Honer William G, Cervantes-Larios Alejandro, Jones Andrea A, Vila-Rodriguez Fidel, Montaner Julio S, Tran Howard, Nham Jimmy, Panenka William J, Lang Donna J, Thornton Allen E, Vertinsky Talia, Barr Alasdair M, Procyshyn Ric M, Smith Geoffrey N, Buchanan Tari, Krajden Mel, Krausz Michael, MacEwan G William, Gicas Kristina M, Leonova Olga, Langheimer Verena, Rauscher Alexander, Schultz Krista
1 Department of Psychiatry, University of British Columbia, Vancouver, British Columbia.
2 School of Population and Public Health, University of British Columbia, Vancouver, British Columbia.
Can J Psychiatry. 2017 Jul;62(7):482-492. doi: 10.1177/0706743717693781. Epub 2017 Feb 15.
The Hotel Study was initiated in Vancouver's Downtown East Side (DTES) neighborhood to investigate multimorbidity in homeless or marginally housed people. We evaluated the clinical effectiveness of existing, illness-specific treatment strategies and assessed the effectiveness of health care delivery for multimorbid illnesses.
For context, we mapped the housing locations of patients presenting for 552,062 visits to the catchment hospital emergency department (2005-2013). Aggregate data on 22,519 apprehensions of mentally ill people were provided by the Vancouver Police Department (2009-2015). The primary strategy was a longitudinal cohort study of 375 people living in the DTES (2008-2015). We analysed mortality and evaluated the clinical and health service delivery effectiveness for infection with human immunodeficiency virus or hepatitis C virus, opioid dependence, and psychosis.
Mapping confirmed the association between poverty and greater number of emergency visits related to substance use and mental illness. The annual change in police apprehensions did not differ between the DTES and other policing districts. During 1581 person-years of cohort observation, the standardized mortality ratio was 8.43 (95% confidence interval, 6.19 to 11.50). Physician visits were common (84.3% of participants over 6 months). Clinical treatment effectiveness was highest for HIV/AIDS, intermediate for opioid dependence, and lowest for psychosis. Health service delivery mechanisms provided examples of poor access, poor treatment adherence, and little effect on multimorbid illnesses.
Clinical effectiveness was variable, and illness-specific service delivery appeared to have little effect on multimorbidity. New models of care may need to be implemented.
“酒店研究”在温哥华市中心东区（DTES）社区启动，旨在调查无家可归或住房条件差的人群中的多种疾病共患情况。我们评估了现有的针对特定疾病的治疗策略的临床效果，并评估了针对多种共患疾病的医疗服务效果。
为了解背景情况，我们绘制了在集水区医院急诊科就诊552,062次的患者的居住地点图（2005 - 2013年）。温哥华警察局提供了22,519例精神病患者拘押情况的汇总数据（2009 - 2015年）。主要策略是对居住在DTES的375人进行纵向队列研究（2008 - 2015年）。我们分析了死亡率，并评估了人类免疫缺陷病毒或丙型肝炎病毒感染、阿片类药物依赖和精神病的临床及医疗服务提供效果。
绘图证实了贫困与更多与物质使用和精神疾病相关的急诊就诊之间的关联。DTES与其他警区之间警察拘押人数的年度变化没有差异。在1581人年的队列观察期间，标准化死亡率为8.43（95%置信区间，6.19至11.50）。看医生很常见（6个月以上参与者中有84.3%）。临床治疗效果在艾滋病毒/艾滋病方面最高，在阿片类药物依赖方面中等，在精神病方面最低。医疗服务提供机制存在就医困难、治疗依从性差以及对多种共患疾病效果不佳的情况。
临床效果参差不齐，针对特定疾病的服务提供似乎对多种疾病共患情况影响不大。可能需要实施新的护理模式。
