High Utilizers of Emergency Health Services in a Population-Based Cohort of Homeless Adults

We identified predictors of emergency department (ED) use among a population-based prospective cohort of homeless adults in Toronto, Ontario. We assessed ED visit rates using administrative data from the Institute for Clinical Evaluative Sciences (2005-2009). We then used logistic regression to iden...

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Bibliographic Details
Published in:American journal of public health (1971) 2013-12, Vol.103 (S2), p.S302-S310
Main Authors: CHAMBERS, Catharine, CHIU, Shirley, KATIC, Marko, KISS, Alex, REDELMEIER, Donald A, LEVINSON, Wendy, HWANG, Stephen W
Format: Article
Language:English
Subjects:
Access To Care
Adult
Adults
Age Factors
Biological and medical sciences
Emergency medical care
Emergency Service, Hospital - utilization
Emergency services
Epidemiology
Female
Gender
General aspects
Health care policy
Health insurance
Health services utilization
Health Status
Homeless people
Homeless Persons - statistics & numerical data
Homelessness
Hospitals
Humans
Male
Medical sciences
Mens health
Mental disorders
Mental Health
Mental health care
Middle Aged
Miscellaneous
Native North Americans
Ontario - epidemiology
Population
Public health
Public health. Hygiene
Public health. Hygiene-occupational medicine
Research and Practice
Risk Factors
Sample size
Sex Factors
Social Support
Socioeconomic Factors
Studies
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Description
Summary:We identified predictors of emergency department (ED) use among a population-based prospective cohort of homeless adults in Toronto, Ontario. We assessed ED visit rates using administrative data from the Institute for Clinical Evaluative Sciences (2005-2009). We then used logistic regression to identify predictors of ED use. Frequent users were defined as participants with rates in the top decile (≥ 4.7 visits per person-year). Among 1165 homeless adults, 892 (77%) had at least 1 ED visit during the study. The average rate of ED visits was 2.0 visits per person-year, whereas frequent users averaged 12.1 visits per person-year. Frequent users accounted for 10% of the sample but contributed more than 60% of visits. Predictors of frequent use in adjusted analyses included birth in Canada, higher monthly income, lower health status, perceived unmet mental health needs, and perceived external health locus of control from powerful others; being accompanied by a partner or dependent children had a protective effect on frequent use. Among homeless adults with universal health insurance, a small subgroup accounted for the majority of visits to emergency services. Frequent use was driven by multiple predisposing, enabling, and need factors.
ISSN:0090-0036
1541-0048
DOI:10.2105/ajph.2013.301397