Thakarar Kinna, Morgan Jake R, Gaeta Jessie M, Hohl Carole, Drainoni Mari-Lynn
Section of Infectious Diseases, Boston Medical Center, Boston, Massachusetts.
Department of Health Policy and Management, Boston University School of Public Health, Boston, Massachusetts.
PLoS One. 2015 Apr 23;10(4):e0124552. doi: 10.1371/journal.pone.0124552. eCollection 2015.
Homelessness, HIV, and substance use are interwoven problems. Furthermore, homeless individuals are frequent users of emergency services. The main purpose of this study was to identify risk factors for frequent emergency room (ER) visits and to examine the effects of housing status and HIV serostatus on ER utilization. The second purpose was to identify risk factors for frequent ER visits in patients with a history of illicit drug use.
A retrospective analysis was performed on 412 patients enrolled in a Boston-based health care for the homeless program (HCH). This study population was selected as a 2:1 HIV seronegative versus HIV seropositive match based on age, sex, and housing status. A subgroup analysis was performed on 287 patients with history of illicit drug use. Chart data were analyzed to compare demographics, health characteristics, and health service utilization. Results were stratified by housing status. Logistic models using generalized estimating equations were used to predict frequent ER visits.
In homeless patients, hepatitis C was the only predictor of frequent ER visits (OR 4.49, p<0.01). HIV seropositivity was not predictive of frequent ER visits. In patients with history of illicit drug use, mental health (OR 2.53, 95% CI 1.07-5.95) and hepatitis C (OR 2.85, 95% CI 1.37-5.93) were predictors of frequent ER use. HIV seropositivity did not predict ER use (OR 0.45, 95% CI 0.21 - 0.97).
In a HCH population, hepatitis C predicted frequent ER visits in homeless patients. HIV seropositivity did not predict frequent ER visits, likely because HIV seropositive HCH patients are engaged in care. In patients with history of illicit drug use, hepatitis C and mental health disorders predicted frequent ER visits. Supportive housing for patients with mental health disorders and hepatitis C may help prevent unnecessary ER visits in this population.
无家可归、感染艾滋病毒和药物使用是相互交织的问题。此外，无家可归者经常使用急诊服务。本研究的主要目的是确定频繁急诊室就诊的风险因素，并研究住房状况和艾滋病毒血清学状态对急诊室利用率的影响。第二个目的是确定有非法药物使用史患者频繁急诊室就诊的风险因素。
对参与波士顿无家可归者医疗保健项目（HCH）的412名患者进行回顾性分析。根据年龄、性别和住房状况，选取该研究人群中艾滋病毒血清学阴性与血清学阳性患者的比例为2:1。对287名有非法药物使用史的患者进行亚组分析。分析病历数据以比较人口统计学、健康特征和医疗服务利用率。结果按住房状况分层。使用广义估计方程的逻辑模型来预测频繁急诊室就诊情况。
在无家可归患者中，丙型肝炎是频繁急诊室就诊的唯一预测因素（比值比4.49，p<0.01）。艾滋病毒血清学阳性不能预测频繁急诊室就诊。在有非法药物使用史的患者中，心理健康（比值比2.53，95%置信区间1.07 - 5.95）和丙型肝炎（比值比2.85，95%置信区间1.37 - 5.93）是频繁使用急诊室的预测因素。艾滋病毒血清学阳性不能预测急诊室使用情况（比值比0.45，95%置信区间0.21 - 0.97）。
在无家可归者医疗保健人群中，丙型肝炎可预测无家可归患者频繁急诊室就诊。艾滋病毒血清学阳性不能预测频繁急诊室就诊，可能是因为艾滋病毒血清学阳性的无家可归者医疗保健患者接受了治疗。在有非法药物使用史的患者中，丙型肝炎和心理健康障碍可预测频繁急诊室就诊。为有心理健康障碍和丙型肝炎的患者提供支持性住房可能有助于预防该人群不必要的急诊室就诊。
