Factors identifying high-frequency and low-frequency health service utilization among substance-using adults |
Article in Press, Corrected Proof
22 February 2007
Thomas P. O'Toole M.D.a, , E- mail: thomas.o'toole@va.gov
Robin Pollini Ph.D., M.P.H.a,
Paulette Gray B.S.a,
Theodore Jones B.A.b,
George Bigelow Ph.D.a and
Daniel E. Ford M.D., M.P.H.a
aJohns Hopkins University School of Medicine, Baltimore, MD, USA
bJohns Hopkins Hospital, Baltimore, MD, USA
Abstract
Understanding why substance-using patients seek care at emergency departments (EDs) and who utilizes such service at high rates is important in tailoring and targeting interventions.
We conducted a retrospective/prospective cohort study of 326 medically ill substance-using adults to identify factors associated with 12-month high-frequency utilization of ambulatory care, ED, and inpatient medical care.
The majority were actively using heroin (74.6%), cocaine (62.4%), and alcohol (54.4%); 94.8% had a chronic medical condition; and 53.8% reported a chronic mental health condition.
High-frequency use of ED (≥ 3 visits) was independently associated with being female (adjusted odds ratio [AOR] = 1.88; 95% confidence interval [95% CI] = 1.12, 3.17), being African American (AOR = 2.36; 95% CI = 1.30, 4.29), being homeless (AOR = 2.07; 95% CI = 1.08, 3.96), a history of > 1 substance abuse treatment episode (AOR = 4.10; 95% CI = 3.28, 10.87), and ≥ 1 ambulatory care visit (AOR = 8.94; 95% CI = 3.28, 24.41).
However, the combination of having certain chronic conditions (seizure disorder, hepatitis B, and hepatitis C) and accessing ambulatory care was protective against high-frequency use of ED.
In contrast, high-frequency use of ambulatory care (≥ 3 visits) was independently associated with having insurance (Medicare/Medicaid: AOR = 2.39; 95% CI = 1.31, 4.69), having HIV/AIDS (AOR = 3.15; 95% CI = 1.70, 5.85), and receiving substance abuse treatment during the study period (AOR = 3.58; 95% CI = 1.61, 7.98)
Efforts to redirect medical care to more subacute settings will likely require both capacity building and addressing a client's underlying needs, including homelessness, access to substance abuse treatment, and chronic disease management.
