Stenius-Ayoade Agnes, Haaramo Peija, Erkkilä Elisabet, Marola Niko, Nousiainen Kirsi, Wahlbeck Kristian, Eriksson Johan G
Folkhälsan Research Center, Helsinki, Finland.
National Institute for Health and Welfare, Mental Health Unit, Helsinki, Finland.
BMC Health Serv Res. 2017 Jun 21;17(1):428. doi: 10.1186/s12913-017-2372-3.
Homelessness is associated with increased morbidity, mortality and health care use. The aim of this study was to examine the role of mental disorders in relation to the use of 1) daytime primary health care services and 2) after hours primary health care emergency room (PHER) services among homeless shelter users in the Helsinki Metropolitan Area, Finland.
The study cohort consists of all 158 homeless persons using the four shelters operating in the study area during two selected nights. The health records were analyzed over a period of 3 years prior to the sample nights and data on morbidity and primary health care visits were gathered. We used negative binomial regression to estimate the association between mental disorders and daytime visits to primary health care and after hours visits to PHERs.
During the 3 years the 158 homeless persons in the cohort made 1410 visits to a physician in primary health care. The cohort exhibited high rates of mental disorders, including substance use disorders (SUDs); i.e. 141 persons (89%) had a mental disorder. We found dual diagnosis, defined as SUD concurring with other mental disorder, to be strongly associated with daytime primary health care utilization (IRR 11.0, 95% CI 5.9-20.6) when compared with those without any mental disorder diagnosis. The association was somewhat weaker for those with only SUDs (IRR 4.9, 95% CI 2.5-9.9) or with only other mental disorders (IRR 5.0, 95% CI 2.4-10.8). When focusing upon the after hours visits to PHERs we observed that both dual diagnosis (IRR 14.1, 95% CI 6.3-31.2) and SUDs (11.5, 95% CI 5.7-23.3) were strongly associated with utilization of PHERs compared to those without any mental disorder. In spite of a high numbers of visits, we found undertreatment of chronic conditions such as hypertension and diabetes.
Dual diagnosis is particularly strongly associated with primary health care daytime visits among homeless persons staying in shelters, while after hours visits to primary health care level emergency rooms are strongly associated with both dual diagnosis and SUDs. Active treatment for SUDs could reduce the amount of emergency visits made by homeless shelter users.
无家可归与发病率、死亡率增加以及医疗保健使用增多相关。本研究的目的是探讨精神障碍在芬兰赫尔辛基大都市区无家可归者收容所使用者中与以下两方面的关系：1）日间初级卫生保健服务的使用；2）非工作时间初级卫生保健急诊室（PHER）服务的使用。
研究队列包括在两个选定夜晚使用研究区域内四个收容所的所有158名无家可归者。对样本夜之前3年期间的健康记录进行分析，并收集发病率和初级卫生保健就诊数据。我们使用负二项回归来估计精神障碍与日间初级卫生保健就诊以及非工作时间PHER就诊之间的关联。
在这3年中，队列中的158名无家可归者进行了1410次初级卫生保健就诊。该队列精神障碍发生率较高，包括物质使用障碍（SUD）；即141人（89%）患有精神障碍。我们发现，与未被诊断出任何精神障碍的人相比，双重诊断（定义为SUD与其他精神障碍并存）与日间初级卫生保健利用密切相关（发病率比[IRR]为11.0，95%置信区间[CI]为5.9 - 20.6）。对于仅患有SUD的人（IRR为4.9，95% CI为2.5 - 9.9）或仅患有其他精神障碍的人（IRR为5.0，95% CI为2.4 - 10.8），这种关联稍弱。当关注非工作时间的PHER就诊时，我们观察到与未患任何精神障碍的人相比，双重诊断（IRR为14.1，95% CI为6.3 - 31.2）和SUD（11.5，95% CI为5.7 - 23.3）均与PHER的利用密切相关。尽管就诊次数很多，但我们发现高血压和糖尿病等慢性病治疗不足。
双重诊断与住在收容所的无家可归者日间初级卫生保健就诊尤其密切相关，而非工作时间的初级卫生保健急诊室就诊则与双重诊断和SUD均密切相关。积极治疗SUD可减少无家可归者收容所使用者的急诊就诊次数。
