Predictors of Emergency Department Use among Individuals with Current or Previous Experience of Homelessness.

Morgane Gabet,Zhirong Cao,Marie-Josée Fleury,Guy Grenier

doi:10.3390/ijerph16244965

Abstract

This study assessed the contributions of predisposing, enabling, and needs factors in predicting emergency department (ED) use among 270 individuals with current or previous experience of homelessness. Participants were recruited from three different types of housing (shelter, temporary housing and permanent housing) in Montreal, Quebec (Canada). They were interviewed at baseline (T0), and again 12 months after recruitment (T1). Longitudinal data analyses were conducted on associations between a set of baseline predictors (T0) with the dependent variable (ED users vs. non-users) from T1. Predictors were identified according to the Gelberg–Andersen Behavioral Model. Findings revealed two needs factors associated with ED use: having a substance use disorder (SUD) and low perceived physical health. Two enabling factors, use of ambulatory specialized services and stigma, were also related to ED use. No predisposing factors were retained in the model, and ED use was not associated with type of housing. Improvements are needed in SUD and physical health management in order to reduce ED use, as well as interventions aimed at stigma prevention for this vulnerable population.

Highlights

Emergency department (ED) overcrowding and misuse are constant and increasing concerns worldwide [1], not least in Canada and in the province of Québec [2]
Homeless individuals who are affected by mental disorders (MD) and/or substance use disorders (SUD) account for the high incidence of ED overcrowding [12]
Model as a conceptual framework, this study identified predictors of ED use in a sample of 270 currently or previously homeless individuals living in three types of housing in Quebec, who were followed over a 12 month period after recruitment

Summary

Introduction

ED overcrowding has had an important negative impact, as evidenced in increased wait times [5], and reduced patient safety, comfort and satisfaction [6,7]. This has led to concerted efforts among policy makers and healthcare professionals to find ways of reducing ED use [2]. Individuals with psychiatric diagnoses, such as schizophrenia [10] and co-occurring MD/SUD [11], are more likely to make high use of ED. Predisposing factors are individual characteristics (e.g., age, sex), including beliefs and attitudes that may influence ED and other service use.

Methods

Results

Discussion

Conclusion