Hinds Aynslie M, Bechtel Brian, Distasio Jino, Roos Leslie L, Lix Lisa M
Department of Community Health Sciences, University of Manitoba, S113-750 Bannatyne Ave, Winnipeg, Manitoba, R3E 0W3, Canada.
Cross Ministry and Community Partnership Initiatives Community and Social Services, 3rd floor, 10044-108 Street, Edmonton, Alberta, T5J 5E6, Canada.
BMC Health Serv Res. 2018 Jun 5;18(1):411. doi: 10.1186/s12913-018-3109-7.
Residence in public housing, a subsidized and managed government program, may affect health and healthcare utilization. We compared healthcare use in the year before individuals moved into public housing with usage during their first year of tenancy. We also described trends in use.
We used linked population-based administrative data housed in the Population Research Data Repository at the Manitoba Centre for Health Policy. The cohort consisted of individuals who moved into public housing in 2009 and 2010. We counted the number of hospitalizations, general practitioner (GP) visits, specialist visits, emergency department visits, and prescriptions drugs dispensed in the twelve 30-day intervals (i.e., months) immediately preceding and following the public housing move-in date. Generalized linear models with generalized estimating equations tested for a period (pre/post-move-in) by month interaction. Odds ratios (ORs), incident rate ratios (IRRs), and means are reported along with 95% confidence intervals (95% CIs).
The cohort included 1942 individuals; the majority were female (73.4%) who lived in low income areas and received government assistance (68.1%). On average, the cohort had more than four health conditions. Over the 24 30-day intervals, the percentage of the cohort that visited a GP, specialist, and an emergency department ranged between 37.0% and 43.0%, 10.0% and 14.0%, and 6.0% and 10.0%, respectively, while the percentage of the cohort hospitalized ranged from 1.0% to 5.0%. Generally, these percentages were highest in the few months before the move-in date and lowest in the few months after the move-in date. The period by month interaction was statistically significant for hospitalizations, GP visits, and prescription drug use. The average change in the odds, rate, or mean was smaller in the post-move-in period than in the pre-move-in period.
Use of some healthcare services declined after people moved into public housing; however, the decrease was only observed in the first few months and utilization rebounded. Knowledge of healthcare trends before individuals move in are informative for ensuring the appropriate supports are available to new public housing residents. Further study is needed to determine if decreased healthcare utilization following a move is attributable to decreased access.
居住在由政府补贴和管理的公共住房中可能会影响健康状况和医疗保健的使用情况。我们比较了个人入住公共住房前一年的医疗保健使用情况与入住第一年期间的使用情况。我们还描述了使用趋势。
我们使用了曼尼托巴省卫生政策中心人口研究数据存储库中基于人群的关联行政数据。该队列由2009年和2010年入住公共住房的个人组成。我们统计了在公共住房入住日期之前和之后紧接着的十二个30天时间段（即月份）内的住院次数、全科医生（GP）就诊次数、专科医生就诊次数、急诊科就诊次数以及发放的处方药数量。使用广义估计方程的广义线性模型对入住前后时间段按月的交互作用进行了检验。报告了比值比（OR）、发病率比（IRR）以及均值，并给出95%置信区间（95%CI）。
该队列包括1942名个体；大多数为女性（73.4%），居住在低收入地区并接受政府援助（68.1%）。该队列平均患有四种以上健康问题。在这24个30天时间段内，该队列中去看全科医生、专科医生和急诊科的比例分别在37.0%至43.0%、10.0%至14.0%以及6.0%至10.0%之间，而住院的比例在1.0%至5.0%之间。总体而言，这些比例在入住日期前的几个月中最高，在入住日期后的几个月中最低。住院、全科医生就诊和处方药使用的时间段按月交互作用具有统计学意义。入住后时期的比值、发生率或均值的平均变化比入住前时期小。
人们入住公共住房后，一些医疗保健服务的使用有所下降；然而，这种下降仅在最初几个月中观察到，并且利用率随后反弹。了解个人入住前的医疗保健趋势有助于确保为新的公共住房居民提供适当的支持。需要进一步研究以确定入住后医疗保健利用率的下降是否归因于可及性的降低。
