Aix Marseille University, School of Medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, Marseille, 13005, France; Department of Research and Innovation, Support Unit for Clinical Research and Economic Evaluation, Assistance Publique - Hôpitaux de Marseille, Marseille, 13385, France.
Aix Marseille University, School of Medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, Marseille, 13005, France; Department of Psychiatry, Sainte-Marguerite University Hospital, Marseille, 13009, France.
Public Health. 2020 Aug;185:224-231. doi: 10.1016/j.puhe.2020.05.019. Epub 2020 Jul 14.
There is limited evidence available on the health-seeking behaviours of individuals in relation to determinants of healthcare use. This study aimed to analyse the determinants of healthcare use (including both hospital and outpatient services) among homeless people with severe mental health illnesses.
The study used data from a multicentre, randomised, controlled trial conducted in four large French cities (the French Housing First Study).
Data were drawn from 671 homeless people enrolled in the study between August 2011 and April 2014. Mobile mental health outreach teams recruited homeless individuals with severe mental health illnesses who were living on the street or in emergency shelters, hospitals or prisons. Data collection was performed during face-to-face interviews. Healthcare service use included hospitalisations, mental health and regular emergency department (ED) visits and outpatient visits to healthcare facilities or physicians' offices over a 6-month follow-up period. The data were analysed with zero-inflated (ZI) two-part models.
In total, 61.1% of participants had at least one hospitalisation stay over the previous 6 months, with a mean of 25 (+/- 39.2) hospital days, and the majority (51%) had visited the ED (either for regular or mental health issues) during the same time period. The results confirmed the role of financial barriers (resources and health insurance) in seeking hospital care (P < 0.05). The main predictors for hospital use in the study population were a better social functioning score (odds ratio [OR]: 1.03; P < 0.001) and having schizophrenia (OR: 1.39; P < 0.01). Higher mental health scores (assessed by the Medical Outcomes Study 36-item Short Form Health Survey) (OR: 1.03, P < 0.01) and alcohol dependence (OR: 2.13; P < 0.01) were associated with not using ED healthcare services. Being 'absolutely homeless' predicted an increased use of the ED and a zero use of outpatient services. Inversely, no association with factors related to the homelessness trajectory was found in hospital ZI negative binomial models.
This study is important because a comprehensive understanding of the determinants of healthcare use enables healthcare systems to adapt and develop. The efficiency of medicosocial interventions targeting the homeless population with mental health illnesses must also be assessed.
NCT01570712.
关于医疗保健使用的决定因素，个体的就医行为相关的证据有限。本研究旨在分析严重精神疾病的无家可归者的医疗保健使用（包括医院和门诊服务）的决定因素。
该研究使用了 2011 年 8 月至 2014 年 4 月在法国四个大城市（法国住房优先研究）进行的一项多中心、随机、对照试验的数据。
数据来自于该研究中招募的 671 名无家可归的严重精神疾病患者，这些患者居住在街头或紧急避难所、医院或监狱中。通过面对面访谈收集数据。医疗保健服务使用包括住院、精神健康和常规急诊（ED）就诊以及在 6 个月的随访期间到医疗机构或医生办公室进行的门诊就诊。使用零膨胀（ZI）两部分模型分析数据。
在过去 6 个月中，共有 61.1%的参与者至少有一次住院治疗，平均住院天数为 25（+/-39.2）天，大多数（51%）在同一时期内曾去过 ED（无论是常规就诊还是精神健康问题）。结果证实了财务障碍（资源和健康保险）在寻求医院护理方面的作用（P<0.05）。研究人群中住院治疗的主要预测因素是更好的社会功能评分（比值比[OR]：1.03；P<0.001）和患有精神分裂症（OR：1.39；P<0.01）。更高的精神健康评分（通过医疗结果研究 36 项简短健康调查评估）（OR：1.03，P<0.01）和酒精依赖（OR：2.13；P<0.01）与不使用 ED 医疗服务相关。“绝对无家可归”预测 ED 使用增加和门诊服务零使用。相反，在医院 ZI 负二项式模型中，与无家可归轨迹相关的因素没有关联。
这项研究很重要，因为全面了解医疗保健使用的决定因素可以使医疗保健系统能够进行调整和发展。还必须评估针对有精神健康疾病的无家可归者的医疗社会干预措施的效率。
NCT01570712。
