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High utilizers of emergency health services in a population-based cohort of homeless adults

Author

Listed:
  • Chambers, C.
  • Chiu, S.
  • Katic, M.
  • Kiss, A.
  • Redelmeier, D.A.
  • Levinson, W.
  • Hwang, S.W.

Abstract

Objectives. We identified predictors of emergency department (ED) use among a population-based prospective cohort of homeless adults in Toronto, Ontario. Methods. 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). Results. 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. Conclusions. 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.

Suggested Citation

  • Chambers, C. & Chiu, S. & Katic, M. & Kiss, A. & Redelmeier, D.A. & Levinson, W. & Hwang, S.W., 2013. "High utilizers of emergency health services in a population-based cohort of homeless adults," American Journal of Public Health, American Public Health Association, vol. 103(S2), pages 302-310.
    • Handle: RePEc:aph:ajpbhl:10.2105/ajph.2013.301397_5
    DOI: 10.2105/AJPH.2013.301397
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    Cited by:

    1. Downes, Henry & Phillips, David C. & Sullivan, James X., 2022. "The effect of emergency financial assistance on healthcare use," Journal of Public Economics, Elsevier, vol. 208(C).
    2. Gitte Valentin & Claus Vinther Nielsen & Anne-Sofie Meldgaard Nielsen & Merete Tonnesen & Kristina Louise Bliksted & Katrine Tranberg Jensen & Karen Ingerslev & Thomas Maribo & Lisa Gregersen Oesterga, 2023. "Bridging Inequity Gaps in Healthcare Systems While Educating Future Healthcare Professionals—The Social Health Bridge-Building Programme," IJERPH, MDPI, vol. 20(19), pages 1-17, September.
    3. Chisom N. Iwundu & Pooja Agrawal & Michael S. Businelle & Darla E. Kendzor & Lorraine R. Reitzel, 2020. "Predictors of Overnight and Emergency Treatment among Homeless Adults," IJERPH, MDPI, vol. 17(12), pages 1-9, June.
    4. Tammy Kiser & Linda Hulton, 2018. "Addressing Health Care Needs in the Homeless Population: A New Approach Using Participatory Action Research," SAGE Open, , vol. 8(3), pages 21582440187, July.
    5. Morgane Gabet & Guy Grenier & Zhirong Cao & Marie-Josée Fleury, 2019. "Predictors of Emergency Department Use among Individuals with Current or Previous Experience of Homelessness," IJERPH, MDPI, vol. 16(24), pages 1-12, December.

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