scholarly journals Pathways into Homelessness: Recently Homeless Adults Problems and Service Use Before and After Becoming Homeless in Amsterdam

2016 ◽  
pp. 13-30
Keyword(s):  
Service Use ◽  
Homeless Adults ◽  
Before And After

scholarly journals Factors associated with higher healthcare costs in a cohort of homeless adults with a mental illness and a general cohort of adults with a history of homelessness

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kathryn Wiens ◽  
Laura C. Rosella ◽  
Paul Kurdyak ◽  
Simon Chen ◽  
Tim Aubry ◽  
...  
Keyword(s):  
Mental Illness ◽  
Healthcare Costs ◽  
Service Use ◽  
Multinomial Logistic Regression ◽  
Service Planning ◽  
Inpatient Service ◽  
Homeless Adults ◽  
Targeted Interventions ◽  
Factors Associated ◽  
History Of

Abstract Background Healthcare costs are disproportionately incurred by a relatively small group of people often described as high-cost users. Understanding the factors associated with high-cost use of health services among people experiencing homelessness could help guide service planning. Methods Survey data from a general cohort of adults with a history of homelessness and a cohort of homeless adults with mental illness were linked with administrative healthcare records in Ontario, Canada. Total costs were calculated using a validated costing algorithm and categorized based on population cut points for the top 5%, top 6–10%, top 11–50% and bottom 50% of users in Ontario. Multinomial logistic regression was used to identify the predisposing, enabling, and need factors associated with higher healthcare costs (with bottom 50% as the reference). Results Sixteen percent of the general homeless cohort and 30% percent of the cohort with a mental illness were in the top 5% of healthcare users in Ontario. Most healthcare costs for the top 5% of users were attributed to emergency department and inpatient service costs, while the costs from other strata were mostly for physician services, hospital outpatient clinics, and medications. The odds of being within the top 5% of users were higher for people who reported female gender, a regular medical doctor, past year acute service use, poor perceived general health and two or more diagnosed chronic conditions, and were lower for Black participants and other racialized groups. Older age was not consistently associated with higher cost use; the odds of being in the top 5% were highest for 35-to-49-year year age group in the cohort with a mental illness and similar for the 35–49 and ≥ 50-year age groups in the general homeless cohort. Conclusions This study combines survey and administrative data from two cohorts of homeless adults to describe the distribution of healthcare costs and identify factors associated with higher cost use. These findings can inform the development of targeted interventions to improve healthcare delivery and support for people experiencing homelessness.

scholarly journals Racial and Ethnic Service Use Disparities Among Homeless Adults With Severe Mental Illnesses Receiving ACT

2011 ◽  
Vol 62 (6) ◽  
pp. 598-604 ◽  
Author(s):  
Marcela Horvitz-Lennon ◽  
Dongli Zhou ◽  
Sharon-Lise T. Normand ◽  
Margarita Alegría ◽  
Wes K. Thompson
Keyword(s):  
Service Use ◽  
Mental Illnesses ◽  
Homeless Adults

scholarly journals A Primary Care Emergency Service Reduction Did Not Increase Office-Hour Service Use: A Longitudinal Follow-up Study

2019 ◽  
Vol 10 ◽  
pp. 215013271986515
Author(s):  
Mika Lehto ◽  
Katri Mustonen ◽  
Jarmo Kantonen ◽  
Marko Raina ◽  
Anna-Maria K. Heikkinen ◽  
...  
Keyword(s):  
Primary Care ◽  
Emergency Service ◽  
Service Use ◽  
Age Groups ◽  
The Public ◽  
Before And After ◽  
Care Systems ◽  
Gp Visits ◽  
A Minor

This study, conducted in a Finnish city, examined whether decreasing emergency department (ED) services in an overcrowded primary care ED and corresponding direction to office-hour primary care would guide patients to office-hour visits to general practitioners (GP). This was an observational retrospective study based on a before-and-after design carried out by gradually decreasing ED services in primary care. The interventions were ( a) application of ABCDE-triage combined with public guidance on the proper use of EDs, ( b) cessation of a minor supplementary ED, and finally ( c) application of “reverse triage” with enhanced direction of the public to office-hour services from the remaining ED. The numbers of visits to office-hour primary care GPs in a month were recorded before applying the interventions fully (preintervention period) and in the postintervention period. The putative effect of the interventions on the development rate of mortality in different age groups was also studied as a measure of safety. The total number of monthly visits to office-hour GPs decreased slowly over the whole study period without difference in this rate between pre- and postintervention periods. The numbers of office-hour GP visits per 1000 inhabitants decreased similarly. The rate of monthly visits to office-hour GP/per GP did not change in the preintervention period but decreased in the postintervention period. There was no increase in the mortality in any of the studied age groups (0-19, 20-64, 65+ years) after application of the ED interventions. There is no guarantee that decreasing activity in a primary care ED and consecutive enhanced redirecting of patients to the office-hour primary care systems would shift patients to office-hour GPs. On the other hand, this decrease in the ED activity does not seem to increase mortality either.

Barriers and Supports to Substance Abuse Service Use Among Homeless Adults

2013 ◽  
Vol 34 (2) ◽  
pp. 81-98 ◽  
Author(s):  
Michael D. Brubaker ◽  
Ellen A. Amatea ◽  
Edil Torres-Rivera ◽  
M. David Miller ◽  
Laura Nabors
Keyword(s):  
Substance Abuse ◽  
Service Use ◽  
Substance Abuse Service ◽  
Homeless Adults

scholarly journals An Ecological Study of a Universal Employee Depression Awareness and Stigma Reduction Intervention: “Right Direction”

2021 ◽  
Vol 12 ◽  
Author(s):  
Benjamin Doty ◽  
Adrienne Grzenda ◽  
Seungyoung Hwang ◽  
Sean Godar ◽  
Darcy Gruttadaro ◽  
...  
Keyword(s):  
Mental Health ◽  
Service Use ◽  
Linear Mixed Model ◽  
Psychiatric Treatment ◽  
Care Utilization ◽  
Study Cohort ◽  
Treatment Utilization ◽  
Intervention Period ◽  
Post Intervention ◽  
Before And After

Objective: Right Direction (RD) was a component of a universal employee wellness program implemented in 2014 at Kent State University (KSU) to increase employees' awareness of depression, reduce mental health stigma, and encourage help-seeking behaviors to promote mental health. We explored changes in mental health care utilization before and after implementation of RD.Methods: KSU Human Resources census and service use data were used to identify the study cohort and examine the study objectives. A pre-post design was used to explore changes in mental health utilization among KSU employees before and after RD. Three post-intervention periods were examined. A generalized linear mixed model approach was used for logistic regression analysis between each outcome of interest and intervention period, adjusted by age and sex. Logit differences were calculated for post-intervention periods compared to the pre-intervention period.Results: Compared to the pre-intervention period, the predicted proportion of employees seeking treatment for depression and anxiety increased in the first post-intervention period (OR = 2.14, 95% Confidence Interval [CI] = 1.37–3.34), then declined. Outpatient psychiatric treatment utilization increased significantly in the first two post-intervention periods (OR =1.89, 95% CI = 1.23–2.89; OR = 1.75, 95% CI = 1.11–2.76). No difference was noted in inpatient psychiatric treatment utilization across post-intervention periods. Unlike prescription for anxiolytic prescriptions, receipt of antidepressant prescriptions increased in the second (OR = 2.25, 95% CI = 1.56–3.27) and third (OR = 2.16, 95% CI = 1.46–3.20) post-intervention periods.Conclusions: Effects of RD may be realized over the long-term with follow-up enhancements such as workshops/informational sessions on mindfulness, stress management, resiliency training, and self-acceptance.

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