Association between primary heath care and dental service use among supportive housing tenants with behavioral health conditions.

Abstract

Homeless persons are at high risk for poor oral health. Supportive housing can improve housing stability for persons with behavioural health conditions, but its impact on dental service use has been little studied. Data for this evaluation come from matched public service records for eligible applicants to a New York City supportive housing program (NY III) targeting chronic homelessness. NY III tenants (N=5678) were compared with applicants not placed in housing (N=6536) and applicants placed in other supportive housing programmes (N=4823). Regression analysis was used to assess the association between supportive housing, primary care use, clinical severity and the likelihood of dental visits. Over four observation years, 71% of applicants had at least one dental visit for any cause and 57% for preventive dental care. Incidence of dental visits was lower for persons with physical disability (IRR=0.91; 95% CI=0.85, 0.97, P=.003), psychiatric hospital stays (IRR=0.78; 95% CI=0.68, 0.88, P<.001) and age over 54. Persons engaged in primary care (IRR=1.26; 95% CI=1.21, 1.31, P<.001) and outpatient mental health care (IRR=1.16; 95% CI=1.12, 1.21, P<.001) had greater incidence of dental visits. Supportive housing was associated with greater dental service use. The positive association between primary care, mental health care and dental care suggests important points of entry for dental care. Oral health education and service referrals in supportive housing and primary care settings may improve oral health service delivery to persons experiencing social exclusion due to homelessness, mental illness and poor oral health.