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Emergency Department Use among HIV-Infected Released Jail Detainees
Release from short-term jail detention is highly destabilizing, associated with relapse to substance use, recidivism, and disrupted health care continuity. Little is known about emergency department (ED) use, potentially a surrogate for medical, psychiatric, or social instability, by people living w...
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Published in: | Journal of urban health 2015-02, Vol.92 (1), p.108-135 |
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description | Release from short-term jail detention is highly destabilizing, associated with relapse to substance use, recidivism, and disrupted health care continuity. Little is known about emergency department (ED) use, potentially a surrogate for medical, psychiatric, or social instability, by people living with HIV/AIDS (PLWHA) leaving jails. All ED visits were reviewed from medical records for a cohort of 109 PLHWA in the year following release from county jail in Connecticut, between January 1, 2008 and December 31, 2010. Primary outcomes were frequency and timing of ED visits, modeled using multivariate negative binomial regression and Cox proportional hazards regression, respectively. Demographic, substance use, and psychiatric disorder severity factors were evaluated as potential covariates. Overall, 71 (65.1 %) of the 109 participants made 300 unique ED visits (2.75 visits/person-year) in the year following jail-release. Frequency of ED use was positively associated with female sex (incidence rate ratios, IRR 2.40 [1.36–4.35]), homelessness (IRR 2.22 [1.15–4.41]), and recent substance use (IRR 2.47 [1.33–4.64]), and inversely associated with lifetime drug severity (IRR 0.01 [0–0.10]), and being retained in HIV primary care (IRR 0.80 [0.65–0.99]). Those in late or sustained HIV care used the ED sooner than those not retained in HIV primary care (median for late retention 16.3 days, median for sustained retention 24.9 days, median for no retention not reached at 12 months,
p
value 0.004). Using multivariate modeling, those who used the ED earliest upon release were more likely to be homeless (HR 1.98 [1.02–3.84]), to be retained in HIV care (HR 1.30 [1.04–1.61]), and to have recently used drugs (HR 2.51 [1.30–4.87]), yet had a low lifetime drug severity (HR 0.01 [0.00–0.14]). Among PLWHA released from jail, frequency of ED use is high, often soon after release, and is associated with social and drug-related destabilizing factors. Future interventions for this specific population should focus on addressing these resource gaps, ensuring housing, and establishing immediate linkage to HIV primary care after release from jail. |
doi_str_mv | 10.1007/s11524-014-9905-4 |
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p
value 0.004). Using multivariate modeling, those who used the ED earliest upon release were more likely to be homeless (HR 1.98 [1.02–3.84]), to be retained in HIV care (HR 1.30 [1.04–1.61]), and to have recently used drugs (HR 2.51 [1.30–4.87]), yet had a low lifetime drug severity (HR 0.01 [0.00–0.14]). Among PLWHA released from jail, frequency of ED use is high, often soon after release, and is associated with social and drug-related destabilizing factors. Future interventions for this specific population should focus on addressing these resource gaps, ensuring housing, and establishing immediate linkage to HIV primary care after release from jail.</description><identifier>ISSN: 1099-3460</identifier><identifier>EISSN: 1468-2869</identifier><identifier>DOI: 10.1007/s11524-014-9905-4</identifier><identifier>PMID: 25331820</identifier><language>eng</language><publisher>Boston: Springer US</publisher><subject>Adult ; Cohort Studies ; Connecticut - epidemiology ; Drug abuse ; Emergency medical care ; Emergency medical services ; Emergency Service, Hospital - utilization ; Epidemiology ; Female ; Health Informatics ; HIV ; HIV Infections - epidemiology ; Homelessness ; Hospitalization - statistics & numerical data ; Human immunodeficiency virus ; Humans ; Male ; Medicine ; Medicine & Public Health ; Mental health ; Middle Aged ; Multivariate Analysis ; Prisoners ; Prisoners - statistics & numerical data ; Prisons ; Public Health ; Retention ; Sex Factors ; Sexually transmitted diseases ; Socioeconomic Factors ; STD ; Substance use</subject><ispartof>Journal of urban health, 2015-02, Vol.92 (1), p.108-135</ispartof><rights>The New York Academy of Medicine 2014</rights><rights>The New York Academy of Medicine 2015</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c573t-4bb9838e29f12775457dc5d7803fcbfb47dfe1bd88503c7f3a18779a63a358153</citedby><cites>FETCH-LOGICAL-c573t-4bb9838e29f12775457dc5d7803fcbfb47dfe1bd88503c7f3a18779a63a358153</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.proquest.com/docview/1657511861/fulltextPDF?pq-origsite=primo$$EPDF$$P50$$Gproquest$$H</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/1657511861?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>230,314,780,784,885,21394,27924,27925,33611,33612,43733,74221</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25331820$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Boyd, Andrew T.</creatorcontrib><creatorcontrib>Song, Dahye L.</creatorcontrib><creatorcontrib>Meyer, Jaimie P.</creatorcontrib><creatorcontrib>Altice, Frederick L.</creatorcontrib><title>Emergency Department Use among HIV-Infected Released Jail Detainees</title><title>Journal of urban health</title><addtitle>J Urban Health</addtitle><addtitle>J Urban Health</addtitle><description>Release from short-term jail detention is highly destabilizing, associated with relapse to substance use, recidivism, and disrupted health care continuity. Little is known about emergency department (ED) use, potentially a surrogate for medical, psychiatric, or social instability, by people living with HIV/AIDS (PLWHA) leaving jails. All ED visits were reviewed from medical records for a cohort of 109 PLHWA in the year following release from county jail in Connecticut, between January 1, 2008 and December 31, 2010. Primary outcomes were frequency and timing of ED visits, modeled using multivariate negative binomial regression and Cox proportional hazards regression, respectively. Demographic, substance use, and psychiatric disorder severity factors were evaluated as potential covariates. Overall, 71 (65.1 %) of the 109 participants made 300 unique ED visits (2.75 visits/person-year) in the year following jail-release. Frequency of ED use was positively associated with female sex (incidence rate ratios, IRR 2.40 [1.36–4.35]), homelessness (IRR 2.22 [1.15–4.41]), and recent substance use (IRR 2.47 [1.33–4.64]), and inversely associated with lifetime drug severity (IRR 0.01 [0–0.10]), and being retained in HIV primary care (IRR 0.80 [0.65–0.99]). Those in late or sustained HIV care used the ED sooner than those not retained in HIV primary care (median for late retention 16.3 days, median for sustained retention 24.9 days, median for no retention not reached at 12 months,
p
value 0.004). Using multivariate modeling, those who used the ED earliest upon release were more likely to be homeless (HR 1.98 [1.02–3.84]), to be retained in HIV care (HR 1.30 [1.04–1.61]), and to have recently used drugs (HR 2.51 [1.30–4.87]), yet had a low lifetime drug severity (HR 0.01 [0.00–0.14]). Among PLWHA released from jail, frequency of ED use is high, often soon after release, and is associated with social and drug-related destabilizing factors. Future interventions for this specific population should focus on addressing these resource gaps, ensuring housing, and establishing immediate linkage to HIV primary care after release from jail.</description><subject>Adult</subject><subject>Cohort Studies</subject><subject>Connecticut - epidemiology</subject><subject>Drug abuse</subject><subject>Emergency medical care</subject><subject>Emergency medical services</subject><subject>Emergency Service, Hospital - utilization</subject><subject>Epidemiology</subject><subject>Female</subject><subject>Health Informatics</subject><subject>HIV</subject><subject>HIV Infections - epidemiology</subject><subject>Homelessness</subject><subject>Hospitalization - statistics & numerical data</subject><subject>Human immunodeficiency virus</subject><subject>Humans</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Mental health</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Prisoners</subject><subject>Prisoners - statistics & numerical data</subject><subject>Prisons</subject><subject>Public Health</subject><subject>Retention</subject><subject>Sex Factors</subject><subject>Sexually transmitted diseases</subject><subject>Socioeconomic Factors</subject><subject>STD</subject><subject>Substance use</subject><issn>1099-3460</issn><issn>1468-2869</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>ALSLI</sourceid><sourceid>M2R</sourceid><recordid>eNqNkU9r3DAQxUVoadJtP0AuxdBLL2o1-mNJl0DYpsmWQCEkvQpZHm8dbHkjeQv59tWySUgDhZ5mYH5680aPkGNgn4Ex_SUDKC4pA0mtZYrKA3IEsjaUm9q-Kj2zlgpZs0PyNudbxqCWmr8hh1wJAYazI7I8GzGtMYb76itufJpHjHN1k7Hy4xTX1cXqJ13FDsOMbXWFA_pcmu--Hwo_-z4i5nfkdeeHjO8f6oLcfDu7Xl7Qyx_nq-XpJQ1Ki5nKprFGGOS2A661kkq3QbXaMNGFpmukbjuEpjVGMRF0JzwYra2vhRfKgBILcrLX3WybEdtQnCY_uE3qR5_u3eR79_ck9r_cevrtpBAGBCsCnx4E0nS3xTy7sc8Bh8FHnLbZQV1LsAq0-Q9UGckBYKf68QV6O21TLD-xo7QCMDUUCvZUSFPOCbsn38DcLk23T9OVNN0uzeJ6QT48P_jpxWN8BeB7IJdRXGN6tvqfqn8AOl2ohA</recordid><startdate>20150201</startdate><enddate>20150201</enddate><creator>Boyd, Andrew T.</creator><creator>Song, Dahye L.</creator><creator>Meyer, Jaimie P.</creator><creator>Altice, Frederick L.</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>0-V</scope><scope>3V.</scope><scope>7T2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88J</scope><scope>8AO</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ALSLI</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>C1K</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M2R</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope><scope>7U2</scope><scope>5PM</scope></search><sort><creationdate>20150201</creationdate><title>Emergency Department Use among HIV-Infected Released Jail Detainees</title><author>Boyd, Andrew T. ; Song, Dahye L. ; Meyer, Jaimie P. ; Altice, Frederick L.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c573t-4bb9838e29f12775457dc5d7803fcbfb47dfe1bd88503c7f3a18779a63a358153</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Adult</topic><topic>Cohort Studies</topic><topic>Connecticut - epidemiology</topic><topic>Drug abuse</topic><topic>Emergency medical care</topic><topic>Emergency medical services</topic><topic>Emergency Service, Hospital - utilization</topic><topic>Epidemiology</topic><topic>Female</topic><topic>Health Informatics</topic><topic>HIV</topic><topic>HIV Infections - epidemiology</topic><topic>Homelessness</topic><topic>Hospitalization - statistics & numerical data</topic><topic>Human immunodeficiency virus</topic><topic>Humans</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Mental health</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Prisoners</topic><topic>Prisoners - statistics & numerical data</topic><topic>Prisons</topic><topic>Public Health</topic><topic>Retention</topic><topic>Sex Factors</topic><topic>Sexually transmitted diseases</topic><topic>Socioeconomic Factors</topic><topic>STD</topic><topic>Substance use</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Boyd, Andrew T.</creatorcontrib><creatorcontrib>Song, Dahye L.</creatorcontrib><creatorcontrib>Meyer, Jaimie P.</creatorcontrib><creatorcontrib>Altice, Frederick L.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Social Sciences Premium Collection【Remote access available】</collection><collection>ProQuest Central (Corporate)</collection><collection>Health and Safety Science Abstracts (Full archive)</collection><collection>ProQuest Health and Medical</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Social Science Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database (Proquest)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>Social Science Premium Collection</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>Social Science Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>Safety Science and Risk</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of urban health</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Boyd, Andrew T.</au><au>Song, Dahye L.</au><au>Meyer, Jaimie P.</au><au>Altice, Frederick L.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Emergency Department Use among HIV-Infected Released Jail Detainees</atitle><jtitle>Journal of urban health</jtitle><stitle>J Urban Health</stitle><addtitle>J Urban Health</addtitle><date>2015-02-01</date><risdate>2015</risdate><volume>92</volume><issue>1</issue><spage>108</spage><epage>135</epage><pages>108-135</pages><issn>1099-3460</issn><eissn>1468-2869</eissn><abstract>Release from short-term jail detention is highly destabilizing, associated with relapse to substance use, recidivism, and disrupted health care continuity. Little is known about emergency department (ED) use, potentially a surrogate for medical, psychiatric, or social instability, by people living with HIV/AIDS (PLWHA) leaving jails. All ED visits were reviewed from medical records for a cohort of 109 PLHWA in the year following release from county jail in Connecticut, between January 1, 2008 and December 31, 2010. Primary outcomes were frequency and timing of ED visits, modeled using multivariate negative binomial regression and Cox proportional hazards regression, respectively. Demographic, substance use, and psychiatric disorder severity factors were evaluated as potential covariates. Overall, 71 (65.1 %) of the 109 participants made 300 unique ED visits (2.75 visits/person-year) in the year following jail-release. Frequency of ED use was positively associated with female sex (incidence rate ratios, IRR 2.40 [1.36–4.35]), homelessness (IRR 2.22 [1.15–4.41]), and recent substance use (IRR 2.47 [1.33–4.64]), and inversely associated with lifetime drug severity (IRR 0.01 [0–0.10]), and being retained in HIV primary care (IRR 0.80 [0.65–0.99]). Those in late or sustained HIV care used the ED sooner than those not retained in HIV primary care (median for late retention 16.3 days, median for sustained retention 24.9 days, median for no retention not reached at 12 months,
p
value 0.004). Using multivariate modeling, those who used the ED earliest upon release were more likely to be homeless (HR 1.98 [1.02–3.84]), to be retained in HIV care (HR 1.30 [1.04–1.61]), and to have recently used drugs (HR 2.51 [1.30–4.87]), yet had a low lifetime drug severity (HR 0.01 [0.00–0.14]). Among PLWHA released from jail, frequency of ED use is high, often soon after release, and is associated with social and drug-related destabilizing factors. Future interventions for this specific population should focus on addressing these resource gaps, ensuring housing, and establishing immediate linkage to HIV primary care after release from jail.</abstract><cop>Boston</cop><pub>Springer US</pub><pmid>25331820</pmid><doi>10.1007/s11524-014-9905-4</doi><tpages>28</tpages><oa>free_for_read</oa></addata></record> |
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subjects | Adult Cohort Studies Connecticut - epidemiology Drug abuse Emergency medical care Emergency medical services Emergency Service, Hospital - utilization Epidemiology Female Health Informatics HIV HIV Infections - epidemiology Homelessness Hospitalization - statistics & numerical data Human immunodeficiency virus Humans Male Medicine Medicine & Public Health Mental health Middle Aged Multivariate Analysis Prisoners Prisoners - statistics & numerical data Prisons Public Health Retention Sex Factors Sexually transmitted diseases Socioeconomic Factors STD Substance use |
title | Emergency Department Use among HIV-Infected Released Jail Detainees |
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