Open AccessHealth service use and predictors of high health service use among adults experiencing homelessness: a retrospective cohort study
Author(s) -
Mitchell Rebecca J.,
Karin Eyal,
Power Joseph,
Foung Hayden,
Jones Naidene,
Nielssen Olav
Publication year - 2022
Publication title -
australian and new zealand journal of public health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.946
H-Index - 76
eISSN - 1753-6405
pISSN - 1326-0200
DOI - 10.1111/1753-6405.13302
Subject(s) - medicine , referral , retrospective cohort study , cohort , logistic regression , mental health , public health , family medicine , health care , cohort study , gerontology , psychiatry , nursing , economics , economic growth
Objective : To describe the characteristics and cost of health service use of a cohort of 2,140 people attending homeless hostel clinics, and identify predictors of high health service use and time to readmission. Method : A retrospective cohort study of 2,140 adults who attended a homeless hostel clinic and were hospitalised in New South Wales (NSW) using linked clinic, health and mortality data from 1 July 2008 to 30 June 2021. Multivariable logistic regression examined predictors of high health service users. Results : There were 27,466 hospital admissions, with a median cost of A$81,481 per person, and a total cost of A$548.2 million. Twenty per cent of the cohort were readmitted within 28 days and 27.4% were classified as high users of health services. Factors associated with high use were age ≥45 years, female (AOR: 1.52; 95%CI 1.05‐2.22), the presence of a mental disorder, substance use disorder (AOR: 1.36; 95%CI: 1.03‐1.82), or if the person had been homeless for >1 year (AOR: 1.31; 95%CI: 1.06‐1.62). Conclusions and implications for public health : The high health costs generated by homeless adults confirm the need to develop models of supported housing with a focus on integrated care, improved referral pathways and better coordination with community‐based support agencies.