Determinants of Hospital Use and Physician Services Among Adults With a History of Homelessness

Abstract

Background: People experiencing homelessness have diverse patterns of healthcare use. This study examined the distribution and determinants of healthcare encounters among adults with a history of homelessness.

Methods: Administrative healthcare records were linked with survey data for a general cohort of adults with a history of homelessness and a cohort of homeless adults with mental illness. Binary and count models were used to identify factors associated with hospital admissions, emergency department visits and physician visits for comparison across the 2 cohorts.

Results: During the 1-year follow-up period, a higher proportion of people in the cohort with a mental illness used any inpatient (27% vs 14%), emergency (63% vs 53%), or physician services (90% vs 76%) compared to the general homeless cohort. People from racialized groups were less likely use nearly all health services, most notably physician services. Other factors, such as reporting of a regular source of care, poor perceived general health, and diagnosed chronic conditions were associated with higher use of all health services except psychiatric inpatient care.

Conclusion: When implementing interventions for patients with the greatest health needs, we must consider the unique factors that contribute to higher healthcare use, as well as the barriers to healthcare access.

Keywords: Homeless persons; emergency department; healthcare utilization; hospital; physician services.

Figure 1.

The distribution of healthcare encounters for the cohort with a mental illness and the general homeless cohort during a 1-year period. Cohort 1 = Cohort with a mental illness (At Home/Chez Soi study). Cohort 2 = General homeless cohort (Health and Housing in Transition study.