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Emergency department use and hospitalizations among homeless adults with substance dependence and mental disorders

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 concurr...

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Autores principales: Cheung, Adrienne, Somers, Julian M, Moniruzzaman, Akm, Patterson, Michelle, Frankish, Charles J, Krausz, Michael, Palepu, Anita
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4636835/
https://www.ncbi.nlm.nih.gov/pubmed/26242968
http://dx.doi.org/10.1186/s13722-015-0038-1
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author Cheung, Adrienne
Somers, Julian M
Moniruzzaman, Akm
Patterson, Michelle
Frankish, Charles J
Krausz, Michael
Palepu, Anita
author_facet Cheung, Adrienne
Somers, Julian M
Moniruzzaman, Akm
Patterson, Michelle
Frankish, Charles J
Krausz, Michael
Palepu, Anita
author_sort Cheung, Adrienne
collection PubMed
description 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. Trial registration: ISRCTN57595077 and ISRCTN66721740
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spelling pubmed-46368352015-11-08 Emergency department use and hospitalizations among homeless adults with substance dependence and mental disorders Cheung, Adrienne Somers, Julian M Moniruzzaman, Akm Patterson, Michelle Frankish, Charles J Krausz, Michael Palepu, Anita Addict Sci Clin Pract Research 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. Trial registration: ISRCTN57595077 and ISRCTN66721740 BioMed Central 2015-08-05 2015 /pmc/articles/PMC4636835/ /pubmed/26242968 http://dx.doi.org/10.1186/s13722-015-0038-1 Text en © Cheung et al. 2015 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Cheung, Adrienne
Somers, Julian M
Moniruzzaman, Akm
Patterson, Michelle
Frankish, Charles J
Krausz, Michael
Palepu, Anita
Emergency department use and hospitalizations among homeless adults with substance dependence and mental disorders
title Emergency department use and hospitalizations among homeless adults with substance dependence and mental disorders
title_full Emergency department use and hospitalizations among homeless adults with substance dependence and mental disorders
title_fullStr Emergency department use and hospitalizations among homeless adults with substance dependence and mental disorders
title_full_unstemmed Emergency department use and hospitalizations among homeless adults with substance dependence and mental disorders
title_short Emergency department use and hospitalizations among homeless adults with substance dependence and mental disorders
title_sort emergency department use and hospitalizations among homeless adults with substance dependence and mental disorders
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4636835/
https://www.ncbi.nlm.nih.gov/pubmed/26242968
http://dx.doi.org/10.1186/s13722-015-0038-1
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