nach oben

Erschienen in:

25.07.2016

Residential Stability Reduces Unmet Health Care Needs and Emergency Department Utilization among a Cohort of Homeless and Vulnerably Housed Persons in Canada

verfasst von: Denise Jaworsky, Anne Gadermann, Arnaud Duhoux, Trudy E. Naismith, Monica Norena, Matthew J. To, Stephen W. Hwang, Anita Palepu

Erschienen in: Journal of Urban Health | Ausgabe 4/2016

Einloggen, um Zugang zu erhalten

Abstract

This study examined the association of housing status over time with unmet physical health care needs and emergency department utilization among homeless and vulnerably housed persons in Canada. Homeless and vulnerably housed individuals completed interviewer-administered surveys on housing, unmet physical health care needs, health care utilization, sociodemographic characteristics, substance use, and health conditions at baseline and annually for 4 years. Generalized logistic mixed effects regression models examined the association of residential stability with unmet physical health care needs and emergency department utilization, adjusting for potential confounders. Participants were from Vancouver (n = 387), Toronto (n = 390), and Ottawa (n = 396). Residential stability was associated with lower odds of having unmet physical health needs (adjusted odds ratio (AOR), 0.82; 95 % confidence interval (CI), 0.67, 0.98) and emergency department utilization (AOR, 0.74; 95 % CI, 0.62, 0.88) over the 4-year follow-up period, after adjusting for potential confounders. Residential stability is associated with fewer unmet physical health care needs and lower emergency department utilization among homeless and vulnerably housed individuals. These findings highlight the need to address access to stable housing as a significant determinant of health disparities.

LePage JP, Bradshaw LD, Cipher DJ, Crawford AM, Hoosyhar D. The effects of homelessness on Veterans’ health care service use: an evaluation of independence from comorbidities. Public Health. 2014; 128(11): 985–92. doi:10.1016/j.puhe.2014.07.004.CrossRefPubMed

Garibaldi B, Conde-Martel A, O’Toole TP. Self-reported comorbidities, perceived needs, and sources for usual care for older and younger homeless adults. J Gen Intern Med. 2005; 20(8): 726–30. doi:10.1111/j.1525-1497.2005.0142.x.CrossRefPubMedPubMedCentral

Wagner J, Diehl K, Mutsch L, Loffler W, Burkert N, Freidl W. Health status and utilisation of the healthcare system by homeless and non-homeless people in Vienna. Health Soc Care Community. 2014; 22(3): 300–7. doi:10.1111/hsc.12083.CrossRefPubMed

Stratigos AJ, Katsambas AD. Medical and cutaneous disorders associated with homelessness. Skinmed. 2003; 2(3): 168–72.CrossRefPubMed

Grossberg AL, Carranza D, Lamp K, Chiu MW, Lee C, Craft N. Dermatologic care in the homeless and underserved populations: observations from the Venice Family Clinic. Cutis. 2012; 89(1): 25–32.PubMed

Milloy MJ, Kerr T, Bangsberg DR, Buxton J, Parashar S, Guillemi S, et al. Homelessness as a structural barrier to effective antiretroviral therapy among HIV-seropositive illicit drug users in a Canadian setting. AIDS Patient Care STDS. 2012; 26(1): 60–7. doi:10.1089/apc.2011.0169.

Palepu A, Gadermann A, Hubley AM, Farrell S, Gogosis E, Aubry T, et al. Substance use and access to health care and addiction treatment among homeless and vulnerably housed persons in three Canadian cities. PLoS ONE. 2013; 8(10): e75133. doi:10.1371/journal.pone.0075133.CrossRefPubMedPubMedCentral

Krausz RM, Clarkson AF, Strehlau V, Torchalla I, Li K, Schuetz CG. Mental disorder, service use, and barriers to care among 500 homeless people in 3 different urban settings. Soc Psychiatry Psychiatr Epidemiol. 2013; 48(8): 1235–43. doi:10.1007/s00127-012-0649-8.CrossRefPubMed

Lebrun-Harris LA, Baggett TP, Jenkins DM, Sripipatana A, Sharma R, Hayashi AS, et al. Health status and health care experiences among homeless patients in federally supported health centers: findings from the 2009 patient survey. Health Serv Res. 2013; 48(3): 992–1017. doi:10.1111/1475-6773.12009.CrossRefPubMed

10.

Kertesz SG, McNeil W, Cash JJ, Desmond R, McGwin G Jr, Kelly J, et al. Unmet need for medical care and safety net accessibility among Birmingham’s homeless. J Urban Health. 2014; 91(1): 33–45. doi:10.1007/s11524-013-9801-3.CrossRefPubMed

11.

Khandor E, Mason K, Chambers C, Rossiter K, Cowan L, Hwang SW. Access to primary health care among homeless adults in Toronto, Canada: results from the Street Health survey. Open Med. 2011; 5(2): e94–103.PubMedPubMedCentral

12.

Reid KW, Vittinghoff E, Kushel MB. Association between the level of housing instability, economic standing and health care access: a meta-regression. J Care Poor Underserved. 2008; 19(4): 1212–28. doi:10.1353/hpu.0.0068.CrossRef

13.

Teruya C, Longshore D, Andersen RM, Arangua L, Nyamathi A, Leake B, et al. Health and health care disparities among homeless women. Women Health. 2010; 50(8): 719–36. doi:10.1080/03630242.2010.532754.CrossRefPubMedPubMedCentral

14.

Baggett TP, O’Connell JJ, Singer DE, Rigotti NA. The unmet health care needs of homeless adults: a national study. Am J Public Health. 2010; 100(7): 1326–33. doi:10.2105/AJPH.2009.180109.CrossRefPubMedPubMedCentral

15.

Canavan R, Barry MM, Matanov A, Barros H, Gabor E, Greacen T, et al. Service provision and barriers to care for homeless people with mental health problems across 14 European capital cities. BMC Health Serv Res. 2012; 12: 222. doi:10.1186/1472-6963-12-222.CrossRefPubMedPubMedCentral

16.

Martens WH. Vulnerable categories of homeless patients in Western societies: experience serious barriers to health care access. Med Law. 2009; 28(2): 221–39.PubMed

17.

Kushel MB, Gupta R, Gee L, Haas JS. Housing instability and food insecurity as barriers to health care among low-income Americans. J Gen Intern Med. 2006; 21(1): 71–7. doi:10.1111/j.1525-1497.2005.00278.x.CrossRefPubMedPubMedCentral

18.

Hodgson KJ, Shelton KH, van den Bree MB. Mental health problems in young people with experiences of homelessness and the relationship with health service use: a follow-up study. Evid Based Ment Health. 2014; 17(3): 76–80. doi:10.1136/ebmental-2014-101810.CrossRefPubMed

19.

Vijayaraghavan M, Tochterman A, Hsu E, Johnson K, Marcus S, Caton CL. Health, access to health care, and health care use among homeless women with a history of intimate partner violence. J Community Health. 2012; 37(5): 1032–9. doi:10.1007/s10900-011-9527-7.CrossRefPubMed

20.

Hwang SW, Aubry T, Palepu A, Farrell S, Nisenbaum R, Hubley AM, et al. The health and housing in transition study: a longitudinal study of the health of homeless and vulnerably housed adults in three Canadian cities. Int J Public Health. 2011; 56(6): 609–23. doi:10.1007/s00038-011-0283-3.CrossRef

21.

Ardilly P, Le Blanc D. Sampling and weighting a survey of homeless persons: a French example. Surv Methodol. 2001; 27(1): 109–18.

22.

Tsemberis S, McHugo G, Williams V, Hanrahan P, Stefancic A. Measuring homelessness and residential stability: the residential time-line follow-back inventory. J Community Psychol. 2007; 35(1): 29–42. doi:10.1002/jcop.20132.CrossRef

23.

French MT, Roebuck MC, McGeary KA, Chitwood DD, McCoy CB. Using the drug abuse screening test (DAST-10) to analyze health services utilization and cost for substance users in a community-based setting. Subst Use Misuse. 2001; 36(6–7): 927–46.CrossRefPubMed

24.

Yudko E, Lozhkina O, Fouts A. A comprehensive review of the psychometric properties of the drug abuse screening test. J Subst Abuse Treat. 2007; 32(2): 189–98. doi:10.1016/j.jsat.2006.08.002.CrossRefPubMed

25.

Maisto SA, Carey MP, Carey KB, Gordon CM, Gleason JR. Use of the AUDIT and the DAST-10 to identify alcohol and drug use disorders among adults with a severe and persistent mental illness. Psychol Assess. 2000; 12(2): 186–92. doi:10.1037/1040-3590.12.2.186.CrossRefPubMed

26.

Barbor TF, de la Fuente JR, Saunders J, Grant M. AUDIT: the alcohol use disorders identification test: guidelines for use in primary health care. Geneva, Switzerland: World Health Organization; 1992.

27.

Donovan DM, Kivlahan DR, Doyle SR, Longabaugh R, Greenfield SF. Concurrent validity of the Alcohol Use Disorders Identification Test (AUDIT) and AUDIT zones in defining levels of severity among out-patients with alcohol dependence in the COMBINE study. Addiction. 2006; 101(12): 1696–704. doi:10.1111/j.1360-0443.2006.01606.x.CrossRefPubMed

28.

The Health and Housing in Transition (HHiT) Study Team. Housing definitions and housing variables. University of Toronto TSpace. https://tspace.library.utoronto.ca/handle/1807/69938. Published 2015. Accessed 12 Feb 2016.

29.

Lasser KE, Himmelstein DU, Woolhandler S. Access to care, health status, and health disparities in the United States and Canada: results of a cross-national population-based survey. Am J Public Health. 2006; 96(7): 1300–7. doi:10.2105/AJPH.2004.059402.CrossRefPubMedPubMedCentral

30.

Sanmartin C, Houle C, Tremblay S, Berthelot JM. Changes in unmet health care needs. Health Rep. 2002; 13(3): 15–21.PubMed

31.

Hwang SW, Ueng JJ, Chiu S, Kiss A, Tolomiczenko G, Cowan L, et al. Universal health insurance and health care access for homeless persons. Am J Public Health. 2010; 100(8): 1454–61. doi:10.2105/AJPH.2009.182022.CrossRefPubMedPubMedCentral

32.

Hwang SW, Chambers C, Katic M. Accuracy of self-reported health care use in a population-based sample of homeless adults. Health Serv Res. 2016; 51(1): 282–301. doi:10.1111/1475-6773.12329.CrossRefPubMed

33.

Stahre M, VanEenwyk J, Siegel P, Njai R. Housing insecurity and the association with health outcomes and unhealthy behaviors, Washington State, 2011. Prev Chronic Dis. 2015; 12, E109. doi:10.5888/pcd12.140511.CrossRefPubMedPubMedCentral

34.

Hwang SW, Chambers C, Chiu S, Katic M, Kiss A, Redelmeier DA, et al. A comprehensive assessment of health care utilization among homeless adults under a system of universal health insurance. Am J Public Health. 2013; 103(Suppl 2): S294–301. doi:10.2105/AJPH.2013.301369.CrossRefPubMedPubMedCentral

35.

Tsai J, Doran KM, Rosenheck RA. When health insurance is not a factor: national comparison of homeless and nonhomeless US veterans who use Veterans Affairs Emergency Departments. Am J Public Health. 2013; 103(Suppl 2): S225–31. doi:10.2105/AJPH.2013.301307.CrossRefPubMedPubMedCentral

36.

Duchon LM, Weitzman BC, Shinn M. The relationship of residential instability to medical care utilization among poor mothers in New York City. Med Care. 1999; 37(12): 1282–93.CrossRefPubMed

37.

Aidala AA, Wilson MG, Shubert V, Gogolishvili D, Globerman J, Rueda S, et al. Housing status, medical care, and health outcomes among people living with HIV/AIDS: a systematic review. Am J Public Health. 2016; 106(1): 95. doi:10.2105/AJPH.2015.302905a.CrossRef

38.

Kushel MB, Perry S, Bangsberg D, Clark R, Moss AR. Emergency department use among the homeless and marginally housed: results from a community-based study. Am J Public Health. 2002; 92(5): 778–84.CrossRefPubMedPubMedCentral

39.

Aubry T, Tsemberis S, Adair CE, Veldhuizen S, Streiner D, Latimer E, et al. One-year outcomes of a randomized controlled trial of housing first with ACT in five Canadian cities. Psychiatr Serv. 2015; 66(5): 463–9. doi:10.1176/appi.ps.201400167.CrossRefPubMed

40.

Kessell ER, Bhatia R, Bamberger JD, Kushel MB. Public health care utilization in a cohort of homeless adult applicants to a supportive housing program. J Urban Health. 2006; 83(5): 860–73. doi:10.1007/s11524-006-9083-0.CrossRefPubMedPubMedCentral

41.

Raven MC, Doran KM, Kostrowski S, Gillespie CC, Elbel BD. An intervention to improve care and reduce costs for high-risk patients with frequent hospital admissions: a pilot study. BMC Health Serv Res. 2011; 11: 270. doi:10.1186/1472-6963-11-270.CrossRefPubMedPubMedCentral

42.

Rosella LC, Fitzpatrick T, Wodchis WP, Calzavara A, Manson H, Goel V. High-cost health care users in Ontario, Canada: demographic, socio-economic, and health status characteristics. BMC Health Serv Res. 2014; 14: 532. doi:10.1186/s12913-014-0532-2.CrossRefPubMedPubMedCentral

Titel: Residential Stability Reduces Unmet Health Care Needs and Emergency Department Utilization among a Cohort of Homeless and Vulnerably Housed Persons in Canada
verfasst von: Denise Jaworsky
Anne Gadermann
Arnaud Duhoux
Trudy E. Naismith
Monica Norena
Matthew J. To
Stephen W. Hwang
Anita Palepu
Publikationsdatum: 25.07.2016
Verlag: Springer US
Erschienen in: Journal of Urban Health / Ausgabe 4/2016
Print ISSN: 1099-3460
Elektronische ISSN: 1468-2869
DOI: https://doi.org/10.1007/s11524-016-0065-6

Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Springer Medizin

Residential Stability Reduces Unmet Health Care Needs and Emergency Department Utilization among a Cohort of Homeless and Vulnerably Housed Persons in Canada

Abstract

Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Springer Medizin

Abstract

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 4/2016

Housing Quality in a Randomized Controlled Trial of Housing First for Homeless Individuals with Mental Illness: Correlates and Associations with Outcomes

Factors Associated with Pregnancy among Incarcerated African American Adolescent Girls

Sustaining Chicago’s Informal Caregivers: an Age-Friendly Approach

Changes in Attitudes toward Guns and Shootings following Implementation of the Baltimore Safe Streets Intervention

Urban Health Research in Africa: Themes and Priority Research Questions

Impacting Health Disparities in Urban Communities: Preparing Future Healthcare Providers for “Neighborhood-Engaged Care” Through a Community Engagement Course Intervention