Predictors of Frequent Emergency Room Visits among a Homeless Population

Thakarar, Kinna; Morgan, Jake R.; Gaeta, Jessie M.; Hohl, Carole; Drainoni, Mari-Lynn

doi:10.1371/journal.pone.0124552

Cited by 41 publications

(24 citation statements)

References 40 publications

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“…“Homeless” was defined as any patient living in transitional housing, shelter, doubled up, living on the street, or whose housing status was “other” or “unknown” at the index visit. “Housed” was defined as any patient whose housing status was listed as housed with or without supportive services (e.g., outreach, medical care, case management) 14,15 , assisted living, rest home, or nursing home.…”

Section: Methodsmentioning

confidence: 99%

Homelessness, HIV, and Incomplete Viral Suppression

Thakarar¹,

Morgan²,

Gaeta³

et al. 2016

hpu

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Background The importance of HIV viral suppression is widely known, however few studies have examined the effects of homelessness on HIV viral suppression Methods The study included HIV-seropositive patients in a health care for the homeless program (HCH). Electronic medical record data for 138 patients were analyzed to compare demographic characteristics, health characteristics, and utilization by housing status. For the 95 individuals with available HIV viral loads, multivariable logistic analysis was performed to examine factors associated with incomplete viral suppression Results The adjusted odds ratio of incomplete HIV viral load suppression was 3.84 times higher in homeless compared with housed (95% CI 1.36– 10.36) individuals. Illicit drug use and combined antiretrovirals (cART) were associated with HIV viral suppression Conclusions Homelessness predicted incomplete HIV viral suppression. Stable housing may improve viral suppression and access to cART. Drug use was associated with viral suppression, likely because of patient engagement with on-site addiction services.

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Section: Methodsmentioning

confidence: 99%

Homelessness, HIV, and Incomplete Viral Suppression

Thakarar¹,

Morgan²,

Gaeta³

et al. 2016

hpu

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“…The homeless population is vulnerable due to limited self-care ability, substance abuse and co-morbidities such as infections, skin diseases or HIV 18–20. Similar to patients with mental health conditions, many use the ED as a regular source of care 5, 17, 21–23.…”

Section: Introductionmentioning

confidence: 99%

Increased 30-Day Emergency Department Revisits Among Homeless Patients with Mental Health Conditions

Lam¹,

Arora²,

Menchine³

2016

WestJEM

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IntroductionPatients with mental health conditions frequently use emergency medical services. Many suffer from substance use and homelessness. If they use the emergency department (ED) as their primary source of care, potentially preventable frequent ED revisits and hospital readmissions can worsen an already crowded healthcare system. However, the magnitude to which homelessness affects health service utilization among patients with mental health conditions remains unclear in the medical community. This study assessed the impact of homelessness on 30-day ED revisits and hospital readmissions among patients presenting with mental health conditions in an urban, safety-net hospital.MethodsWe conducted a secondary analysis of administrative data on all adult ED visits in 2012 in an urban safety-net hospital. Patient demographics, mental health status, homelessness, insurance coverage, level of acuity, and ED disposition per ED visit were analyzed using multilevel modeling to control for multiple visits nested within patients. We performed multivariate logistic regressions to evaluate if homelessness moderated the likelihood of mental health patients’ 30-day ED revisits and hospital readmissions.ResultsStudy included 139,414 adult ED visits from 92,307 unique patients (43.5±15.1 years, 51.3% male, 68.2% Hispanic/Latino). Nearly 8% of patients presented with mental health conditions, while 4.6% were homeless at any time during the study period. Among patients with mental health conditions, being homeless contributed to an additional 28.0% increase in likelihood (4.28 to 5.48 odds) of 30-day ED revisits and 38.2% increase in likelihood (2.04 to 2.82 odds) of hospital readmission, compared to non-homeless, non-mental health (NHNM) patients as the base category. Adjusted predicted probabilities showed that homeless patients presenting with mental health conditions have a 31.1% chance of returning to the ED within 30-day post discharge and a 3.7% chance of hospital readmission, compared to non-homeless patients presenting with mental health conditions (25.2%, 2.6%) and NHNM (7.7%, 1.5%).ConclusionHomeless patients presenting with mental health conditions were more likely to return to the ED within 30 days and to be readmitted to the hospital. Interventions providing housing might improve their overall care management and have the potential to reduce ED revisits and hospital readmissions.

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“…For example, unstable housing is associated with higher levels of substance use and other risky injection behaviours, and drug OD is a leading cause of death in the homeless population. 111–113 Supportive services provided by addiction counsellors, nurses, case managers and social workers may improve healthcare delivery in PWID. 114115 Homelessness is also a risk factor for increased ED use among PWID; thus, addressing homelessness may reduce unnecessary acute care visits.…”

Section: Case Management For Concrete Needs/bolstering Supportive Sermentioning

confidence: 99%

“…114115 Homelessness is also a risk factor for increased ED use among PWID; thus, addressing homelessness may reduce unnecessary acute care visits. 113 The use of case management to help patients acquire housing, insurance, other benefits and access to education and job training may be effective in linking patients to and retaining them in care. 116 …”

Section: Case Management For Concrete Needs/bolstering Supportive Sermentioning

confidence: 99%

Optimising health and safety of people who inject drugs during transition from acute to outpatient care: narrative review with clinical checklist

Thakarar

Weinstein

Walley

2016

Postgraduate Medical Journal

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The opioid epidemic in the USA continues to worsen. Medical providers are faced with the challenge of addressing complications from opioid use disorders and associated injection drug use. Unsafe injection practices among people who inject drugs (PWID) can lead to several complications requiring acute care encounters in the emergency department and inpatient hospital. Our objective is to provide a narrative review to help medical providers recognise and address key health issues in PWID, who are being released from the emergency department and inpatient hospital. In the midst of rises in overdose deaths and infections such as hepatitis C, we highlight several health issues for PWID, including overdose and infection prevention. We provide a clinical checklist of actions to help guide providers in the care of these complex patients. The clinical checklist includes strategies also applicable to low-resource settings, which may lack addiction treatment options. Our review and clinical checklist highlight key aspects of optimising the health and safety of PWID.

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Predictors of Frequent Emergency Room Visits among a Homeless Population

Cited by 41 publications

References 40 publications

Homelessness, HIV, and Incomplete Viral Suppression

Homelessness, HIV, and Incomplete Viral Suppression

Increased 30-Day Emergency Department Revisits Among Homeless Patients with Mental Health Conditions

Optimising health and safety of people who inject drugs during transition from acute to outpatient care: narrative review with clinical checklist

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