Determinants of Hospital Use and Physician Services Among Adults With a History of Homelessness. (October 2022)

• Record Type: Journal Article
• Authors: Wiens, Kathryn; Rosella, Laura C; Kurdyak, Paul; Chen, Simon; Aubry, Tim; Stergiopoulos, Vicky; Hwang, Stephen W
• Is Part Of: Health services insights. Volume 15(2022)
• Publication Date: 2022-10
• Subjects: Homeless persons -- emergency department -- physician services -- hospital -- healthcare utilization; Medical care -- Periodicals; Public health -- Periodicals; Delivery of Health Care; Quality of Health Care; Medical care; Public health; Periodicals; Fulltext; Internet Resources; Periodicals; Periodicals; 362.105
• DOI: 10.1177/11786329221127150
• Languages: English
• ISSNs: 1178-6329

Abstract

Background: People experiencing homelessness have diverse patterns of healthcare use. This study examined the distribution and determinants of healthcare encounters among adults with a history of homelessness. Methods: Administrative healthcare records were linked with survey data for a general cohort of adults with a history of homelessness and a cohort of homeless adults with mental illness. Binary and count models were used to identify factors associated with hospital admissions, emergency department visits and physician visits for comparison across the 2 cohorts. Results: During the 1-year follow-up period, a higher proportion of people in the cohort with a mental illness used any inpatient (27% vs 14%), emergency (63% vs 53%), or physician services (90% vs 76%) compared to the general homeless cohort. People from racialized groups were less likely use nearly all health services, most notably physician services. Other factors, such as reporting of a regular source of care, poor perceived general health, and diagnosed chronic conditions were associated with higher use of all health services except psychiatric inpatient care Conclusion: When implementing interventions for patients with the greatest health needs, we must consider the unique factors that contribute to higher healthcare use, as well as the barriers to healthcare access.