Zhang Linda, Norena Monica, Gadermann Anne, Hubley Anita, Russell Lara, Aubry Tim, To Matthew J, Farrell Susan, Hwang Stephen, Palepu Anita
a Division of General Internal Medicine , Department of Medicine, University of British Columbia , Vancouver , British Columbia , Canada.
b Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital , Vancouver , British Columbia , Canada.
J Dual Diagn. 2018 Jan-Mar;14(1):21-31. doi: 10.1080/15504263.2017.1392055. Epub 2018 Apr 25.
Individuals who are homeless or vulnerably housed have a higher prevalence of concurrent disorders, defined as having a mental health diagnosis and problematic substance use, compared to the general housed population. The study objective was to investigate the effect of having concurrent disorders on health care utilization among homeless or vulnerably housed individuals, using longitudinal data from the Health and Housing in Transition Study.
In 2009, 1190 homeless or vulnerably housed adults were recruited in Ottawa, Toronto, and Vancouver, Canada. Participants completed baseline interviews and four annual follow-up interviews, providing data on sociodemographics, housing history, mental health diagnoses, problematic drug use with the Drug Abuse Screening Test (DAST-10), problematic alcohol use with the Alcohol Use Disorders Identification Test (AUDIT), chronic health conditions, and utilization of the following health care services: emergency department (ED), hospitalization, and primary care. Concurrent disorders were defined as the participant having ever received a mental health diagnosis at baseline and having problematic substance use (i.e., DAST-10 ≥ 6 and/or AUDIT ≥ 20) at any time during the study period. Three generalized mixed effects logistic regression models were used to examine the independent association of having concurrent disorders and reporting ED use, hospitalization, or primary care visits in the past 12 months.
Among our sample of adults who were homeless or vulnerably housed, 22.6% (n = 261) reported having concurrent disorders at baseline. Individuals with concurrent disorders had significantly higher odds of ED use (adjusted odds ratio [AOR] = 1.71; 95% confidence interval [CI], 1.4-2.11), hospitalization (AOR = 1.45; 95% CI, 1.16-1.81), and primary care visits (AOR = 1.34; 95% CI, 1.05-1.71) in the past 12 months over the four-year follow-up period, after adjusting for potential confounders.
Concurrent disorders were associated with higher rates of health care utilization when compared to those without concurrent disorders among homeless and vulnerably housed individuals. Comprehensive programs that integrate mental health and addiction services with primary care as well as community-based outreach may better address the unmet health care needs of individuals living with concurrent disorders who are vulnerable to poor health outcomes.
与有固定住所的普通人群相比，无家可归或住房条件差的个体中，并存疾病（定义为患有心理健康诊断和物质使用问题）的患病率更高。本研究的目的是利用“过渡时期健康与住房研究”的纵向数据，调查并存疾病对无家可归或住房条件差的个体医疗保健利用情况的影响。
2009年，在加拿大渥太华、多伦多和温哥华招募了1190名无家可归或住房条件差的成年人。参与者完成了基线访谈和四次年度随访访谈，提供了有关社会人口统计学、住房历史、心理健康诊断、使用药物滥用筛查测试（DAST - 10）评估的药物使用问题、使用酒精使用障碍识别测试（AUDIT）评估的酒精使用问题、慢性健康状况以及以下医疗保健服务利用情况的数据：急诊科（ED）、住院治疗和初级保健。并存疾病定义为参与者在基线时曾接受过心理健康诊断，且在研究期间的任何时间存在物质使用问题（即DAST - 10≥6和/或AUDIT≥20）。使用三个广义混合效应逻辑回归模型来检验并存疾病与过去12个月内报告的急诊科就诊、住院治疗或初级保健就诊之间的独立关联。
在我们的无家可归或住房条件差的成年人样本中，22.6%（n = 261）报告在基线时患有并存疾病。在调整潜在混杂因素后，患有并存疾病的个体在四年随访期内过去12个月内急诊科就诊（调整后的优势比[AOR] = 1.71；95%置信区间[CI]，1.4 - 2.11）、住院治疗（AOR = 1.45；95% CI，1.16 - 1.81）和初级保健就诊（AOR = 1.34；95% CI，1.05 - 1.71）的几率显著更高。
与无家可归和住房条件差的个体中没有并存疾病的人相比，并存疾病与更高的医疗保健利用率相关。将心理健康和成瘾服务与初级保健以及社区外展相结合的综合项目，可能更好地满足患有并存疾病且易出现不良健康结果的个体未得到满足的医疗保健需求。
