Determinants of physician utilization, emergency room use, and hospitalizations among populations with multiple health vulnerabilities

Abstract

Understanding the factors that influence differing types of health care utilization within vulnerable groups can serve as a basis for projecting future health care needs, forecasting future health care expenditures, and influencing social policy. In this article the Behavioral Model for Vulnerable Populations is used to evaluate discretionary (physician visits) and non-discretionary (emergency room visits, and hospitalizations) health utilization patterns of a sample of 1466 respondents with one or more vulnerable health classification. Reported vulnerabilities include: (1) persons with substance disorders; (2) homeless persons; (3) persons with mental health problems; (4) victims of violent crime; (5) persons diagnosed with HIV/AIDS; (6) and persons in receipt of public benefits. Hierarchical logistic regression is used on three nested models to model factors that influence physician visits, emergency room visits, and hospitalizations. Additionally, bivariate logistic regression analyses are completed using a vulnerability index to evaluate the impact of increased numbers of vulnerability on all three forms of health care utilization. Findings from this study suggest the Behavioral Model of Vulnerable Populations be employed in future research regarding health care utilization patterns among vulnerable populations. This article encourages further research investigating the cumulative effect of health vulnerabilities on the use of non-discretionary services so that this behavior could be better understood and appropriate social policies and behavioral interventions implemented.

Comorbidity Profile and Healthcare Utilization in Elderly Patients with Serious Mental Illnesses

“…It was surprising that attendance at a primary care clinic was associated with increased likelihood of emergency visits but this may reflect the possibility that entrance to a primary care clinic is sometimes precipitated by an emergency room visit for the mentally ill. Even when all these factors are considered, however, being chronically mentally ill was associated with an increased number of emergency room visits as is found in younger patients (39). …”

Personal control and service connection as paths to improved mental health and exiting homelessness among severely marginalized homeless youth

“…In other words, service use appears to compete with personal control and shows a stronger effect on mental health outcomes. In fact, service use has consistently been associated with better mental health outcomes among those experiencing homelessness (Gabrielan et al, 2015; Small, 2010). Given that mental health problems are strongly connected to social isolation and loneliness, especially among those experiencing homelessness (Cruwys et al, 2014; Hodgson et al, 2015), service connection might mediate cumulative risk and mental health status by reducing loneliness and social isolation.…”

Correlates of Hospital Use in Homeless and Unstably Housed Women: The Role of Physical Health and Pain

“…Multiple prior studies have examined correlates of health services use among people who are homeless and unstably housed, identifying a wide array of factors associated with ED visits and/or hospitalizations including: basic sociodemographic characteristics such as age, race, and insurance coverage; mental illness and substance abuse; chronic medical conditions, worse physical health, and disability; crime and victimization; and subsistence needs such as homelessness and food insecurity (Baggett et al, 2011; Chartier, Carrico, Weiser, Kushel, & Riley, 2012; Kushel et al, 2001 & 2002; Lim, Andersen, Leake, Cunningham, & Gelberg, 2002; Padgett, Struening, Andrews, & Pittman, 1995; Small, 2011; Stein, Andersen, Koegel, & Gelberg, 2000; Weinreb, Perloff, Goldberg, Lessard, & Hosmer, 2006; Weiser et al, 2013). The Behavioral Model for Vulnerable Populations divides these factors into predisposing, enabling and need categories as a conceptual framework for understanding the use of health services (Gelberg, Andersen, & Leake, 2000).…”