Abstract
BACKGROUND:
Homelessness, substance use, and mental
disorders each have been associated with higher rates of emergency department
(ED) use and hospitalization. We sought to understand the correlation between
ED use, hospital admission, and substance dependence among homeless individuals
with concurrent mental illness who participated in a 'Housing First' (HF)
intervention trial.
METHODS:
The Vancouver At Home study consisted of
two randomized controlled trials addressing homeless individuals with mental
disorders who have "high" or "moderate" levels of need.
Substance dependence was determined at baseline prior to randomization, using
the Mini International Neuropsychiatric Interview diagnostic tool, version 6.0.
To assess health service use, we reviewed the number of ED visits and the
number of hospital admissions based on administrative data for six urban
hospitals. Negative binomial regression modeling was used to test the
independent association between substance dependence and health service use (ED
use and hospitalization), adjusting for HF intervention, age, gender,
ethnicity, education, duration of lifetime homelessness, mental disorders,
chronic health conditions, and other variables that were selected a priori to
be potentially associated with use of ED services and hospital admission.
RESULTS:
Of the 497 homeless adults with mental
disorders who were recruited, we included 381 participants in our analyses who
had at least 1 year of follow-up and had a personal health number that could be
linked to administrative health data. Of this group, 59% (n = 223) met criteria
for substance dependence. We found no independent association between substance
dependence and ED visits or hospital admissions [rate ratio (RR) = 0.85; 95% CI
0.62-1.17 and RR = 1.21; 95% CI 0.83-1.77, respectively]. The most responsible
diagnoses (defined as the diagnosis that accounts for the length of stay) for
hospital admissions were schizo-affective disorder, schizophrenia-related
disorder, or bipolar affective disorder; collectively reported in 48% (n = 263)
of admissions. Fifteen percent (n = 84) of hospital admissions listed substance
dependence as the most responsible diagnosis.
CONCLUSIONS:
Substance dependence was not independently
associated with ED use or hospital admission among homeless adults with mental
disorders participating in an HF trial. Hospital admissions among this cohort
were primarily associated with severe mental disorders.
1Department of Medicine, Centre for Health Evaluation
and Outcome Sciences, University of British Columbia, 588B-1081 Burrard Street,
Vancouver, BC, V6Z 1Y6, Canada. adrienne.cheung@alumni.ubc.ca.
2Faculty of Health Sciences, Simon Fraser University,
Vancouver, Canada. jsomers@sfu.ca.
3Faculty of Health Sciences, Simon Fraser University,
Vancouver, Canada. akm_moniruzzaman@sfu.ca.
4Faculty of Health Sciences, Simon Fraser University,
Vancouver, Canada. mlpatter@sfu.ca.
5School of Population and Public Health, Vancouver,
Canada. jim.frankish@ubc.ca.
6School of Population and Public Health, Vancouver,
Canada. m.krausz@me.com.
7Department of Psychiatry, University of British
Columbia, Vancouver, Canada. m.krausz@me.com.
8Department of Medicine, Centre for Health Evaluation
and Outcome Sciences, University of British Columbia, 588B-1081 Burrard Street,
Vancouver, BC, V6Z 1Y6, Canada. apalepu@hivnet.ubc.ca.
No comments:
Post a Comment