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Concurrent Disorders and Health Care Utilization Among Homeless and Vulnerably Housed Persons in Canada.
J Dual Diagn. 2018 Jan-Mar; 14(1):21-31.JD

Abstract

OBJECTIVE

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.

Authors+Show Affiliations

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.b Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital , Vancouver , British Columbia , Canada. c School of Population and Public Health, University of British Columbia , Vancouver , British Columbia , Canada.d Department of Education Counselling Psychology and Special Education , University of British Columbia , Vancouver , British Columbia , Canada.b Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital , Vancouver , British Columbia , Canada.e School of Psychology, University of Ottawa , Ottawa , Ontario , Canada.f Centre for Urban Health Solutions, St. Michael's Hospital , Toronto , Ontario , Canada.g Royal Ottawa Health Care Group , Ottawa , Ontario , Canada.f Centre for Urban Health Solutions, St. Michael's Hospital , Toronto , Ontario , Canada. h Division of General Internal Medicine, Department of Medicine , University of Toronto , Toronto , Ontario , Canada.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.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

29494795

Citation

Zhang, Linda, et al. "Concurrent Disorders and Health Care Utilization Among Homeless and Vulnerably Housed Persons in Canada." Journal of Dual Diagnosis, vol. 14, no. 1, 2018, pp. 21-31.
Zhang L, Norena M, Gadermann A, et al. Concurrent Disorders and Health Care Utilization Among Homeless and Vulnerably Housed Persons in Canada. J Dual Diagn. 2018;14(1):21-31.
Zhang, L., Norena, M., Gadermann, A., Hubley, A., Russell, L., Aubry, T., To, M. J., Farrell, S., Hwang, S., & Palepu, A. (2018). Concurrent Disorders and Health Care Utilization Among Homeless and Vulnerably Housed Persons in Canada. Journal of Dual Diagnosis, 14(1), 21-31. https://doi.org/10.1080/15504263.2017.1392055
Zhang L, et al. Concurrent Disorders and Health Care Utilization Among Homeless and Vulnerably Housed Persons in Canada. J Dual Diagn. 2018 Jan-Mar;14(1):21-31. PubMed PMID: 29494795.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Concurrent Disorders and Health Care Utilization Among Homeless and Vulnerably Housed Persons in Canada. AU - Zhang,Linda, AU - Norena,Monica, AU - Gadermann,Anne, AU - Hubley,Anita, AU - Russell,Lara, AU - Aubry,Tim, AU - To,Matthew J, AU - Farrell,Susan, AU - Hwang,Stephen, AU - Palepu,Anita, Y1 - 2018/04/25/ PY - 2018/3/2/pubmed PY - 2019/7/4/medline PY - 2018/3/2/entrez KW - Health status KW - acute care KW - homelessness KW - primary care KW - public health policy SP - 21 EP - 31 JF - Journal of dual diagnosis JO - J Dual Diagn VL - 14 IS - 1 N2 - OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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. SN - 1550-4271 UR - https://www.unboundmedicine.com/medline/citation/29494795/Concurrent_Disorders_and_Health_Care_Utilization_Among_Homeless_and_Vulnerably_Housed_Persons_in_Canada_ L2 - https://www.tandfonline.com/doi/full/10.1080/15504263.2017.1392055 DB - PRIME DP - Unbound Medicine ER -