Gordon Adam J, McGinnis Kathleen A, Conigliaro Joseph, Rodriguez-Barradas Maria C, Rabeneck Linda, Justice Amy C
Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania 15240, USA.
Med Care. 2006 Aug;44(8 Suppl 2):S37-43. doi: 10.1097/01.mlr.0000223705.00175.3d.
Alcohol use is a frequent root cause of homelessness, and both homelessness and alcohol use influence the quality and quantity of interactions with health care providers.
The objectives of this study are to compare rates of homelessness and alcohol use in a cohort of human immunodeficiency virus (HIV)-infected persons and to evaluate the influence of homelessness and alcohol use on utilization of health services. RESEARCH DESIGN AND MEASURES: Data were obtained from the Veterans Aging Cohort 3-Site Study, a cohort study of 881 HIV-infected veterans at 3 VA hospitals. In a baseline survey, we assessed current and past history of homelessness and levels of alcohol consumption. Health care service utilization (ambulatory visits, emergency room visits, and hospital admissions) for the preceding 6 months was determined by self-report and VA administrative records. Logistic regression was used to assess whether homelessness and drinking variables were associated with health care visits in the past 6 months.
Among HIV-infected veterans with complete data (n = 839), 62 (7%) were currently homeless, and 212 (25.3%) had a past, but not current, history of homelessness. Among the currently homeless, 36% reported alcohol consumption, 34% were hazardous drinkers, 46% were binge drinkers, and 26% had a diagnosis of alcohol abuse. When adjusting for age, severity of HIV disease, and use of illicit drugs, hazardous drinking (adjusted odds ratio [AOR] 0.68, 95% confidence interval [CI] 0.49-0.93) and current homelessness (AOR 0.56, 95% CI 0.32-0.97) were associated with less than 2 outpatient clinic visits. HIV-infected veterans who were homeless in the past were more likely to be hospitalized in the prior 6 months than those never homeless (AOR 1.51, 95% CI 1.07-2.11).
Although homeless HIV-infected veterans tend to use inpatient services more than nonhomeless HIV infected veterans, they were less likely to achieve optimum outpatient care. Alcohol use complicates the effect of homelessness on adherence to outpatient care and is associated with increased inpatient utilization among HIV-infected veterans.
酒精使用是导致无家可归的常见根源，而无家可归和酒精使用都会影响与医疗服务提供者互动的质量和频率。
本研究的目的是比较一组感染人类免疫缺陷病毒（HIV）者的无家可归率和酒精使用率，并评估无家可归和酒精使用对医疗服务利用的影响。研究设计与测量：数据来自退伍军人老龄化队列三站点研究，这是一项对3家退伍军人事务部（VA）医院的881名感染HIV的退伍军人进行的队列研究。在基线调查中，我们评估了当前和过去的无家可归史以及酒精消费水平。通过自我报告和VA行政记录确定前6个月的医疗服务利用情况（门诊就诊、急诊就诊和住院）。使用逻辑回归评估无家可归和饮酒变量是否与过去6个月的医疗就诊相关。
在有完整数据的感染HIV的退伍军人中（n = 839），62人（7%）目前无家可归，212人（25.3%）有过去但非当前的无家可归史。在目前无家可归者中，36%报告有饮酒行为，34%为危险饮酒者，46%为暴饮者，26%被诊断为酒精滥用。在调整年龄、HIV疾病严重程度和非法药物使用情况后，危险饮酒（调整后的优势比[AOR] 0.68，95%置信区间[CI] 0.49 - 0.93）和当前无家可归（AOR 0.56，95% CI 0.32 - 0.97）与门诊就诊次数少于2次相关。过去无家可归的感染HIV的退伍军人在过去6个月内住院的可能性比从未无家可归者更高（AOR 1.51，95% CI 1.07 - 2.11）。
尽管无家可归的感染HIV的退伍军人比无家可归的感染HIV的退伍军人更倾向于使用住院服务，但他们获得最佳门诊护理的可能性较小。酒精使用使无家可归对门诊护理依从性的影响变得复杂，并与感染HIV的退伍军人住院利用率增加相关。
