emergency and GP contacts. Around 1.0% had their first SM record captured at death.Conclusion Individuals with SM records are frequent attendees to healthcare services, particularly after their index SM event. Healthcare contacts represent vital opportunities to engage those with SM issues early to reduce harm and potential escalation of use and refer to specialist treatment and support. Journal Article BMJ Public Health 3 2 e002369 BMJ 2753-4294 13 7 2025 2025-07-13 10.1136/bmjph-2024-002369 COLLEGE NANME Medical School COLLEGE CODE MEDS Swansea University Another institution paid the OA fee This study was funded by the UK Government. 2025-08-14T15:51:48.9500278 2025-07-15T23:07:22.5238324 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Health Data Science Columbus Ohaeri 0000-0002-6016-3245 1 Ian Farr 2 Grace Bailey 0000-0003-4646-3134 3 Hywel Evans 0000-0001-6745-4187 4 Ryan Phillips 5 Olabambo Oluwasuji 6 Josh Dixon 7 Josie Smith 0000-0002-7671-104x 8 69978__34951__30f5ca96d882423c8291140f6dc9b853.pdf 69978.VoR.pdf 2025-08-14T15:49:04.5985813 Output 2546487 application/pdf Version of Record true © Author(s) (or their employer(s)) 2025. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY- NC 4.0) license. true eng http://creativecommons.org/licenses/by-nc/4.0/
title Enhancing opportunities to reduce escalation to substance use disorders through early engagement: a retrospective observational data linkage study of primary and secondary care in Wales
spellingShingle Enhancing opportunities to reduce escalation to substance use disorders through early engagement: a retrospective observational data linkage study of primary and secondary care in Wales
Ian Farr
Grace Bailey
Hywel Evans
title_short Enhancing opportunities to reduce escalation to substance use disorders through early engagement: a retrospective observational data linkage study of primary and secondary care in Wales
title_full Enhancing opportunities to reduce escalation to substance use disorders through early engagement: a retrospective observational data linkage study of primary and secondary care in Wales
title_fullStr Enhancing opportunities to reduce escalation to substance use disorders through early engagement: a retrospective observational data linkage study of primary and secondary care in Wales
title_full_unstemmed Enhancing opportunities to reduce escalation to substance use disorders through early engagement: a retrospective observational data linkage study of primary and secondary care in Wales
title_sort Enhancing opportunities to reduce escalation to substance use disorders through early engagement: a retrospective observational data linkage study of primary and secondary care in Wales
author_id_str_mv 3c02e7e9c2b064ee3e96e83b9777dde4
1e09a407fca9e8047e7738b18d381130
73cc98a5b8e4122fdfcee5d88208b0b7
author_id_fullname_str_mv 3c02e7e9c2b064ee3e96e83b9777dde4_***_Ian Farr
1e09a407fca9e8047e7738b18d381130_***_Grace Bailey
73cc98a5b8e4122fdfcee5d88208b0b7_***_Hywel Evans
author Ian Farr
Grace Bailey
Hywel Evans
author2 Columbus Ohaeri
Ian Farr
Grace Bailey
Hywel Evans
Ryan Phillips
Olabambo Oluwasuji
Josh Dixon
Josie Smith
format Journal article
container_title BMJ Public Health
container_volume 3
container_issue 2
container_start_page e002369
publishDate 2025
institution Swansea University
issn 2753-4294
doi_str_mv 10.1136/bmjph-2024-002369
publisher BMJ
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Health Data Science{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Health Data Science
document_store_str 1
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description Introduction Substance misuse (SM) remains a challenging public health concern despite substantial evidence from traditional research methods for effective interventions. Studies which used whole population linked data are scarce but may be useful in informing early identification and prevention of escalation. We examined the type and timing of healthcare service contacts in those presenting with SM-related issues in Wales to describe sociodemographic characteristics and quantify the frequency of pre-and-post index SM healthcare contacts as potential opportunities for preventative interventions. We defined the index as the first SM-related record in healthcare settings.Methods We conducted a whole population cohort study on 168 774 persons aged at least 10 years whose index SM contact with health services was between 1 January 2010 and 31 December 2019. We examined their records both prospectively and retrospectively for 2 years from the index SM event date.Results Inpatient admission (36.0%) and primary care (30.0%) were the main points of first SM-related contact. Median age was 39 years; the majority were males (62.3%) of white ethnicity (71.0%). One in four lived in the most deprived areas. The majority (60.3%) had alcohol as the problem substance at baseline. Approximately 38.0% (63 520) of the cohort had at least a second SM-related event within 24 months postindex SM event, indicating potential missed opportunities for referral to relevant SM specialist treatment services. Inpatient admissions increased by 71.0% after the index SM date (ISMD) compared with pre-ISMD (84 237 and 49 327, respectively). Injury, poisoning and digestive disorders were the most frequent reasons for admissions. However, admissions relating to mental disorders more than tripled after the ISMD (8421 admissions from 2696 patients—a 212.0% increase). Similar increases were found in emergency and GP contacts. Around 1.0% had their first SM record captured at death.Conclusion Individuals with SM records are frequent attendees to healthcare services, particularly after their index SM event. Healthcare contacts represent vital opportunities to engage those with SM issues early to reduce harm and potential escalation of use and refer to specialist treatment and support.
published_date 2025-07-13T05:29:37Z
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