Repeat ER Visits among Homeless Driven by Hepatitis C.
Hepatitis C is a common reason for frequent emergency room (ER) visits by homeless people, and mental health disorders and hepatitis C fuel repeat visits for those with substance use histories, a new study led by School of Public Health and Boston Medical Center researchers shows.
The study, published in the journal PLOS ONE, recommends that in order to reduce frequent use of emergency services, resources should be devoted to providing stable housing and targeted services for homeless patients with hepatitis C and mental health disorders.
“Prior research has identified homelessness as a risk factor for hepatitis C, thus suggesting that stable housing could play a role in the prevention of hepatitis C and its associated risks,” the study says. “These results may also have implications for improving treatment for hepatitis C patients.
“If primary care programs for homeless individuals focus on hepatitis C management and treatment, the expense of newer, potentially curative, hepatitis C pharmacotherapeutics may be mitigated by a decrease in ER visits.”
The study examined ER utilization among more than 400 patients enrolled in a program of health care for the homeless (HCH) that provides comprehensive outpatient services. To be eligible for the program, individuals must be homeless at the time of enrollment.
Patients included in the study had at least one outpatient visit between July 1, 2011, and June 20, 2012. “Frequent” ER visits were defined as two or more visits within a year following the outpatient appointment.
Although the researchers hypothesized that homeless individuals would have a higher rate of frequent ER visits compared to housed individuals, the study found no significant differences in visits among the two groups. But while hepatitis C was a significant predictor of ER use among homeless people, it was not a factor for housed individuals.
Housed patients tended to be older and had more health conditions, alcohol, and mental health disorders than homeless people—possibly indicating that “more housing opportunities are available to individuals with significant health problems,” or that participation in case-management services “may be the precipitant to obtaining housing.”
Prior studies have shown that factors such as older age, previous hospital admissions, and HIV are factors in frequent emergency room visits. But the new study found that HIV was not a driver of repeat ER visits in either housed or homeless patients.
Frequent ER visits are a significant cost concern. One recent analysis of costs of 6,494 persons served by a Boston HCH program found that total annual expenditures due to ER visits were estimated at more than $16 million annually, the study says.
Authors of the study include Kinna Thakarar of the section of infectious diseases at Boston Medical Center (BMC); Jake Morgan, a researcher at BMC; Mari-Lynn Drainoni, associate professor of health policy and management at SPH; and Jessie Gaeta and Carole Hohl of Boston Health Care for the Homeless and BMC.
Submitted by: Lisa Chedekel